THROMBOCYTE INDICES RELATION WITH GESTATIONAL HYPERTENSIVE DISORDERS

BACKGROUNDIndices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) are considered new markers of the systemic inflammatory response (SIR), and have been widely implemented for the diagnosis of patients with inflammatory diseases. These new indicators have also been widely investigated in preeclampsia (PE) but less analyzed in hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome.AIMTo compare SIR markers among HELLP patients, PE only patients, and healthy gravidae.METHODSThis retrospective case-control study enrolled 630 cases, including 210 patients with HELLP syndrome (HELLP group), 210 patients with only PE (PE group) and 210 healthy gravidae (control group). The three groups were matched by age, parity, status of assisted reproduction, and multiple pregnancies. Birthweight, gestational age at complete blood count collection, gestational age at delivery, mode of delivery, etc. were recorded. The main indices as NLR, PLR, MPV, PDW, and RDW among the groups were compared, as well as some secondary outcomes including neutrophil, platelets, and hemoglobin.RESULTSThe NLR (6.4 vs 4.3 vs 3.5), MPV (11.9 vs 11.2 vs 10.7), PDW (16.4 vs 13.3 vs 14.2), leukocyte (12.4 × 109/L vs 9.7 × 109/L vs 8.7 × 109/L) and neutrophil count (9.9 × 109/L vs 7.3 × 109/L vs 6.1 × 109/L) were highest in the HELLP group, lower in the PE group, and lowest in the control group. Both the overall comparisons between the three groups (all bP < 0.01) and pairwise comparisons between every two groups elicited statistically significant differences (all dP < 0.01, except control vs PE: cP < 0.05 in PDW). The average lymphocyte counts were 1.4 (1.1, 2.0) × 109/L in the HELLP group, 1.6 (1.3, 2.0) × 109/L in the PE group and 1.7 (1.4, 2.0) × 109/L in the control group. The overall comparison of lymphocyte count within the three groups had statistically significant differences (P = 0.000). The pairwise comparisons between every two groups demonstrated that the HELLP group had a lower lymphocyte count than both the PE (P = 0.019) and control groups (P = 0.000), but the difference between the PE and control groups was not statistically significant (P = 0.432). The overall comparisons on platelet counts and the PLR among these three groups also showed statistically significant differences (both P = 0.000), from low to high being those in the HELLP group (43.4 × 109/L, 64.0), control group (180.5 × 109/L, 103.6) and PE group (181.5 × 109/L, 112.8). Pairwise comparisons of neither index displayed statistically significant differences between the PE and control groups (both P > 0.05), while the differences in the two indices between the HELLP group and the two other groups were still statistically significant (all P = 0.000). RDW values were highest in the HELLP group (14.5% [13.6, 15.3]), lower in the control group (14.1% [13.5, 14.8]) and lowest in the PE group (13.9% [13.4, 14.9]). The difference between the PE and control group did not show statistical significance (P = 1.000), while RDW values in the HELLP group were higher than those in the other two groups (cP < 0.05 vs control, dP < 0.01 vs PE).CONCLUSIONSIR markers such as NLR, RDW, MPV, and PDW were increased and PLR was decreased in HELLP. These SIR markers may become new indicators in the evaluation of HELLP syndrome.

Sinonasal inverted papillomas are benign neoplasms of the nasal cavity and paranasal sinuses. They have characteristic features such as a high risk of recurrence and possible malignant transformation. This study was conducted to investigate the relationship between sinonasal inverted papilloma and inflammatory blood markers. Sixty-five patients who were diagnosed histologically as having sinonasal inverted papilloma and 65 age- and sex-matched healthy controls were included in the study. Inflammatory blood markers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) of the patient and control groups were compared. There were no statistically significant differences between the patients and controls for white blood cell, platelet, hemoglobin, neutrophil, and lymphocyte counts (P > .05). No statistically significant difference was found between the patients and controls for NLR, PLR, RDW, MPV, and PDW (P > .05). In the logistic regression analysis model, which was created to investigate the effects of inflammatory blood markers in determining the patient group, the increase in the NLR and decrease in the PLR were found to be statistically significant factors (P = .008, P = .039). This is the first study in the literature to investigate the relationship between sinonasal inverted papilloma and inflammatory blood markers, and the results suggest that NLR and PLR may be used to distinguish patients with sinonasal inverted papilloma from controls.

