Fibrinogen-to-Albumin, Platelet-to-Albumin, and Creatinine-to-Albumin Ratios in the Assessment of Preeclampsia Severity: A Retrospective Case–Control Study

Background: Preeclampsia (PE) is a multisystem pregnancy disorder associated with endothelial dysfunction, inflammation, and coagulation abnormalities. This study evaluated the fibrinogen-to-albumin ratio (FAR), platelet-to-albumin ratio (PAR), and creatinine-to-albumin ratio (CrAR) in relation to preeclampsia severity. Methods: This single-center retrospective case–control study included 205 pregnant women: 104 healthy controls, 70 patients with non-severe PE, and 31 with severe PE. Clinical, obstetric, neonatal, and laboratory data were reviewed. Group comparisons, receiver operating characteristic (ROC) analysis, and logistic regression adjusted for maternal age, body mass index, and gestational age at sampling were performed. Results: Fibrinogen and FAR were significantly higher in severe than in non-severe PE. Fibrinogen showed an area under the curve of 0.685, with 67.7% sensitivity and 58.6% specificity at a cut-off of 5.05 g/L. FAR showed an area under the curve of 0.657, with 67.7% sensitivity and 64.3% specificity at a cut-off of 0.143. Both fibrinogen and FAR remained independently associated with severe PE after adjustment for maternal age, body mass index, and gestational age at sampling. FAR did not demonstrate superior discriminatory performance compared with fibrinogen alone. PAR did not differ significantly among groups, while CrAR was higher in preeclampsia than in controls but did not discriminate severe disease. Conclusions: Fibrinogen and FAR were associated with severe PE but demonstrated only modest discriminatory performance. FAR did not outperform fibrinogen alone, and its incremental value beyond fibrinogen remains uncertain. Therefore, these findings should be considered exploratory and do not support the use of FAR or fibrinogen as standalone tools for clinical screening, risk stratification, or decision-making. Further prospective, multicenter studies are needed to determine whether these markers provide clinically meaningful value within broader multimodal assessment models.