AI Summary & Key Takeaways
AI InsightTherefore, the GRIm score should not be used as a standalone diagnostic or prognostic tool, but may warrant further investigation as an adjunct to established clinical and laboratory assessments in prospective, externally validated studies.
📌 3 Key Takeaways
Abstract
Aims: To evaluate the Gustave Roussy Immune (GRIm) score and its individual components in women with intrahepatic cholestasis of pregnancy, and to explore their discriminatory performance for intrahepatic cholestasis of pregnancy and composite adverse perinatal outcomes. Methods: This retrospective case–control study included 130 females with singleton pregnancies in the third trimester: 65 diagnosed with intrahepatic cholestasis of pregnancy and 65 controls. Females with conditions that could substantially affect hepatic, inflammatory, or hematologic parameters were excluded. The GRIm score was calculated by assigning one point for each of the following: serum lactate dehydrogenase above 245 U/L, serum albumin below 35 g/L, and a neutrophil-to-lymphocyte ratio above 6. Group comparisons and receiver operating characteristic curve analyses were performed. Optimal cut-offs were determined using the Youden index. Results: The median GRIm score was higher in females with intrahepatic cholestasis of pregnancy than in controls [1 (1-2) vs. 0 (0–1); p<0.001]. Serum albumin below 35 g/L (70.8% vs. 27.7%; p<0.001) and lactate dehydrogenase above 245 U/L (32.3% vs. 10.8%; p=0.003) were more frequent in the intrahepatic cholestasis group, whereas the difference in neutrophil-to lymphocyte ratio above 6 was not statistically significant (20.0% vs. 9.2%; p=0.082). The GRIm score demonstrated moderate discriminatory performance for intrahepatic cholestasis of pregnancy, with an area under the curve of 0.740 (95% confidence interval, 0.655–0.825; p<0.001). A threshold of ≥2 provided 36.9% sensitivity and 95.4% specificity. Serum albumin showed similar discriminatory performance, with an area under the curve of 0.753. For composite adverse perinatal outcomes, the GRIm score yielded an area under the curve of 0.705 (95% confidence interval, 0.586–0.824; p=0.001), with 46.2% sensitivity and 85.6% specificity at a threshold of ≥2. Conclusion: The GRIm score demonstrated moderate discriminatory performance for intrahepatic cholestasis of pregnancy and composite adverse perinatal outcomes, mainly characterized by high specificity but limited sensitivity. Its performance was not superior to that of serum albumin alone. Therefore, the GRIm score should not be used as a standalone diagnostic or prognostic tool, but may warrant further investigation as an adjunct to established clinical and laboratory assessments in prospective, externally validated studies.