Total and differential white blood cell counts, high-sensitivity C-reactive protein, and the metabolic syndrome in non-affective psychoses

Abstract

The metabolic syndrome is highly prevalent in patients with schizophrenia, and is associated with a state of chronic, low-grade inflammation. Schizophrenia is also associated with increased inflammation, including aberrant blood levels of pro-inflammatory cytokines and high-sensitivity C-reactive protein (hsCRP). The purpose of this study is to investigate the relationship between total and differential white blood cell (WBC) counts, hsCRP, and the metabolic syndrome in patients with schizophrenia and related non-affective psychoses. 59 inpatients and outpatients age 18–70 with non-affective psychotic disorders and 22 controls participated in this cross-sectional study. Subjects had a fasting blood draw between 8 and 9 am for glucose, lipids, total and differential WBC counts, and hsCRP. Vital signs and anthropometric measures were obtained. Patients with non-affective psychosis and the metabolic syndrome had significantly higher total WBC counts, monocytes, and hsCRP levels than patients without the metabolic syndrome (p≤0.04 for each). In binary logistic regression analyses, after controlling for potential confounding effects of age, race, sex, age at first hospitalization for psychosis, parental history of diabetes, smoking, and psychotropic medications, total WBC count, monocytes, and hsCRP were significant predictors of metabolic syndrome in patients (p≤0.04 for each). hsCRP was also a significant predictor of increased waist circumference and triglycerides in patients (p≤0.05 for each). Our findings suggest that measurement of total and differential WBC counts and hsCRP blood levels may be germane to the clinical care of patients with schizophrenia and related disorders, and support an association between inflammation and metabolic disturbance in these patients.

Inflammation and metabolic changes in first episode psychosis: Preliminary results from a longitudinal study

“…These results are consistent with a previous cross-sectional study, which identified hsCRP as a predictor of elevated triglyceride levels in a non-affective psychoses sample (Miller et al, 2013); our findings suggest that this association also holds for longitudinal changes, and applies also to patients with a range of psychosis diagnostic categories. Interestingly, in our sample changes in hsCRP were found to predict increases in triglycerides independent of changes in weight, which to date has been considered as the main risk factor for metabolic changes in FEP.…”

“…One previous longitudinal study found that elevated baseline Interleukin (IL)-1b levels predicted an increased risk of weight gain in patients six-months after the initiation of risperidone treatment (Song et al, 2014). Also of note, in a recent cross-sectional study in patients with psychosis, hsCRP predicted metabolic syndrome, as well as, independently, increased waist circumference and elevated triglycerides (Miller et al, 2013).…”

Associated illness severity in schizophrenia and diabetes mellitus: A systematic review

“…Dyslipidaemia has been shown to be associated with first-episode psychosis (Perry et al, 2016, Misiak et al, 2017b, and an abnormal inflammatory response in patients with first-episode psychosis (Russell et al, 2015, Miller et al, 2013. It is therefore possible that our hypothesis may extend to other elements of the metabolic syndrome, and this may warrant future research.…”

Letter to the Editor: Lipid profile disturbances in antipsychotic-naive patients with first-episode non-affective psychosis

“…Interestingly, there is evidence in the literature that abnormal inflammatory markers are also associated with dyslipidaemia in studies of patients with first-episode psychosis (Russell et al, 2015, Miller et al, 2013, suggesting our hypothesis may be significant not only for dysglycaemia in first-episode psychosis, but dyslipidaemia also.…”