Objective: Assessment of the systemic inflammatory response of the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) is shown as a new biomarker. Red cell distribution width (RDW) is the size of red blood cells and have been found related to adverse events in many diseases. Mean platelet volume (MPV) indicates platelet volume and platelet volume is a potential indication of platelet activity. The aim of our study is to investigate hematological changes in patients with panic disorder (PD) through readily available markers such as NLR, PLR, RDW and MPV. Methods: Thirty-nine patients between the ages of 18 and 75 who were diagnosed with PD according to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) and forty healthy control subjects were included in the study. MPV, NLR, PLR and RDW were measured and recorded for groups. Hamilton Depression Scale, Hamilton Anxiety Scale, Clinical Global Impressions Scale (CGI-S) and Panic Disorder Severity Scale were applied to the patients. Results: There were no statistically significant differences between groups in terms of sociodemographic characteristics. No significant correlation was found between NLR, PLR and RDW values and clinical scales. MPV was negatively correlated with the severity of panic disorder. There was no correlation between MPV and other variables. Conclusion: Our study is the first study to examine NLR, PLR and RDW associations in PD patients. There are studies showing that increased sympathetic activity leads to increased MPV. In our study, the MPV value did not differ between PD and control group. However, there was a negative correlation between the severity of panic disorder and MPV.

SummaryBackgroundMean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have all been investigated as novel inflammatory markers of cardiac and oncological diseases, while there is only a limited number of studies investigating these markers in chronic obstructive pulmonary disease (COPD). In the present study we examine NLR, PLR; and other markers, such as eosinophil, MPV, plateletcrit (PCT), platelet distribution width (PDW), red cell distribution width (RDW), and C-reactive protein (CRP) in patients with stable and acute exacerbation of COPD.MethodsStable COPD (Group 1, n=140), COPD with acute exacerbation (Group 2, n=110), and healthy controls (Group 3, n=50) were included in the study. Leukocyte, CRP, hemoglobin (HB), RDW, platelet, MPV, PCT, PDW, neutrophil, lymphocyte, eosinophil, NLR, and PLR were analyzed in all groups.ResultsHB, leukocyte, platelet, neutrophil, eosinophil, MPV, PCT, CRP, NLR, and PLR were significantly higher, while the lymphocyte was lower in Group 1 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while lymphocyte was lower in Group 2 than in Group 3. Leukocyte, neutrophil, RDW, CRP, NLR, and PLR were significantly higher, while HB, platelet, MPV, PCT, and lymphocyte were significantly lower in Group 2 than in Group 1. NLR and PLR increased significantly in patients with bronchiectasis when compared to those without in Group 1.ConclusionsOur study results suggest that NLR, PLR and RDW can be used as simple and cost-effective markers for the evaluation of severity of exacerbation and for predicting hospitalization and further exacerbations in patients with COPD.

BackgroundAs a multisystem infectious disease, there is an inflammation, which causes increase in acute phase reactants in brucellosis. The mean platelet volume (MPV), platelet distribution width (PDW), red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been identified as markers of inflammation. The present study aimed to evaluate diagnostic values of these biomarkers in brucella arthritis (BA).MethodsThe study included 64 children with BA and 66 healthy control subjects. Demographic features, joint involvement, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and hematological variables were retrospectively recorded. In addition, results of synovial fluid and serum tube agglutination test for brucella together with treatment regimens were recorded.ResultsThe mean age of the patients (53.1 % male) was 92.3 ± 41.2 months. The most commonly affected joint was ankle (53.1 %). Synovial fluid puncture-brucella agglutination test was positive in 22 (34.3 %) patients. Puncture culture was positive in 9 patients. Most of the patients (57.8 %) were treated with a combination of rifampicin plus sulfamethoxazole/trimethoprim and gentamicin. Significantly higher mean PDW, RDW, MPV, NLR and PLR values were found in children with BA compared to control subjects (p < 0.05). A positive correlation was found between MPV and NLR values (R2 = 0.192, p < 0.001).ConclusionOur findings indicated that NLR and PLR are indirect markers of inflammation that may be observed abnormally increased in children with brucella arthritis. Further longitudinal studies are needed to investigate this topic to establish the more clear associations.

BackgroundBehçet’s disease (BD) is a complex, inflammatory multisystem disorder. Since the lack of universally recognised pathognomonic laboratory test, the diagnosis relies heavily on clinical findings. Currently, the Monocytes to lymphocytes...

