Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio in depression: A meta-analysis

Association between immune-inflammation-based prognostic index and depression: An exploratory cross-sectional analysis of NHANES data

BACKGROUND

Immune-inflammatory mediators influence numerous immune and inflammatory pathways, elevating the likelihood of depression. The systemic immune-inflammation index (SII) emerges as an innovative prognostic indicator, integrating various peripheral blood immune cell subpopulations, specifically neutrophils, platelets, and lymphocytes. This exploratory study aims to examine the correlation between SII and depression.

METHODS

Data from the 2005-2020 National Health and Nutrition Examination Survey (NHANES) were utilized. Depression was diagnosed with a Patient Health Questionnaire score of 10 or higher. The relationship between log2-SII and depression incidence was analyzed using a restricted cubic spline (RCS). Logistic regression was employed to calculate the odds ratio of depression concerning log2-SII. In cases of non-linearity, piecewise linear models with change points were applied to assess the associations in both the overall population and specific subgroups. Additionally, subgroup analyses were conducted to determine the applicability of the findings to particular populations.

RESULTS

A total of 42,133 participants were included in the study, comprising 49.32 % men and 50.68 % women, with an average age of 47.02 ± 17.45 years. RCS analysis demonstrated a J-shaped non-linear relationship between log2-SII and depression incidence. When log2-SII was ≥8.50, SII showed a positive association with depression incidence, even after adjusting for covariates. Additionally, each unit increase in log2-SII corresponded to an 18 % rise in depression incidence (OR = 1.18, 95 % CI: 1.10-1.27). Subgroup analysis further revealed that the association between SII and depression incidence varied across different populations.

LIMITATIONS

Due to the cross-sectional nature of NHANES, causality or long-term implications cannot be inferred. Further research is needed to ascertain if a longitudinal relationship exists between SII and depression.

CONCLUSION

Our findings suggest a significant and complex non-linear association between SII and depression. However, further basic and prospective studies are necessary to explore SII's impact on depression and clarify its underlying mechanisms. Additionally, these studies will provide a foundation for personalized interventions targeting the immune-inflammatory processes in patients with depression and elevated SII.

Sex-specific association of peripheral blood cell indices and inflammatory markers with depressive symptoms in early adolescence

BACKGROUND

Previous studies have reported the correlation of dysregulated blood cell indices and peripheral inflammatory markers with depression in adults but limited studies have examined this correlation in early adolescents.

METHODS

This study used data from the Chinese Early Adolescents Cohort Study, which was conducted in Anhui, China. Students' depression symptoms were repeatedly measured using the Chinese version of the Center for Epidemiological Studies Depression Scale for Children. Students' blood samples were collected in September 2019 and September 2021. The peripheral blood cell counts and inflammatory marker levels were determined using routine blood tests. Multivariable regression models were used to explore the associations between blood cell indices and adolescent depressive symptoms in both the whole sample and the sex-stratified samples.

RESULTS

The white blood cell (WBC) count, neutrophil count (NC), platelet (PLT) count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and systemic immune inflammation index (SII) were positively correlated with the severity of depressive symptoms during follow-up. The mean corpuscular volume (MCV), mean hemoglobin (HGB) volume (MCH), and mean corpuscular HGB concentration (MCHC) exhibited negative temporal correlations with depressive symptoms. Additionally, several sex-specific blood cell markers were correlated with depression. Male adolescents with increased red blood cell (RBC) and female adolescents with decreased HGB levels and upregulated WBC, NC, NLR, and SII levels exhibited severe depressive symptoms at follow-up.

CONCLUSIONS

These findings suggested the potential usefulness of peripheral blood cell indices in the assessment of depression in early adolescents.

Relative value of novel systemic immune-inflammatory indices and classical hematological parameters in predicting depression, suicide attempts and treatment response

This study compared the power of the novel inflammatory markers systemic immune inflammation index (SII) and the system inflammation response index (SIRI) versus the classical hematological indices neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and platelet counts in distinguishing between major depressive disorder (MDD) with and without suicide attempts and distinguishing the non-response to selective serotonin reuptake inhibitor (SSRI) treatment. A total of 139 young adult MDD patients and 54 healthy controls (HC) were included. We found that, in comparison to HC, baseline NLR, PLR, SII, and SIRI were significantly higher in MDD patients, but only NLR and SII had area under the ROC curve (AUC) values greater than 0.7. MDD patients with suicide attempts (SA) showed significantly higher baseline MLR and SIRI, and a tendency to increase NLR compared to those without SA. In terms of AUC, sensitivity, and specificity, NLR was better than MLR, SIRI, SII, and PLR in distinguishing SA. Non-responders to SSRI treatment showed a significant increase in baseline platelet count and PLR compared to responders with an AUC greater than 0.7. These findings highlight the potential benefit of combining novel and classical hematological indices in predicting depression, suicide attempts and treatment response.

