Neutrophil-to-Lymphocyte Ratio Is Independently Associated With Severe Psychopathology in Schizophrenia and Is Changed by Antipsychotic Administration: A Large-Scale Cross-Sectional Retrospective Study

Abstract

Background: Immunological and inflammatory mechanisms play an important role in schizophrenia. The neutrophil-to-lymphocyte ratio (NLR) is a value obtained by dividing the absolute number of neutrophils by the absolute lymphocyte count and represents a biomarker of systemic inflammatory response. There are studies investigating NLR association with psychopathology. However, the relationship has been only studied in small numbers of patients with schizophrenia, which leads to conflicting results and makes the meta-analytic data difficult to interpret. The aim of this study is to perform large-scale cross-sectional analysis on the potential correlation between NLR and disease severity in schizophrenic patients with or without medication. Methods: This cross-sectional retrospective study was conducted in Nanjing Medical University Affiliated Brain Hospital. We identified inpatients with schizophrenia between July 12, 2018 and March 27, 2019 and collected data of NLR, the Clinical Global Impression Severity scale (CGI-S) score and the Brief Psychiatric Rating Scale (BPRS) score.Results: The records of 1,144 identified patients (10.8% drug-free patients) were analyzed. We found that NLR was significantly decreased in schizophrenic patients after antipsychotic administration and there was the discrepant correlation between NLR and psychiatric symptoms in patients with or without antipsychotic medication. The results of multivariate logistic regressions showed that NLR was positively associated with the severity of disease (i.e., the CGI-S score and the BPRS total score) in drug-free patients, and it was negatively associated with the BPRS negative symptoms (i.e., the BPRS negative symptoms score) in drug-therapy patients. Conclusion:The study is the first to confirm the hypothesis that NLR is independently associated with severe psychopathology in schizophrenia and is changed by antipsychotic administration.

Is Elevated Neutrophil Count and Neutrophil-to-Lymphocyte Ratio a Cause or Consequence of Schizophrenia?—A Scoping Review

“…Six studies investigated the effect of antipsychotics on neutrophil numbers ( Table 3 ). Three studies had longitudinal measurements ( 25 , 26 , 31 ), the others were cross-sectional ( 21 , 24 , 27 ). One study included a comparison based on antipsychotic response ( 25 ).…”

“…Among the cross-sectional studies, three studies found no significant difference in neutrophil count and NLR between drug-naïve or drug-free patients compared to medicated patients ( 24 , 26 , 31 ). However, the largest study, with 1,144 participants, found significantly higher neutrophil count and NLR in drug-free patients compared to those that had received antipsychotic therapy ( 27 ).…”

“…Nine studies explored the relationship between neutrophil count or NLR and psychosis symptoms score. Six studies used PANSS, two used the Brief Psychiatric Rating Scale (BPRS) ( 24 , 27 ), and one used items from BPRS in combination with The Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) ( 29 ). Two studies also used the Clinical Global Impression-Severity scale (CGI-S).…”

“…Contrary to these findings, four studies found no correlation between neutrophil numbers and symptoms score (24,27,28,30). However, Zhou et al found that in drug-free patients, NLR was significantly associated with CGI-S and the BPRS total score, while in medicated patients NLR was negatively associated with the BPRS negative symptoms score (27).…”

Hijacked Immune Cells in the Tumor Microenvironment: Molecular Mechanisms of Immunosuppression and Cues to Improve T Cell-Based Immunotherapy of Solid Tumors

“…For many cancer entities, the number of TANs correlates with poor prognosis [ 26 , 27 , 28 ], and the neutrophil-to-lymphocyte ratio (NLR) in the peripheral blood has currently been established as a prognostic marker for some cancer entities [ 29 , 30 ].…”