Department of Medicine, University of Barcelona, Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Barcelona, Spain; Department of Psychiatry, Santa Maria University Hospital Lleida, Lleida, Spain; Copenhagen Research Center for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Gentofte Hospitalsvej 15, 4th floor, Hellerup DK-2900, Denmark.
National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus 8210, Denmark.
Brain Behav Immun. 2024 Nov;122:18-26. doi: 10.1016/j.bbi.2024.07.041. Epub 2024 Aug 7.
Immune mechanisms are associated with adverse outcomes in schizophrenia; however, the predictive value of various peripheral immune biomarkers has not been collectively investigated in a large cohort before.
To investigate how white blood cell (WBC) counts, ratios, and C-Reactive Protein (CRP) levels influence the long-term outcomes of individuals with schizophrenia spectrum disorder (SSD).
We identified all adults in the Central Denmark Region during 1994-2013 with a measurement of WBC counts and/or CRP at first diagnosis of SSD. WBC ratios were calculated, and both WBC counts and ratios were quartile-categorized (Q4 upper quartile). We followed these individuals from first diagnosis until outcome of interest (death, treatment resistance and psychiatric readmissions), emigration or December 31, 2016, using Cox regression analysis to estimate adjusted hazard ratios (aHRs).
Among 6,845 participants, 375 (5.5 %) died, 477 (6.9 %) exhibited treatment resistance, and 1470 (21.5 %) were readmitted during follow-up. Elevated baseline levels of leukocytes, neutrophils, monocytes, LLR, NLR, MLR, and CRP increased the risk of death, whereas higher levels of lymphocytes, platelets, and PLR were associated with lower risk. ROC analysis identified CRP as the strongest predictor for mortality (AUC=0.84). Moreover, elevated levels of leukocytes, neutrophils, monocytes, LLR, NLR and MLR were associated with treatment resistance. Lastly, higher platelet counts decreased the risk of psychiatric readmissions, while elevated LLR increased this risk.
Elevated levels of WBC counts, ratios, and CRP at the initial diagnosis of SSD are associated with mortality, with CRP demonstrating the highest predictive value. Additionally, certain WBC counts and ratios are associated with treatment resistance and psychiatric readmissions.
免疫机制与精神分裂症的不良结局有关；然而，在大规模队列中，各种外周免疫生物标志物的预测价值尚未被综合研究。
探讨白细胞（WBC）计数、比值和 C 反应蛋白（CRP）水平如何影响精神分裂症谱系障碍（SSD）患者的长期结局。
我们在 1994-2013 年期间确定了丹麦中部地区所有首次诊断为 SSD 的成年人的 WBC 计数和/或 CRP 测量值。计算了 WBC 比值，并将 WBC 计数和比值分为四分位数（Q4 上四分位数）。使用 Cox 回归分析从首次诊断开始随访至感兴趣的结局（死亡、治疗抵抗和精神科再入院）、移民或 2016 年 12 月 31 日，以估计调整后的危险比（aHR）。
在 6845 名参与者中，375 人（5.5%）死亡，477 人（6.9%）表现出治疗抵抗，1470 人（21.5%）在随访期间再次入院。基线白细胞、中性粒细胞、单核细胞、LLR、NLR、MLR 和 CRP 水平升高增加了死亡风险，而淋巴细胞、血小板和 PLR 水平升高则降低了死亡风险。ROC 分析确定 CRP 是死亡率的最强预测因子（AUC=0.84）。此外，白细胞、中性粒细胞、单核细胞、LLR、NLR 和 MLR 水平升高与治疗抵抗有关。最后，血小板计数升高降低了精神科再入院的风险，而 LLR 升高则增加了这种风险。
SSD 初始诊断时白细胞计数、比值和 CRP 水平升高与死亡率相关，CRP 具有最高的预测价值。此外，某些白细胞计数和比值与治疗抵抗和精神科再入院有关。