CD177 on neutrophils engages stress-related behavioral changes in male mice

Persistent psychological stress can affect immune homeostasis and is a key factor in the development of depression. Many efforts are focused on the identifcation of pathways that link the immune system and mood disorders. Here, we found that psychological stress caused an increase in the frequency of brain-associated neutrophils and the level of neutrophil-specific antigen CD177 on peripheral neutrophils in male mice. Upregulated levels of blood CD177 are associated with depression in humans. Neutrophil depletion or Cd177 deficiency protected mice from stress-induced behavioral deficits. Importantly, adoptive transfer of CD177+ neutrophils from stressed mice increased the frequency of brain-associated leukocytes, including neutrophils, and caused behavioral defects in naive mice. These effects may be related to the endothelial adhesion advantage of CD177+ neutrophils and the interference of serine protease on endothelial junction. Our findings suggest a critical link between circulating CD177+ neutrophils and psychological stress-driven behavioral disorder.

The relationship of peripheral blood cell inflammatory biomarkers and psychological stress in unmedicated major depressive disorder

BACKGROUND

Recent research has explored the linkage between major depressive disorder (MDD) and inflammation, especially via altered peripheral blood immune markers. However, the relationship between several novel leukocyte-derived ratios (LDR) and psychological stress in MDD remains uncertain. This study aimed to explore the relationship between LDR, clinical characteristics, recent life events, and childhood maltreatment in MDD patients.

METHODS

A cross-sectional case-control study was conducted involving 59 healthy controls (HC) and 50 unmedicated MDD patients. Subjects underwent psychological assessments and peripheral blood measurements. LDR assessed in this study included neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), white blood cell-to-mean platelet volume ratio (WMR), systemic immune inflammation index (SII), multiplication of neutrophil and monocyte counts (MNM), and systemic inflammation response index (SIRI).

RESULTS

MDD patients displayed significant alterations in WMR, PLR, and MNM compared to HC, as well as correlations between several LDR and various clinical features (duration of untreated psychosis and dNLR, the nine-item Patient Health Questionnaire and PLR, the 7-item Generalized Anxiety Disorder Questionnaire and SIRI (NLR and dNLR). There was a significant difference in the comparison of WMR in first-episode patients than in recurrent patients. Analyses further revealed an association between Life Event Scale total scores and NLR (dNLR). No correlation was found between Childhood Trauma Questionnaire total (or subscale) scores and LDR. Additionally, WMR and dNLR presented potential predictive value for distinguishing between MDD and HC.

CONCLUSION

The study concludes that MDD and some clinical features are associated with alterations in some peripheral blood LDR. These findings emphasize the potential role of peripheral blood LDR in the pathogenesis and clinical heterogeneity of MDD.

Inflammatory Hematological Ratios in Adolescents with Mental Disorders: A Scoping Review

BACKGOUND

Inflammatory hematological ratios (IHRs), such as neutrophil to lymphocyte, monocyte to lymphocyte, and platelet to lymphocyte ratios, are associated with mental disorders, symptoms severity, and the disease phase. Evidence from the studies in adult patients has been summarized in systematic reviews and meta-analyses. The results of the studies in adolescents remain poorly systematized.

AIM

To summarize the findings from the studies that investigated the relationship of IHRs with mental disorders in adolescent patients.

METHODS

This scoping review included studies of IHRs in patients aged 10-19 years with mental disorders (other than anorexia nervosa), published in English by December 31, 2023. The search for relevant papers was performed in MEDLINE. The studies were categorized into two groups: studies with external controls (healthy adolescents) and studies with internal controls (patients in different phases of mental disorder, with or without self-harm/suicidal behaviors).