Objectives: Identifying reliable biomarkers to predict mortality in critically ill patients is crucial for optimizing management in intensive care units (ICUs). Inflammatory and metabolic markers are increasingly recognized for their prognostic value. This study aims to evaluate the association of various inflammatory and metabolic markers with ICU mortality. Methods: This prospective observational study was conducted from January 2023 to January 2024 in the City Hospital’s ICU. A total of 160 critically ill patients were enrolled. Laboratory parameters, including white blood cell (WBC) count, red cell distribution width (RDW), platelet count, neutrophil count, mean platelet volume (MPV), monocyte count, lymphocyte count, procalcitonin (PCT), C-reactive protein (CRP), calcium (Ca++), and vitamin D levels, were analyzed. Additionally, ratios such as the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory index (SII), and pan-immune-inflammation value (PIV) were calculated. Plasma levels of Gla-rich protein (GRP) and dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) were measured using ELISA. Results: The mean age of the patients included in the study was 60.5 ± 15.8 years. Cardiovascular disease was present in 72 patients (45%), respiratory system disease in 58 (36%), and chronic kidney disease (CKD) in 38 (24%). Additionally, 61 patients (38%) had diabetes, and 68 (42%) had hypertension. Inflammatory markers, including PLR, NLR, and PIV, were all significantly higher in non-survivors, while calcium and vitamin D levels were lower (p < 0.05). Higher WBC, RDW, neutrophil count, PLR, NLR, PIV, CRP, procalcitonin, GRP, and dp-ucMGP levels were positively correlated with longer hospital stays and increased mortality. In contrast, platelet and lymphocyte counts were negatively correlated with both outcomes (p < 0.05). Vitamin D levels showed an inverse relationship with both hospital stay and mortality, indicating that lower levels were associated with worse outcomes (p < 0.05). In multiple logistic regression analysis, elevated WBC count (OR = 1.20, p = 0.02), RDW (OR = 1.35, p = 0.01), neutrophil count (OR = 1.25, p = 0.01), MPV (OR = 1.20, p = 0.02), PLR (OR = 1.30, p = 0.01), NLR (OR = 1.40, p = 0.001), PIV (OR = 1.50, p = 0.001), CRP (OR = 1.32, p = 0.01), procalcitonin (OR = 1.45, p = 0.001), GRP (OR = 1.40, p = 0.001), and dp-ucMGP (OR = 1.30, p = 0.001) levels were significantly associated with increased mortality. Conclusions: Inflammatory and metabolic markers, particularly NLR, PLR, PIV, GRP, and dp-ucMGP, are strong predictors of mortality in ICU patients. These markers provide valuable insights for risk stratification and early identification of high-risk patients, potentially guiding more targeted interventions to improve outcomes.

Objective: A complex inflammatory response forms against the local effects of malignancy. In the differentiation of colorectal cancer from benign colorectal polypoid lesions, inflammatory biomarkers such as platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and Red Cell Distribution Width (RDW) have previously provided promising results. This study aimed to investigate the results of immature granulocytes (IG) and as yet unstudied biomarkers such as nucleated red blood cells (NRBC), platelet distribution width (PDW), and Mean Platelet Volume (MPV) with new inflammatory indexes such as the RDW-lymphocyte ratio (RDWLR) and the PDW-lymphocyte ratio (PDWLR). Material and Method: The hematological biomarkers were compared between 269 patients with colorectal benign polyps and 57 patients with colorectal adenocarcinoma. To determine the sensitivity and specificity of the biomarkers related to the neoplastic characteristics of the colorectal polyps, the Receiver Operating Characteristics (ROC) curve analysis was performed. Results: The mean NRBC count, IG count, and rates were similar in both groups. In the colorectal carcinoma group, PDW was lower (p=0.004) and RDW was higher (p=0.018). The NLR, PLR, RDWLR, and PDWLR values were significantly higher in the colorectal carcinoma group (p

