The evaluation of neutrophil-lymphocyte ratio in patients with first episode psychosis

Nalan Varsak, Memduha Aydın, İbrahim Eren
2.555 360


Introduction: There is a growing consensus in the literature that inflammation may play a role in the pathophysiology of schizophrenia. The blood neutrophil-lymphocyte ratio is a simple, inexpensive and reliable marker of inflammation. The aim of this study is to assess the relationship between first episode psychosis (FEP) and neutrophil–lymphocyte ratio (NLR) and to investigate if there is a relation between NLR and severity of disease.

Methods: In this retrospective study we analyzed 58 FEP patients’ medical records from January 2011 to June 2014 who had been treated at our hospital. Hematologic parameters, Brief Psychiatric Rating Scale (BPRS) scores and demographic data of the patients were obtained from the medical records of 58 FEP patients. Hematologic parameters and NLR values of 58 patients with FEP compared to values of 37 healthy control group. Correlation between NLR and BPRS scores were calculated.

Results: Mean NLR was significantly higher in patients compared to control group (2.22 ± 1.25 vs. 1.63 ± 0.38, p = 0.041). Neutrophil count was not different between patients and healthy control (4.03 ± 0.70 vs. 4.20 ± 1.48, p = 0.525), but lymphocyte count was significantly lower in patients (2.56 ± 0.55 vs. 2.19 ± 0.77, p = 0.013).  In the FEP patients, NLR was not significantly correlate with severity of disease (BPRS score) (n = 58; r = 0.060, p = 0.655).

Conclusion: Our findings suggest that NLR levels are increased in physically healthy antipsychotic- naive first episode psychosis patients compared to physically and mentally healthy individuals.


Brief psychiatric rating scale, first-episode psychosis, neutrophil-lymphocyte ratio, inflammation

Full Text:



Sperner-Unterweger B. Immunological etiology of major psychiatric disorders: evidence and therapeutic implications. Drugs 2005;65(11):1493-520.

Madhusudan A, Vogel P, Knuesel I. Impact of prenatal immune system disturbances on brain development. J Neuroimmune Pharmacol 2013;8(1):79-86.

Najjar S, Pearlman DM. Neuroinflammation and white matter pathology in schizophrenia: systematic review. Schizophr Res 2015;161(1):102-12.

Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102(1):5-14.

Halazun KJ, Aldoori A, Malik HZ, Al-Mukhtar A, Prasad KR, Toogood GJ, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts survival following hepatic resection for colorectal liver metastases. Eur J Surg Oncol 2008;34(1):55-60.

Yamanaka T, Matsumoto S, Teramukai S, Ishiwata R, Nagai Y, Fukushima M. The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology 2007;73(3-4):215-20.

Kuyumcu ME, Yesil Y, Ozturk ZA, Kizilarslanoglu C, Etgül S, Halil M, et al. The evaluation of neutrophil-lymphocyte ratio in Alzheimer's disease. Dement Geriatr Cogn Disord 2012;34(2):69-74.

Halazun HJ, Mergeche JL, Mallon KA, Connolly ES, Heyer EJ. Neutrophil-lymphocyte ratio as a predictor of cognitive dysfunction in carotid endarterectomy patients. J Vasc Surg 2014;59(3):768-73.

Semiz M, Yildirim O, Canan F, Demir S, Hasbek E, Tuman TC, et al. Elevated neutrophil/lymphocyte ratio in patients with schizophrenia. Psychiatr Danub 2014;26(3):220-25.

Demir S, Atli A, Bulut M, İbiloğlu AO, Güneş M, Kaya MC, et al. Neutrophil–lymphocyte ratio in patients with major depressive disorder undergoing no pharmacological therapy. Neuropsychiatric disease and treatment. 2015; 11:2253.

Miller BJ, Buckley P, Seabolt W, Mellor A, Kirkpatrick B. Meta-analysis of cytokine alterations in schizophrenia: clinical status and antipsychotic effects. Biol Psychiatry 2011;70(7):663-71.

Mondelli V, Howes O. Inflammation: its role in schizophrenia and the potential anti-inflammatory effects of antipsychotics. Psychopharmacology (Berl) 2014;231(2):317-18.

Chiang SS, Riedel M, Schwarz M, Mueller N. Is T-helper type 2 shift schizophrenia-specific? Primary results from a comparison of related psychiatric disorders and healthy controls. Psychiatry Clin Neurosci 2013;67(4):228-36.

Chen Q, Yang LX, Li XD,Yin D, Shi SM, Chen EB, et al. The elevated preoperative neutrophil-to-lymphocyte ratio predicts poor prognosis in intrahepatic cholangiocarcinoma patients undergoing hepatectomy. Tumour Biol 2015 Feb 12; doi: 10.1007/s13277-015-3188-6

Langsenlehner T, Thurner EM, Krenn-Pilko S, Langsenlehner U, Stojakovic T, Gerger A, et al. Validation of the neutrophil-to-lymphocyte ratio as a prognostic factor in a cohort of European prostate cancer patients. World J Urol Jan 24 2015;doi: 10.1007/s00345-015-1494-7

Li S, Xu X, Liang D, Tian G, Song S, He Y. Prognostic value of blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with gastric cancer. Zhonghua Zhong Liu Za Zhi [Chinese journal of oncology] 2014;36(12):910-15.

Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 2010;105(2):186-91.

Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395(1-2):27-31.

Rembach A, Watt AD, Wilson WJ, Rianey-Smith S, Ellis KA, Rowe CC, et al. An increased neutrophil-lymphocyte ratio in Alzheimer's disease is a function of age and is weakly correlated with neocortical amyloid accumulation. J Neuroimmunol 2014;273(1-2):65-71.

Lieberman JA. Is schizophrenia a neurodegenerative disorder? A clinical and neurobiological perspective. Biol Psychiatry 1999;46(6):729-39.

Kochunov P, Hong LE. Neurodevelopmental and neurodegenerative models of schizophrenia: white matter at the center stage. Schizophr Bull (Bp) 2014;40(4):721-28.

Gupta S, Kulhara P. What is schizophrenia: A neurodevelopmental or neurodegenerative disorder or a combination of both? A critical analysis. Indian J Psychiatry 2010;52(1):21-27.

FAM PRACT PALLIAT CARE       ISSN 2458-8865       E-ISSN 2459-1505