Increased Neutrophil/Lymphocyte Ratio in Patients with Depression is Correlated with the Severity of Depression and Cardiovascular Risk Factors

OBJECTIVE: Chronic inflammation is associated with cardiovascular (CV) risk factors and psychiatric disorders. The neutrophil to lymphocyte ratio (NLR) has been investigated as a new biomarker for systemic inflammatory response. The aim of the study is to investigate the relation of NLR with severity of depression and CV risk factors. METHODS: The study population consisted of 256 patients with depressive disorder. Patients were evaluated with the Hamilton Rating Scale for Depression (HAM-D). Patients were classified into four groups according to their HAM-D score such as mild, moderate, severe, and very severe depression. Patients were also evaluated in terms of CV risk factors. RESULTS: Patients with higher HAM-D score had significantly higher NLR levels compared to patients with lower HAM-D score. Correlation analysis revealed that severity of depression was associated with NLR in depressive patients (r=0.333, p<0.001). Patients with one or more CV risk factors have significantly higher NLR levels. Correlation analysis revealed that CV risk factors were associated with NLR in depressive patients (r=0.132, p=0.034). In logistic regression analyses, NLR levels were an independent predictor of severe or very severe depression (odds ratio: 3.02, 95% confidence interval: 1.867-4.884, p<0.001). A NLR of 1.57 or higher predicted severe or very severe depression with a sensitivity of 61.4% and specificity of 61.2%. CONCLUSION: Higher HAM-D scores are associated with higher NLR levels in depressive patients. NLR more than 1.57 was an independent predictor of severe or very severe depression. A simple, cheap white blood cell count may give an idea about the severity of depression.

Relationship between renal stone formation, mitral annular calcification and bone resorption markers

Mitral annular calcification [MAC] is associated with osteoporosis and there is evidence of reduced bone mineral density [BMD] in patients with renal stone formation [RSF]. Therefore, we designed this study to test if RSF was associated with MAC and if this association could be linked to bone resorption. Fifty-nine patients [mean age, 41.5 years] with RSF and 40 healthy subjects [mean age, 44.2 years] underwent screening for MAC and BMD, and measuurements were taken of serum and urine electrolytes, parathyroid hormone, alkaline phosphatase and urine dypyridoline. MAC was diagnosed in 11 [18%] patients with RSF compared with 1 [2.5%] control [P=.01]. Urine phosphorus, magnesium, sodium, potassium and chloride levels were lower [P<.001, P=.02, P<.001, P<.001 and P<.001, respectively], but serum alkaline phosphatase, calcium and potassium levels were higher [P=.008, P=.007 and P=.001, respectively] in patients with RSF versus those without RSF. None of these abnormalities were found in patients or subjects with MAC. Urine pyridoline levels were higher and T-scores were more negative [more osteopenic] in patients and subjects with MAC than in those without MAC [P=.01 and P=.004, respectively]. In a multivariate analysis, only T-scores and urine dipyridoline level were predictive of MAC [P=.03 and P=.04, respectively]. Screening for MAC and bone resorption markers in patients with RSF demonstrated a high incidence of MAC in these patients. The presence of MAC in patients with RSF was associated with bone resorption markers. This seemingly complex interrelationship between RSF, MAC and bone loss needs to be clarified in further studies

Coronary sinus dilatation a simple additional echocardiographic indicator of severe rheumatic mitral and tricuspid valve disease

To evaluate the usefulness of examining the coronary sinus [CS] anatomic diameter as an additional surrogate marker of severity in chronic rheumatic valve disease [RVD]. In this cross-sectional observational study, we echocardiographically analyzed 88 patients with RVD, and 104 normal subjects in the Department of Cardiology, Gaziantep University Medical Faculty, Gaziantep, Turkey between February 2007 and April 2007. Echocardiographically all valve regurgitation, stenosis, left ventricular function, left/right atrial volume, and pulmonary artery pressure were obtained. Coronary sinus was assessed as a sonolucency in the posterior atrioventricular groove. Strong positive correlation was present between CS measurements and mitral mean gradient, mitral and tricuspid regurgitation grade, tricuspid stenosis gradient, pulmonary artery systolic pressure, left and right atrial volume, and New York Heart Association class. A statistically negative correlation was present between CS measurements and mitral valve area and ejection fraction. Only the mitral valve area, tricuspid regurgitation grade, and the right atrial volume were predictors of body surface area adjusted mean CS dilatation. In this preliminary study, we showed that echocardiographic assessment of dilated CS may provide useful additional information in predicting the severity of mitral/tricuspid RVD. Findings of this study needs to be confirmed in further studies