RESULTS

A total of 11 studies were included in the review (all cross-sectional ones). The results of these studies demonstrate that 1) adolescents with mental disorders (major depressive disorder, psychotic disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, substance use disorders) have higher IHR values than individuals of the same age without corresponding disorders (5 studies); 2) IHR values are positively correlated with the severity of psychopathological symptoms (1 study); 3) higher IHR values are associated with the phase of the mental disorder - manic episode in bipolar disorder (1 study) and exacerbation of psychosis in psychotic disorders (1 study); and 4) higher IHR values are associated with self-harm/suicidal behaviors - suicide attempts (1 study) and non-suicidal self-injury (1 study).

CONCLUSION

IHRs are associated with mental disorders in adolescents, and higher IHR values are associated with a more severe/acute clinical presentation (severity of symptoms, mania, acute psychosis, self-harm/suicidal behaviors). Further studies of higher methodological quality are needed to evaluate the diagnostic and prognostic value of IHRs as biomarkers of mental disorders in adolescence.

Mining key circadian biomarkers for major depressive disorder by integrating bioinformatics and machine learning

OBJECTIVE

This study aimed to identify key clock genes closely associated with major depressive disorder (MDD) using bioinformatics and machine learning approaches.

METHODS

Gene expression data of 128 MDD patients and 64 healthy controls from blood samples were obtained. Differentially expressed were identified and weighted gene co-expression network analysis (WGCNA) was first performed to screen MDD-related key genes. These genes were then intersected with 1475 known circadian rhythm genes to identify circadian rhythm genes associated with MDD. Finally, multiple machine learning algorithms were applied for further selection, to determine the most critical 4 circadian rhythm biomarkers.

RESULTS

Four key circadian rhythm genes (ABCC2, APP, HK2 and RORA) were identified that could effectively distinguish MDD samples from controls. These genes were significantly enriched in circadian pathways and showed strong correlations with immune cell infiltration. Drug target prediction suggested that small molecules like melatonin and escitalopram may target these circadian rhythm proteins.

CONCLUSION

This study revealed discovered 4 key circadian rhythm genes closely associated with MDD, which may serve as diagnostic biomarkers and therapeutic targets. The findings highlight the important roles of circadian disruptions in the pathogenesis of MDD, providing new insights for precision diagnosis and targeted treatment of MDD.

Association of systemic inflammatory indices with anthropometric measures, metabolic factors, and liver function in non-alcoholic fatty liver disease

The present cross-sectional study aimed to explore the relationship between systemic inflammatory indices (SIIs) and anthropometric measures, metabolic, and liver function biomarkers in patients with non-alcoholic fatty liver disease (NAFLD). This study was carried out on 238 NAFLD patients with overweight or obesity, aged 18-55 years. Anthropometric measurements were done and body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were estimated. Metabolic factors including serum glucose, lipid profile, liver function biomarkers, and complete blood cell count were assessed after a 24-h fasting state. SIIs including the ratios of neutrophil to lymphocyte (NLR), monocytes to lymphocyte (MLR), platelet to lymphocyte (PLR), and monocytes to high-density lipoprotein cholesterol (MHR) were calculated. Results indicate that apart from PLR, all of the SIIs significantly changed by increasing steatosis severity (all p < 0.05). Moreover, changes in NLR showed a significant association with anthropometric indices including waist circumference (p = 0.032), BMI (p = 0.047), and WHtR (p = 0.002), as well as levels of fasting blood sugar (p = 0.045), triglycerides, (p = 0.025) and low-density lipoprotein cholesterol (p = 0.006). The findings also indicate the relations between lipid profile and all studied SIIs, notably MHR and MLR. All of the SIIs exhibited associations with some liver function indices as well. MHR was positively correlated with the metabolic risk factors of NAFLD while, oppositely, PLR was considered as a preventive marker of NAFLD.

Association between systemic inflammatory markers and chronic obstructive pulmonary disease: A population-based study

Objective

To investigate whether inflammatory indices, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), product of platelet and neutrophil count (PPN), and lymphocyte-to-monocyte ratio (LMR), correlate with chronic obstructive pulmonary disease (COPD).

Methods

This was a cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) database 2007-2018. The SII, NLR, PLR, PPN and LMR were calculated based on blood cell counts and were log2-transformed. COPD was diagnosed via a questionnaire or spirometry examination. Multivariate logistic regression, sensitivity analysis, subgroup analyses, and interaction tests were performed to evaluate the relationships.

