Preoperative Inflammatory and Nutritional Indices as Predictors of Infectious Complications Following Elective Cesarean Section in Patients With Gestational Diabetes Mellitus: A Retrospective Study.

AIM: Postoperative infection is a significant complication that may adversely affect maternal recovery following cesarean section. Patients with gestational diabetes mellitus (GDM) may be at increased risk due to metabolic dysregulation and altered immune function. This study aimed to investigate preoperative risk factors for infectious complications following elective cesarean section in patients with GDM, with a focus on readily obtainable inflammatory and nutritional indices.

METHODS

This retrospective study included 383 patients with GDM who underwent elective cesarean section at Tongxiang Maternity and Child Health Care Hospital between January 2022 and February 2025. Preoperative inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP), as well as nutritional indices, including prognostic nutritional index (PNI) and hemoglobin (Hb), were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative infection, and a risk stratification approach based on inflammatory and nutritional indices was developed.

RESULTS

Among the 383 patients, 72 (18.8%) developed postoperative infections. Multivariable analysis identified elevated CRP (odds ratio (OR) = 2.383, 95% confidence interval (CI): 1.669-4.427), decreased PNI (OR = 0.680, 95% CI: 0.507-0.842), decreased hemoglobin (OR = 0.854, 95% CI: 0.746-0.945), and elevated PLR (OR = 1.046, 95% CI: 1.006-1.101) as independent risk factors for postoperative infection (all p < 0.05). Receiver operating characteristic (ROC) analysis demonstrated good discriminative performance of the inflammatory and nutritional indices, with CRP showing the strongest performance. Risk stratification based on the number of these factors (CRP, PLR, PNI, Hb) showed infection rates of 0.0%, 1.4%, 14.1%, 84.2%, and 100.0% for patients with 0, 1, 2, 3, and 4 factors, respectively (trend test p < 0.001).

CONCLUSIONS

Preoperative elevation of inflammatory markers (CRP, PLR) and impairment of nutritional status (PNI, Hb) are independent risk factors for post-cesarean infection in patients with GDM. Preoperative risk assessment incorporating these indices may facilitate identification of high-risk patients and support targeted perioperative management strategies.