Effect of thyroid hormone status on complete blood cell count-derived inflammatory biomarkers in patients with moderate-to-severe Graves' ophthalmopathy

Value of Platelet-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios in Differentiating Idiopathic Orbital Inflammation From Orbital Infectious Disease

PURPOSE

Monocyte-lymphocyte ratio (MLR) and platelet-lymphocyte ratio (PLR) are emerging biomarkers; they have not been widely utilized in orbital disease. This study investigated the role of these ratios in distinguishing orbital inflammation from infection.

METHODS

A retrospective review of medical records was conducted to identify adult patients who presented acutely to a single emergency department at an academic medical center and were diagnosed with serologically and biopsy-proven idiopathic orbital inflammation (IOI, n = 9), orbital cellulitis (OC, n = 14), or necrotizing fasciitis (NF, n = 12). MLR and PLR were calculated from the first blood draw on presentation to the emergency department. Statistical analysis was performed via the Mann-Whitney test with a dedicated computerized software package (GraphPad Prism, La Jolla, CA) with p values <0.05 considered statistically significant.

RESULTS

Mean PLRs were 194.90 (SD = 118.01), 304.21 (SD = 341.39), and 203.38 (SD = 196.32) for IOI, NF, and OC, respectively. Mean MLRs were 0.40 (SD = 0.24), 1.74 (SD = 2.41), and 0.75 (SD = 0.40) for IOI, NF, and OC, respectively. MLR was significantly lower in the IOI group compared to the NF group ( p = 0.018) and OC group ( p = 0.020). Differences in MLR between OC and NF groups were not statistically significant ( p = 0.43).

CONCLUSION

While MLR showed no significant difference between different infectious etiologies, it was significantly higher in infectious processes than in IOI, distinguishing inflammation from infection. MLR could be a valuable addition to the diagnostic toolkit for triaging patients in the emergency department and initiating prompt, focused therapy.

Evaluating the Role of CBC-Derived Indices in Children with Hashimoto's Thyroiditis

Background/Objectives: Hashimoto's thyroiditis (HT) is an autoimmune disorder characterized by chronic inflammation of the thyroid gland. Recent evidence indicates that the inflammation may extend beyond the thyroid. The study aims to explore the potential of complete blood count (CBC)-derived indices as markers of systemic inflammation in HT. Materials and Methods: This cross-sectional retrospective study from 1 January 2015, to 31 December 2023 included 147 pediatric HT patients and 144 apparently healthy controls. Thyroid profiles, antibodies, CBC, and protein electrophoresis data were collected from patient records. CBC-derived indices were calculated and compared between the HT and control groups, as well as among HT subgroups. Results: The median age of HT patients was 13.6 years (range: 11.2-15.5 years), with 66% being girls. The control group had a similar age and gender distribution, with a median age of 13.7 years (range: 11-15.8 years) and 70.8% girls. Of the HT patients, 50% had subclinical HT, 15% were euthyroid, and 34% had overt thyroid dysfunction. HT patients showed significantly higher neutrophil and lymphocyte counts, as well as all evaluated CBC-derived indices than controls (p < 0.001)). These differences were not significant among HT subgroups. Logistic regression indicated a strong association between an elevated neutrophil-to-lymphocyte ratio (NLR) and HT diagnosis (p < 0.001), while ROC analysis confirmed NLR as the most accurate CBC-derived marker for distinguishing HT from controls. Conclusions: Elevated NLR levels in pediatric HT patients provide additional evidence that inflammation may extend beyond the thyroid gland. These results support the potential of NLR as a reliable and accessible biomarker for evaluating inflammation in Hashimoto's thyroiditis.

Novel immunoinflammatory blood markers in Graves' orbitopathy: insights into activity and severity

OBJECTIVE

This prospective case-control study examined the novel immunoinflammatory markers obtained from blood counts of patients with Graves' orbitopathy (GO), Graves' disease (GD) and healthy subjects.