Results

23,875 participants, including 1000 COPD patients (453 diagnosed via spirometry examination, 547 diagnosed via a questionnaire), were enrolled in this study. Positive associations were observed between SII (OR 1.231, 95 % CI 1.081,1.401), NLR (OR 1.223, 95 % CI 1.064,1.405), PLR (OR 1.325, 95 % CI 1.086,1.617), PPN (OR 1.157, 95 % CI 1.031,1.298) and COPD, while a negative association was obtained between LMR and COPD (OR 0.794, 95 % CI 0.666,0.948) after covariate adjustments. When divided COPD patients into spirometry-based and questionnaire-based, only SII (OR 1.310, 95%CI 1.122,1.529), PLR (OR 1.669, 95%CI 1.272,2.191) and PPN (OR 1.218, 95%CI 1.050,1.412) significantly correlated with spirometry-based COPD, while only NLR (OR 1.303, 95%CI 1.055,1.609) and LMR (OR 0.524, 95%CI 0.406,0.677) significantly correlated with questionnaire-based COPD after covariate adjustments.

Conclusion

Significant associations are observed between different inflammation indices and COPD. Heterogeneity exists between spirometry-based and questionnaire-based COPD patients. Future studies are needed to verify the results.

Neutrophil-to-lymphocyte ratio as a predictive biomarker for early diagnosis of depression: A narrative review

Depression is a mood disorder that causes persistent feelings of sadness, hopelessness, loss of interest, and decreased energy. Early diagnosis of depression can improve its negative impacts and be effective in its treatment. Previous studies have indicated that inflammation plays an important role in the initiation and development of depression, hence, various inflammatory biomarkers have been investigated for early diagnosis of depression, the most popular of which are blood biomarkers. The Neutrophil to lymphocyte ratio (NLR) may be more informative in the early diagnosis of depression than other widely used markers, such as other leukocyte characteristics or interleukins. Considering the importance of early diagnosis of depression and the role of NLR in early diagnosis of depression, our paper reviews the literature on NLR as a diagnostic biomarker of depression, which may be effective in its treatment. Various studies have shown that elevated NLR is associated with depression, suggesting that NLR may be a valuable, reproducible, easily accessible, and cost-effective method for the evaluation of depression and it may be used in outpatient clinic settings. Closer follow-up can be performed for these patients who have higher NLR levels. However, it seems that further studies on larger samples, taking into account important confounding factors, and assessing them together with other inflammatory markers are necessary to draw some conclusive statements.

The association between inflammation-related biomarkers and the subtypes of cancer-related cognitive impairment in colorectal cancer patients: A latent profile analysis

PURPOSE

Cancer-related cognitive impairment (CRCI) has garnered considerable attention, yet limited research has delved into nuanced distinctions among varying degrees of CRCI in colorectal cancer survivors. This study aimed to identify distinct subgroups based on the patterns of CRCI, assess the heterogeneity among different subgroups, and investigate the potential correlations between the subgroups of CRCI and inflammation-related biomarkers.

METHODS

268 colorectal cancer patients were enrolled in this cross-sectional study, followed by the Functional Assessment of Cancer Therapy-Cognitive Function. The determination of CRCI subgroups was accomplished by the latent profile analysis (LPA). The effects of inflammation-related biomarkers on CRCI were examined using the binary logistic regression analysis. The receiver operating characteristic (ROC) curves assessed the diagnostic efficacy of inflammation-related biomarkers.

RESULTS

Two latent profiles were identified: CRCI (n = 64, 23.88%) and non-CRCI (n = 204, 76.12%). Independent factors for CRCI in colorectal cancer patients were SIRI (OR = 3.248, 95%CI [1.197-8.807], P = 0.021) and ALI (OR = 0.962, 95%CI [0.937-0.989], P = 0.005). The areas under the curve (AUCs) for SIRI and ALI in predicting CRCI were 0.781 and 0.774, with the optimal cut-off values being 0.70 and 37.04, respectively.

CONCLUSIONS

Colorectal cancer patients exhibited divergent cognitive performance profiles, categorized into two subgroups based on LPA. SIRI and ALI were identified as independent factors for CRCI, demonstrating strong diagnostic accuracy. These two inflammation-related biomarkers may potentially be novel indicators to identify and manage the development of CRCI among colorectal cancer patients.

The association between insulin resistance and depressive symptoms - A national representative cross-sectional study

OBJECTIVE

Increasing evidence suggests a positive association between insulin resistance (IR) and depression. However, whether sex-or body mass index-specific differences exist remains controversial, and only few studies have analyzed specific symptom domains. Thus, the present study aimed to analyze the association between IR and depressive symptom domains and to clarify the effects of sex and body mass index.