We aimed to determine the relationship of red cell and platelet distribution widths with the onset of acute myocardial infarction, to enable the early detection and prevention of acute myocardial infarction. Red cell and platelet distribution widths were retrospectively determined in 46 patients with stable angina pectoris and 140 patients with acute myocardial infarction who were brought to the emergency department of our institution. Red cell and platelet distribution widths were determined with an automatic blood cell analyzer, and the results were compared between the acute myocardial infarction and angina pectoris groups. Both red cell and platelet distribution width values obtained at onset were significantly higher in the acute myocardial infarction group than in the angina pectoris group (red cell distribution widths, 46.4 ± 0.51% versus 44.5 ± 0.59%; mean difference -1.91 [95% confidence interval (CI), -3.79 to -0.34]; platelet distribution widths, 12.1 ± 0.22 fL versus 11.1 ± 0.17 fL; mean difference -1.03 [95% CI, -1.58 to -0.47]). The red cell distribution widths before onset was not different between the acute myocardial infarction and angina pectoris groups; however, the platelet distribution widths before onset was higher in the acute myocardial infarction group (red cell distribution widths, 46.5 ± 0.85% versus 45.9 ± 0.59%; mean difference -0.71 [95% CI, -2.74 to 1.30]; platelet distribution widths, 11.4 ± 0.39 fL versus 10.6 ± 0.21 fL; mean difference -0.83 [95% CI, -1.66 to 0.11]). Red cell distribution widths and especially platelet distribution widths may contribute to the early detection of acute myocardial infarction.

ABSTRACTBackground: Debate around the value of laboratory tests in establishing the diagnosis of acute appendicitis (AA) still continues. This prospective study aimed to investigate the changes in mean platelet volume (MPV), platelet distribution width (PDW), and red cell distribution width (RDW) with the diagnosis of acute appendicitis. Method: 200 patients who underwent emergency appendectomy were included. According to postoperative histology, patients were divided into three groups: acute non-complicated, acute complicated appendicitis (positive appendicectomy groups), and negative appendectomy group. White blood cell (WBC), neutrophil, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), platelets (PLT) count, MPV, PDW, RDW, and C-reactive protein (CRP) were compared among the groups. Results: One hundred twenty-five (62.5%) patients had non-complicated acute appendicitis, 20 (10%) had complicated acute appendicitis, while 55 (27.5%) had normal appendix. WBC (p <.001), neutrophil (p <.001), NLR (p <.001), PDW (p =.003), and CRP (p =.001) were higher, while lymphocyte (p <.001) and PLT counts (p =.020) were lower in positive appendectomy compared with negative appendectomy patients. MPV levels were insignificantly different across the groups. RDW level was significantly higher in complicated compared with non-complicated acute appendicitis (p =.006); however, no significant difference was found between positive and negative appendectomy groups. Using receiver operating characteristic analysis, sensitivity, specificity, and diagnostic accuracy respectively were 44.83, 100.0, and 72.415% for WBC count, 72.41, 81.82, and 77.115% for neutrophil count, 48.28, 90.91, and 69.595% for PDW, 89.66, 63.64, and 76.65% for CRP. Conclusions: Increased PDW combined with elevated WBC and neutrophil counts maybe used as diagnostic tests in the cases of acute appendicitis, while MPV and RDW levels were not useful diagnostic markers.

The association of vitamin D deficiency with hemogram-derived inflammatory biomarkers in children

Objective: This study aims to examine systemic inflammatory markers and the influence of feto-maternal factors in post-term pregnancies, assessing their ability to predict the course of these pregnancies. The findings seek to contribute to the existing literature on post-term pregnancy outcomes. Methods: The study retrospectively analyzed data from 250 pregnant women, aged 16 to 45, with a known last menstrual period (LMP) and no active trauma, who were admitted to the Obstetrics and Gynecology, Tepecik Training and Research Hospital between 2018 and 2023. The parameters examined included age, parity, systolic arterial tension (SAT), white blood cell (WBC) count, neutrophil count, lymphocyte count, platelet count, mean platelet volume (MPV), red blood cell distribution width (RDW), and neonatal outcomes. The case group consisted of 125 pregnant women who were at or beyond 42 weeks (≥42+0) according to LMP, while the control group included 125 women between 37 and 40+6 weeks of gestation. Comparisons were made between the groups based on the neutrop- hil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other demographic characteristics. Results: When comparing post-term and term pregnancies, the post-term pregnancy group showed significantly higher values for age, gestation period, height, RDW, and PDW. In contrast, WBC, PLT, MPV, and PLR were significantly higher in the term pregnancy group. No significant differences were found between the two groups in terms of live birth rate, birth weight, birth height, neutrophil count, lymphocyte count, or NLR. Conclusion: In the post-term group, WBC, neutrophil, lymphocyte, MPV, and NLR levels were lower, while PDW and RDW levels were higher compared to the term group. No differences were observed in PLR and PLT levels. Studies with larger sample sizes are recommended to enhance the predictive value of these markers for post-term pregnancies.

ObjectiveNeutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Red-cell-distribution width (RDW) and Platelet-distribution width(PDW) have been proved to be related to the severity of a variety of diseases and poor prognosis. But their predictive value in neonatal pneumonia is still unknown. Therefore, this study explored the predictive value of NLR, PLR, RDW and PDW in the adverse prognosis of neonatal pneumonia.MethodsWe retrospectively analyzed 132 neonates with pneumonia treated in our hospital from April 2022 to October 2024. At the same time, 50 healthy newborns delivered in our hospital during the same period were selected as the control group. The levels of NLR, PLR, RDW and PDW in children with different disease severity and prognosis were analyzed; The correlation between NLR, PLR, RDW, PDW levels and disease severity was analyzed, and the predictive value for the adverse prognosis of neonatal pneumonia.ResultsAmong 132 children, 65 were mild, 44 moderate and 23 severe; 26 cases had poor prognosis. The levels of NLR, PLR, RDW and PDW in children with different disease severity were significantly different (P<0.05). Spearman test showed that NLR, PLR, RDW, PDW were significantly positively correlated with the severity of neonatal pneumonia (P<0.05). Multivariate logistic regression analysis showed that NLR, PLR, RDW and PDW were the related factors influencing the poor prognosis of neonatal pneumonia (p<0.05). ROC curve analysis showed that the value of combined prediction of four indicators for poor prognosis of neonatal pneumonia was higher than that of single indicators, and the sensitivity of combined prediction was 100%, and the specificity was 94.9%.ConclusionNLR, PLR, RDW, PDW were positively correlated with the severity of neonatal pneumonia, and the value of combined prediction of poor prognosis was higher.

OBJECTIVE: Neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) were determined to be good indicators of inflammatory status. The aim of this study was to investigate NLR, PLR, MPV, and RDW, which can provide insight into diagnosis and/or prognosis in adolescents with major depressive disorder (MDD) compared to controls.METHOD: A total of 103 patients diagnosed with MDD, who received no antidepressant therapy within the past 1 month, were included in the study. The control group consisted of 41 healthy subjects with no organic and psychiatric disorders.RESULTS: NLR and MPV values were significantly high in adolescents with MDD compared with healthy controls (2.00 ± 0.80 vs. 1.63 ± 0.64, P = .011; 10.25 ± 0.91 vs. 9.62 ± 1.23, P = .005). There was no difference between the groups on PLR and RDW. There was a positive correlation between NLR and Children’s Depression Scale (CDI) scores in the total study group (r = 0.229, P = .006). There was also a positive correlation between MPV and CDI scores in the total study group (r = 0.185, P = .028).CONCLUSION: The findings of the study reveal that NLR and MPV tend to be higher in adolescents with MDD, and higher NLR values are associated with higher CDI scores in adolescents. The findings of this study are consistent with the relevant literature of inflammatory status in MDD. Our study gave us an idea of the need for larger sample study on the routine use of blood parameters in adolescent depression.

Acute appendicitis (AA) is the most common emergency surgical condition during pregnancy after obstetric and gynecological pathologies. Urgent and accurate diagnosis of AA in pregnant patients reduces maternal and fetal morbidity/mortality rates. This study evaluated the significance of hemogram to diagnose AA during pregnancy. Forty-seven pregnant patients operated for AA in the Ordu or Ondokuz Mayis University Medical School Hospitals between January 2007 and December 2017 were compared with 47 healthy pregnant women in terms of hemogram parameters, including the white blood cell (WBC) count, neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) values. The operated group was evaluated based on post-operative pathologic results and subclassified into appendicitis positive (Group A) and appendicitis negative (Group B) groups. The subgroups were compared to the control group. The WBC and neutrophil count and mean NLR and PLR values were significantly higher in Group A compared to Group B and the control group (p<0.001). The mean lymphocyte count was significantly lower in Group A compared to other groups (p<0.001). The MPV and RDW values and mean platelet count showed no significant difference between groups (p>0.05). When cutoff values for WBC, neutrophil count, NLR, PLR, and lymphocyte counts were set to >10300, >7950, >5.50, >155.2, and ≤1330, respectively, the sensitivity rates were 72.5%, 80%, 90%, 77.5% and 85%, whereas specificity rates were 72.3%, 79.7%, 89.4%, 74.5%, and 82.5%, respectively. When comparing pregnant women diagnosed with AA to patients operated for suspected AA and healthy pregnant women, the WBC and neutrophil count and NLR and PLR values were found to be significantly higher, whereas lymphocyte counts were lower. In addition to medical history, physical examination and imaging techniques, hemogram parameters should be considered to diagnose AA in pregnant women.