METHODS

Demographic data, white cell count parameters, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet-to-neutrophil ratio (PNR), red cell distribution width (RDW), RDW-to-platelet ratio (RDW/PLT), MPV-to-lymphocyte ratio (MPV/ALC), eosinophil-to-lymphocyte ratio (ELR) and systemic immune-inflammatory index (SII) were evaluated. The European Group on Graves Orbitopathy scale and Clinical Activity Score were used for clinical activity and severity assessment.

RESULTS

The GO group showed significantly higher mean MPV (p˂0.001) and MPV/ALC (p=0.03) than the GD group. The PLR (p=0.02), MPV/ALC (p=0.04) and SII (p=0.04) were significantly higher in the GO than healthy group. A significantly higher absolute neutrophil count (p=0.005), NLR (p=0.001), MPV (p=0.001), MPV/ALC (p=0.003), MPV/PLT (p=0.04), RDW (p˂0.001), RDW/PLT (p=0.02) and SII (p=0.01) as well as lower ALC (p=0.01) and PNR (p˂0.001) was observed in the active than inactive GO. Moderate to severe GO group had a significantly higher NLR (p=0.006), PLR (p=0.04), ELR (p=0.006), MPV (p=0.03), MPV/ALC (p=0.002), RDW (p˂0.001), RDW/PLT (p=0.02) and SII (p=0.03) as well as a lower ALC (p=0.01) and PNR (p=0.01) than mild GO.

CONCLUSIONS

The MPV/ALC ratio and MPV levels may identify GD patients at risk of GO. The MPV, MPV/ALC, ALC, NLR, PLR, PNR, RDW, RDW/PLT, MPV/PLT and SII may help distinguish the GO activity and severity. However, the study's small sample size and single-centre design may limit the generalisability of the results. Furthermore, the lack of longitudinal follow-up precludes assessing marker evolution over time.

Inflammatory Markers in Thyroid Eye Disease: A Meta-Analysis

Thyroid Eye Disease (TED) is an inflammatory autoimmune condition affecting the eyes, often associated with Graves' disease. Inflammation is important in TED, involving immune cells and orbital tissues. While inflammatory markers have been studied in other diseases, their role in TED is unclear. We included 734 participants from 5 eligible studies investigated associations between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) and TED. Initial analysis found no significant differences in these markers between TED and control groups. However, sensitivity analysis excluding an outlier study revealed significant differences in NLR, PLR, and MLR between groups, suggesting the potential association between these inflammatory markers and TED. More research is needed, but these findings indicate complex TED pathogenesis and that inflammation may offer insights for TED diagnosis and management.

Identification of immune-related regulatory networks and diagnostic biomarkers in thyroid eye disease

BACKGROUND

Thyroid eye disease (TED) is an orbit-associated autoimmune inflammatory disorder intricately linked to immune dysregulation. Complete pathogenesis of TED remains elusive. This work aimed to mine pathogenesis of TED from immunological perspective and identify diagnostic genes.

METHODS

Gene expression microarray data for TED patients were downloaded from Gene Expression Omnibus, immune-related genes (IRGs) were from ImmPort database, and TED-related transcription factors (TFs) were from Cirtrome Cancer database. Differential analysis, Gene Ontology (GO), and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed. Regulatory networks of TFs and IRGs were constructed with Cytoscape. Diagnostic biomarkers in TED were identified through LASSO. Immune cell infiltration analysis was performed using CIBERSORT.

RESULTS

Twenty-three immune-related DEmRNAs were revealed and were primarily enriched in humoral immune response, positive regulation of inflammatory response, IL-17, and TNF pathways. Co-expression regulatory network included four TFs and 16 immune-related DEmRNAs. Seven diagnostic genes were identified, with Area Under the Curve (AUC) of 0.993 for training set and AUC value of 0.836 for validation set. TED patients exhibited elevated infiltration levels by macrophages M2, mast cells, and CD8 T cells among 22 immune cell types, whereas macrophages M2 and mast cells resting were significantly lower than normal group.

CONCLUSIONS

The seven feature genes had high diagnostic value for TED patients. Our work explored regulatory network and diagnostic biomarkers, laying theoretical basis for TED diagnosis and treatment.