METHODS

The study sample comprised 4007 participants, aged 19-79, from the Korea National Health and Nutrition Examination Study 2020. Participants completed health interviews and examinations, providing data on circulating insulin and glucose levels, the Patient Health Questionnaire-9 (PHQ-9), and related covariates. IR was calculated using the homeostasis model assessment of insulin resistance. Associations between IR and PHQ-9 were analyzed using negative binomial regression with adjustments for the complex survey design.

RESULTS

The association between log-transformed IR and PHQ-9 total scores was statistically significant (incidence rate ratio [IRR] = 1.17, 95% confidence interval [CI] = 1.07-1.29, p = 0.001). Only body mass index specific differences were statistically significant, as the association was only significant in those without obesity (IRR = 1.21, 95% CI = 1.06-1.38, p = 0.005). IR was associated with cognitive/affective (IRR = 1.23, 95% CI = 1.08-1.41, p = 0.002) and somatic (IRR = 1.14, 95% CI = 1.04-1.25, p = 0.005) depressive symptom domains. Sensitivity analyses revealed similar results.

CONCLUSIONS

IR was positively associated with cognitive/affective and somatic depressive symptoms in non-obese individuals.

Quantitative CT parameters combined with preoperative systemic inflammatory markers for differentiating risk subgroups of thymic epithelial tumors

BACKGROUND

Thymic epithelial tumors (TETs) are the most common primary neoplasms of the anterior mediastinum. Different risk subgroups of TETs have different prognosis and therapeutic strategies, therefore, preoperative identification of different risk subgroups is of high clinical significance. This study aims to explore the diagnostic efficiency of quantitative computed tomography (CT) parameters combined with preoperative systemic inflammatory markers in differentiating low-risk thymic epithelial tumors (LTETs) from high-risk thymic epithelial tumors (HTETs).

METHODS

74 Asian patients with TETs confirmed by biopsy or postoperative pathology between January 2013 and October 2022 were collected retrospectively and divided into two risk subgroups: LTET group (type A, AB and B1 thymomas) and HTET group (type B2, B3 thymomas and thymic carcinoma). Statistical analysis were performed between the two groups in terms of quantitative CT parameters and preoperative systemic inflammatory markers. Multivariate logistic regression analysis was used to determine the independent predictors of risk subgroups of TETs. The area under curve (AUC) and optimal cut-off values were calculated by receiver operating characteristic (ROC) curves.

RESULTS

47 TETs were in LTET group, while 27 TETs were in HTET group. In addition to tumor size and CT value of the tumor on plain scan, there were statistical significance comparing in CT value of the tumor on arterial phase (CTv-AP) and venous phase (CTv-VP), and maximum enhanced CT value (CEmax) of the tumor between the two groups (for all, P < 0.05). For systemic inflammatory markers, HTET group was significantly higher than LTET group (for all, P < 0.05), including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII). Multivariate logistic regression analysis showed that NLR (odds ratio [OR] = 2.511, 95% confidence interval [CI]: 1.322-4.772, P = 0.005), CTv-AP (OR = 0.939, 95%CI: 0.888-0.994, P = 0.031) and CTv-VP (OR = 0.923, 95%CI: 0.871-0.979, P = 0.008) were the independent predictors of risk subgroups of TETs. The AUC value of 0.887 for the combined model was significantly higher than NLR (0.698), CTv-AP (0.800) or CTv-VP (0.811) alone. The optimal cut-off values for NLR, CTv-AP and CTv-VP were 2.523, 63.44 Hounsfeld Unit (HU) and 88.29HU, respectively.

CONCLUSIONS

Quantitative CT parameters and preoperative systemic inflammatory markers can differentiate LTETs from HTETs, and the combined model has the potential to improve diagnostic efficiency and to help the patient management.

Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio in ADHD: a systematic review and meta-analysis

Introduction

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with an unclear etiology. Systemic inflammation and immune dysregulation may play a role in the pathogenesis of ADHD. Morphology-derived parameters such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR), have been proposed as peripheral biomarkers of the immune-inflammatory process in various diseases. However, studies examining their role in ADHD remain inconclusive.

Methods

A systematic review and a meta-analysis were conducted to evaluate the association between NLR, MLR, PLR and ADHD. Relevant articles were identified, screened, and assessed for quality according to PRISMA guidelines. Moreover, a qualitative and quantitative analyses were performed.

