Diagnostic Role of Hematological Markers in Post-Dural Puncture Headache in Cesarean Parturient at a Tertiary Care Hospital, Peshawar Research Article
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Abstract
Background: Spinal anesthesia is commonly utilized for cesarean deliveries; however, post-dural puncture headache (PDPH) remains a significant complication. Cerebrospinal fluid (CSF) loss due to dural puncture is a primary cause of PDPH. The current study aims to investigate the diagnostic utility of hematological inflammatory markers in identifying PDPH.
Material & Methods: This prospective case-control study evaluated a total of one hundred and thirty-two (n=132) parturients; case group (n=56) and controls(n=76), after elective cesarean section under spinal anesthesia. Demographic information, clinical features, and associated symptoms were collected, followed by a complete blood count (CBC). Hematological markers included red cell and platelet indices, white blood cell differential counts, and various ratios between parameters, such as MLR, RDWMPV, were recorded. Statistical tests such as chi-square, independent t, Receiver Operating Characteristic (ROC) curve, and Mann-Whitney U were run on the data.
Results: Majority, (91%) of the cases experienced PDPH within 48 hours post-operatively. A significant difference (p=0.04) in Mean platelet volume (MPV) was observed between case and control groups. The RDW/MPV (p=0.02; AUC: 0.612), and MLR (p=0.02; AUC: 0.613) were statistically significant with sensitivity 67.9% and 63.2% and specificity 53.9% and 47.4% respectively. The highest likelihood ratios (LR+) for RDW/MPV and MLR were 1.24 and 1.28, with a cut-off of 1.82, and 0.22, respectively.
Conclusion: This study identifies a higher MPV in parturients with PDPH and introduces new markers, RDW-MPV and MLR, as potential diagnostic tools. RDW-MPV and MLR are novel parameters in the context of PDPH; a large multi-center study will be required before incorporation in clinical practices.
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