The Role of Inflammatory Markers NLR and PLR in Predicting Pelvic Pain in Endometriosis

Abstract

Background/Objectives: Chronic inflammation plays a critical role in pelvic pain among endometriosis patients. This study examines the association between inflammatory markers—specifically the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR)—and pelvic pain in endometriosis. Methods: We conducted a retrospective analysis of endometriosis patients, assessing NLR and PLR levels in those with and without pelvic pain. Diagnostic utility was evaluated using ROC curves, and logistic regression determined associations between these markers, pain presence, and endometriosis severity. Results: Patients with pelvic pain had significantly higher median levels of both NLR and PLR (p < 0.05). NLR demonstrated moderate diagnostic accuracy with an AUC of 0.63, sensitivity of 59%, and specificity of 71% at a cut-off of 1.85. PLR, with a cut-off of 139.77, showed an AUC of 0.60, with a specificity of 82% and sensitivity of 40%, indicating better utility for excluding pain. Logistic regression analysis revealed that NLR > 1.85 was significantly associated with pelvic pain (OR = 3.06, 95% CI: 1.45–6.49, p = 0.003), as was PLR > 139.77 (OR = 2.84, 95% CI: 1.18–6.82, p = 0.02). Advanced rASRM stages (III and IV) also correlated with elevated NLR and PLR values. Conclusions: Elevated NLR and PLR are associated with pelvic pain and advanced stages of endometriosis, suggesting these ratios are potential markers for assessing inflammation and disease severity. Further studies should explore combining NLR and PLR with other biomarkers to improve diagnostic accuracy in endometriosis.