Results

The review contained eight eligible studies, five of which were included in the meta-analysis. The meta-analysis showed that ADHD patients had higher NLR and PLR values compared to health controls. No significant difference in MLR value was observed between the two groups. Analysis in relation to ADHD subtypes showed no significant differences in inflammatory markers in any of the included studies as well. The influence of medical treatment on these ratios could not be adequately assessed due to limited data.

Conclusion

ADHD patients exhibit higher NLR and PLR than healthy controls, which may indicate the potential immune-inflammatory involvement in this disorder. Further studies on inflammatory markers and ADHD, especially those considering the impact of treatment and clinical symptoms, are essential to comprehensively understand this association.

Mechanisms associated with post-stroke depression and pharmacologic therapy

Stroke is one of the most common cerebrovascular diseases, which is the cause of long-term mental illness and physical disability, Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke, and its mechanisms are characterized by complexity, plurality, and diversity, which seriously affects the quality of survival and prognosis of patients. Studies have focused on and recognized neurotransmitter-based mechanisms and selective serotonin-reuptake inhibitors (SSRIs) can be used to treat PSD. Neuroinflammation, neuroendocrinology, neurotrophic factors, and the site of the stroke lesion may affect neurotransmitters. Thus the mechanisms of PSD have been increasingly studied. Pharmacological treatment mainly includes SSRIs, noradrenergic and specific serotonergic antidepressant (NaSSA), anti-inflammatory drugs, vitamin D, ect, which have been confirmed to have better efficacy by clinical studies. Currently, there is an increasing number of studies related to the mechanisms of PSD. However, the mechanisms and pharmacologic treatment of PSD is still unclear. In the future, in-depth research on the mechanisms and treatment of PSD is needed to provide a reference for the prevention and treatment of clinical PSD.

Neutrophil to lymphocyte ratio and antidepressant treatment response in patients with major depressive disorder: Effect of sex and hippocampal volume

Several factors may affect response to treatment in Major Depressive Disorder (MDD) including immune/inflammatory alterations and regional brain volumes, particularly in hippocampal regions which have shown to be influenced by inflammatory status. Neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker found to be elevated in depressed women in large population studies. Here we investigate the effect of NLR on treatment response in MDD patients, and the role of sex and hippocampal volume on influencing this relationship. A sample of 124 MDD depressed inpatients (F = 80) underwent MRI acquisition, admission NLR was calculated by dividing absolute neutrophil by absolute lymphocyte counts and depression severity was assessed at admission and discharge via the Hamilton Depression Rating Scale (HDRS). As a measure of treatment response, delta HDRS was calculated. We found a significant moderation effect of sex on the relationship between NLR and Delta HDRS: a negative relation was found in females and a positive one in males. NLR was found to negatively affect hippocampal volumes in females. Both left and right hippocampal volume positively associated with Delta HDRS. Finally, left hippocampal volume mediated the effect of NLR on Delta HDRS in females. Sex moderated the relation between inflammation and treatment response in line with previous reports linking inflammation to hampered antidepressant effect in females. Further, this effect is partially mediated by hippocampal volume, suggesting that antidepressant response may be hampered by the detrimental effect of inflammation on the brain.

The relationship between neutrophil lymphocyte ratio, platelet lymphocyte ratio, and depression in dialysis patients

Chronic kidney disease is a worldwide public health issue with rising incidence, morbidity/mortality, and cost. Depression and chronic renal disease often coexist, and psychological illnesses are associated with poor results. Early identification of depression reduces morbidity and death. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are reported as practical biomarkers of inflammation and immune system activation. In this study, we aimed to determine the association of NLR and PLR with depression in dialysis patients. This study included 71 adults over 18 without known hematologic or oncologic disease, drug use, or chronic inflammatory diseases. Comorbid chronic diseases, laboratory data, and Beck depression inventory scores were prospectively recorded. A comparison of 2 groups according to the existence of depression was made, and a binomial logistic regression test was used to determine the association between the variables and the presence of depression after adjusting for confounding factors. A receiver operating curve analysis was used to differentiate groups with and without severe depression. Seventy-one patients met the study criteria, with 46 hemodialysis and 25 peritoneal dialysis patients. The majority had hypertension and diabetes mellitus, with 47.89% having minimal-minor depression and 52.11% having moderate-major depression. The 2 groups were similar regarding chronic diseases, with no significant differences in serum creatinine levels, glucose, lipid profiles, or electrolytes. However, when the NLR of the 2 groups was compared, the median was higher in patients with moderate or major depression. Multivariate analysis showed no significant differences between the groups in PLR, triglyceride to glucose ratio, and C-reactive peptide to albumin ratio. The best NLR cutoff value was 3.26, with 48.6% sensitivity, 88.2% specificity, 81.8% positive predictive value, 61.2% negative predictive value, and 67.6% test accuracy. Depression is one of the most common psychiatric conditions in dialysis patients and is linked to increased morbidity, mortality, treatment failure, expense, and hospitalization. NLR helped predict moderate-to-major depression in dialysis patients, even after controlling for confounding factors in multivariate analysis. This study indicated that an NLR successfully identified depressive groups, and patients with an NLR value >3.26 were 6.1 times more likely to have moderate or major depression.

