Correlation of NLR and Procalcitonin in Pregnancy Sepsis: Toward an Affordable Maternal Mortality Prediction Tool

Objective: To evaluate the correlation between neutrophil-to-lymphocyte ratio (NLR) and procalcitonin (PCT) levels in pregnancy-associated sepsis and to assess their combined utility as affordable mortality risk predictors in resource-limited settings. Methods: A retrospective observational study was conducted from January 2024 to July 2025 at Dr. Moewardi Hospital, Surakarta, including 50 pregnant women with sepsis, divided into survivors (n = 33) and non-survivors (n = 17). PCT and NLR levels were compared, their correlation assessed, and receiver operating characteristic (ROC) analysis performed to identify optimal mortality prediction cut-offs. Logistic regression was used to determine mortality risk. Results: Non-survivors exhibited significantly higher PCT (median 112.3 ng/mL vs. 20.0 ng/mL; p < 0.001) and NLR (24.0 vs. 13.0; p < 0.001). A strong positive correlation was observed between PCT and NLR (r = 0.80, p < 0.001). ROC analysis showed good predictive performance for PCT (AUC 0.88, 95% CI: 0.75–0.96) and moderate performance for NLR (AUC 0.80, 95% CI: 0.67–0.91). Logistic regression revealed that elevated PCT (> 50.6 ng/mL) and NLR (> 21.2) were associated with increased mortality risk (OR 7.8 and OR 5.9, respectively). Conclusions: NLR correlates strongly with PCT and serves as a cost-effective surrogate biomarker for maternal sepsis severity. Combined assessment enables affordable risk stratification and may support scalable mortality prediction models in low-resource settings.