背景:免疫机制与精神分裂症的不良结局有关;然而,各种外周免疫生物标志物的预测价值之前尚未在大型队列中进行过共同研究.
目的:为了研究白细胞(WBC)如何计数,比率,和C反应蛋白(CRP)水平影响精神分裂症谱系障碍(SSD)患者的长期预后。
方法:我们在1994-2013年期间确定了丹麦中部地区的所有成年人,并在首次诊断SSD时测量了WBC计数和/或CRP。计算WBC比率。WBC细胞和比率被四分位数分类(Q4上四分位数)。我们从第一次诊断到感兴趣的结果(死亡,治疗阻力和精神病入院),移民或2016年12月31日,使用Cox回归分析估计调整后的风险比(aHRs)。
结果:在6,845名参与者中,375人(5.5%)死亡,477(6.9%)表现出治疗抗性,1470例(21.5%)在随访期间再次入院。白细胞基线水平升高,中性粒细胞,单核细胞,LLR,NLR,MLR,CRP会增加死亡风险,而淋巴细胞水平较高,血小板,和PLR与较低的风险相关。ROC分析确定CRP是死亡率的最强预测因子(AUC=0.84)。此外,白细胞水平升高,中性粒细胞,单核细胞,LLR,NLR和MLR与治疗耐药相关。最后,较高的血小板计数降低了精神病再入院的风险,而LLR升高会增加这种风险。
结论:白细胞计数水平升高,比率,最初诊断为SSD时的CRP与死亡率相关,CRP表现出最高的预测价值。此外,某些WBC计数和比率与治疗抵抗和精神病再入院相关.
BACKGROUND: 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.
OBJECTIVE: 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).
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.