Association between platelet to lymphocyte ratio and depression and symptom severity among adults in the United States: A cross-sectional study

Background

The pathogenesis of depression has not yet been fully understood. The association between platelet to lymphocyte ratio (PLR) and depression has been investigated in previous studies, however, the results were controversial. The objective of the study was to explore the potential relationship between PLR and depression and symptom severity.

Methods

A cross-sectional study was conducted based on the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018. Totally 30,032 adults were analyzed, and 2480 reported depression. Depression and symptom severity were assessed with the Patient Health Questionnaire (PHQ-9). PLR was calculated as the ratio of platelets to lymphocytes. Multivariable weighted-logistic regression models and generalized additive model (GAM) were employed to evaluate the linear and nonlinear association between PLR and depression and symptom severity.

Results

There was a negative association for Q3 (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.68 to 0.99) when comparing participants for Q1 between 10-PLR and depression after fully adjusting the covariates; however, there was no significant association between 10-PLR and symptom severity. GAM showed that 10-PLR was associated with depression and symptom severity in a nonlinear manner. The inflection points were at 12.15. Subgroup analyses showed nonlinear relationships only in specific subgroups. Conclusions: PLR is associated with depression among adults in the United States. U-shaped nonlinear relationships and threshold effects were observed between 10-PLR and depression and symptom severity. Additionally, inflammatory mechanisms vary in different sociodemographic subgroups.

Development and Validation of Nomogram for the Prediction of Malignant Ventricular Arrhythmia Including Circulating Inflammatory Cells in Patients with Acute ST-Segment Elevation Myocardial Infarction

Background

Malignant ventricular arrhythmia (MVA) can seriously affect the hemodynamic changes of the body. In this study, we developed and validated a nomogram to predict the in-hospital MVA risk in patients with STEMI after emergency PCI.

Methods

The multivariable logistic regression analysis included variables with a P<0.05 in the univariate logistic regression analysis and investigated the independent predictors affecting in-hospital MVA after PCI in patients with STEMI in the training cohort. The construction of a nomogram model used independent predictors to predict the risk of in-hospital MVA, and C-index, Hosmer-Lemeshow (HL) test, calibration curves, decision curve analysis (DCA), and receiver operating characteristic (ROC) were used to validate the nomogram.

Results

Killip class [OR=5.034 (95% CI: 1.596-15.809), P=0.005], CK-MB [OR=1.002 (95% CI: 1.001-1.004), P=0.022], serum potassium [OR=0.618 (95% CI: 0.406-0.918), P=0.020], NLR [OR=1.073 (95% CI: 1.034-1.115), P<0.001], and monocyte [OR=1.974 (95% CI: 1.376-2.925), P<0.001] were the independent predictors of in-hospital MVA after PCI in patients with STEMI. A nomogram including the 5 independent predictors was developed to predict the risk of in-hospital MVA. The C-index, equivalent to the area under the ROC curve (AUC), was 0.803 (95% confidence interval [CI]: 0.738-0.868) in the training cohort, and 0.801 (95% CI:0.692-0.911) in the validation cohort, showing that the nomogram had a good discrimination. The HL test (χ²=8.439, P=0.392 in the training cohort; χ²=9.730, P=0.285 in the validation cohort) revealed a good calibration. The DCA suggested an obvious clinical net benefit.

Conclusion

Killip class, CK-MB, serum potassium, NLR, and monocyte were independent factors for in-hospital MVA after PCI in patients with STEMI. The nomogram model constructed based on the above factors to predict the risk of in-hospital MVA had satisfactory discrimination, calibration, and clinical effectiveness, and was an excellent tool for early prediction of the risk of in-hospital MVA after PCI in patients with STEMI.

Monocyte-to-lymphocyte ratio predicts mortality and cardiovascular mortality in the general population

BACKGROUND

Systemic chronic inflammation (SCI) is closely involved in the pathogenesis of many diseases. This study aims to investigate the association between MLR with mortality and cardiovascular disease (CVD) mortality in US adults.

METHODS

35,813 adults were enrolled from the 1999-2014 National Health and Nutrition Examination Survey (NHANES) cycle. Individuals were categorized according to MLR tertiles and followed until 31 December 2019. Kaplan-Meier plots and log-rank tests were utilized to explore survival differences among the MLR tertiles. Adjusted multivariable Cox analysis was employed to investigate the relationship of MLR with mortality and CVD mortality. Restricted cubic spline and subgroup analysis were further used to discern non-linear relationship and the relationship in categories.

RESULTS

During a median follow-up of 134 months, 5865 (16.4%) all-cause deaths and 1602 (4.5%) cardiovascular deaths occurred. Kaplan-Meier plots revealed significant differences in all-cause and cardiovascular mortality among the MLR tertiles. In the fully-adjusted Cox regression model, individuals in the highest tertile of MLR had higher risk of mortality (HR = 1.26, 95% CI: 1.17-1.35) and CVD mortality (HR = 1.41, HR, 95% CI: 1.23-1.62) than those in the lowest tertile. The restricted cubic spline exhibited a J-shaped relationship between MLR with mortality and CVD mortality (P for non-linearity <0.001). The further subgroup analysis demonstrated a robust trend across categories.

CONCLUSION

Our study demonstrated that increased baseline MLR was positively associated with a higher risk of death in US adults. MLR was a strong independent predictor of mortality and CVD mortality in the general population.

Impact of antidepressant treatment on complete blood count parameters and inflammatory ratios in adolescents with major depressive disorder

Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are novel biomarkers of systemic inflammation in depression. This study aims to examines the impact of selective serotonin reuptake inhibitor (SSRI) treatment on complete blood count (CBC) parameters and inflammatory ratios in major depressive disorder (MDD). CBC parameters and inflammatory ratios were examined in a total of 45 drug-naive adolescents with MDD and were compared before and after SSRI treatment for 12 weeks and between responders and nonresponders. Following SSRI treatment in MDD, the red blood cell (RBC) count, hematocrit, and red cell distribution width (RDW) significantly increased. Hemoglobin tended to increase. The MCV, MCH, and MCHC values decreased significantly. White blood cell count, neutrophil percentage, monocyte count, and monocyte and basophil percentages decreased significantly. The percentage of lymphocytes significantly increased. The MLR decreased, whereas the NLR tended to decrease. Platelet count and PLR did not change significantly. A higher platelet count at baseline has been associated with non-response to SSRI treatment in patients with MDD. SSRI treatment increased RBC count, hematocrit, RDW, and lymphocyte percentage, and reduced MLR, and neutrophil and monocyte percentages in responders MDD. We suggest higher platelet counts at baseline as a potential predictor of nonresponders.

Association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and monocyte to lymphocyte ratio with depression: A cross-sectional analysis of the NHANES data

BACKGROUND

The association of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR) with depression has been investigated extensively while the results were conflicting. We aim to investigate whether NLR, PLR, and MLR are associated with depression, as well as to explore the potential non-linear relationship between them.

METHODS

This cross-sectional study was conducted based on representative samples of US adults from the National Health and Nutrition Examination Survey 2005-06 to 2017-18. Major depression was defined as a 9-item Patient Health Questionnaire of 10 or more. Multivariable logistic regression models were used to calculate the odds ratio of depression in relation to NLR, PLR, and MLR with the first quartile of their values as the reference. Restricted cubic splines (RCS) were added to the regression model to estimate the non-linear relationship between NLR, PLR, or MLR and depression.

RESULTS

A total of 34,324 participants were included in the study and 3009 of them were diagnosed with major depression. Only PLR was significantly associated with depression after adjustment of all covariates in the multivariable logistic regression analysis. RCS showed that NLR was significantly associated with depression after adjustment of all covariates and NLR, PLR, and MLR were associated with depression in a non-linear manner.

LIMITATIONS

The cross-sectional design did not imply any causal inferences.

CONCLUSION

NLR and PLR were associated with depression after adjustment of potential confounders in a non-linear manner. Prospective studies might be needed to further reveal the non-linear relationships.