Biomarkers for recurrence of intrauterine adhesions after hysteroscopic adhesiolysis: a retrospective study.

OBJECTIVE

To evaluate the predictive value of peripheral blood inflammatory biomarkers - Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) - for recurrence risk of intrauterine adhesion (IUA) following hysteroscopic adhesiolysis.

METHODS

This retrospective study included 170 patients who underwent hysteroscopic adhesiolysis for IUA between October 2022 and October 2024. Within a 6-month follow-up based on their recurrence status, the patients were categorized into recurrence (R-IUA, n = 60) and non-recurrence (Non-IUA, n = 110) groups. SII, NLR, and PLR levels were assessed preoperatively, 24 hours postoperatively, and on postoperative day 7. Dynamic changes (δSII, δNLR, δPLR) were calculated. ROC curves assessed predictive performance, and logistic regression identified independent risk factors, which were incorporated into a nomogram model.

RESULTS

The R-IUA group had significantly higher levels of SII and NLR at all time points, with δSII showing the strongest predictive accuracy (AUC > 0.85). Multivariate analysis identified δSII, δNLR, amenorrhea, curettage history, and lack of intrauterine stent as independent predictors. The nomogram incorporating these factors achieved an AUC of 0.89.

CONCLUSION

Dynamic inflammatory biomarkers, especially δSII and δNLR, are effective predictors of IUA recurrence and may guide individualized postoperative management.