Examination of Systemic Inflammation Related Hemogram Biomarkers in Children and Adolescents with Generalized Anxiety Disorder

Abstract

Objective: In this study, we aimed to examine the complete blood count parameters and blood-based systemic inflammatory markers in children with generalized anxiety disorder (GAD).
Methods: Retrospectively, complete blood count of 48 GAD diagnosed children and adolescents and age-gender matched 46 healthy controls were compared in terms of hemoglobin (Hb), erythrocyte distribution width (RDW), platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), white blood cell count (WBC), neutrophil, lymphocyte and monocyte counts and neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelet to lymphocyte ratios (PLR). Chi-square test, independent samples t-test and MannWhitney U test were used for statistical evaluation.
Results: MPV levels were found to be significantly higher (p=0.020), while PLT and PDW levels were found to be significantly lower (p=0.018 and p=0.011, respectively) in children and adolescents with GAD. There was no statistically significant difference in terms of Hb, RDW, PCT, WBC neutrophil, lymphocyte and monocyte counts and NLR, MLR, PLR between case and control groups.
Conclusions: Platelet parameters that have been postulated to be associated with inflammation, such as MPV and PDW may be related to possible inflammatory back ground of GAD in children and adolescents and comprehensive prospective studies are required on this subject.

Keywords

• Anxiety disorder
• Inflammation
• Hemogram
• Complete Blood Count
• Children and Adeloscents

Düzeltme: Yaygın Anksiyete Bozukluğu Olan Çocuk ve Ergenlerde Sistemik İnflamasyon İlişkili Hemogram Biyobelirteçlerinin İncelenmesi

Abstract

Amaç: Bu çalışmada yaygın anksiyete bozukluğu olan (YAB) çocuk ve ergenlerde tam kan sayımından bakılan sistemik inflamasyon biyo-belirteçlerinin düzeylerinin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Retrospektif olarak 48 YAB tanılı çocuk ergen ile yaş-cinsiyet açısından eşleştirilmiş 46 sağlıklı kontrol çocuk ve ergenin tam kan sayımı sonuçları; hemoglobin (Hb), eritrosit dağılım genişliği (RDW), trombosit sayısı (PLT), ortalama trombosit hacmi (MPV), trombosit dağılım genişliği (PDW), plateletkrit (PCT), beyaz kan hücre sayımı (WBC), nötrofil, lenfosit ve monosit sayıları ve nötrofil / lenfosit oranı (NLR), monosit / lenfosit oranı (MLR), trombosit / lenfosit oranları (PLR) açısından karşılaştırıldı. İstatistiksel değerlendirmede ki-kare testi, bağımsız örneklemler t-testi ve Mann-Whitney U testi kullanıldı.
Bulgular: YAB olan çocuk ve ergenlerde, MPV düzeyleri anlamlı olarak yüksek (p = 0,020) ve PLT ve PDW düzeyleri anlamlı olarak düşük (sırasıyla p = 0,018 ve p = 0,011) bulundu. Hb, RDW, PCT, WBC, nötrofil, lenfosit ve monosit sayıları, NLR, MLR, PLR açısından olgu ve kontrol grupları arasında istatistiksel olarak anlamlı bir farklılık saptanmadı.
Sonuç: MPV ve PDW gibi inflamasyonla ilişkili olduğu öne sürülen trombosit parametreleri, çocuk ve ergenlerde YAB'nin olası inflamatuar arka planıyla ilişkili olabilir ve bu konuda kapsamlı ileriye dönük çalışmalara ihtiyaç vardır.

Keywords

• Anksiyete bozukluğu
• İflamasyon
• Hemogram
• Tam kan sayımı
• Çocuk ve ergenler

References

1. References 1. Bronsard G, Alessandrini M, Fond G, Loundou A, Auquier P, Tordjman S, et al. The Prevalence of Mental Disorders Among Children and Adolescents in the Child Welfare System: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016;95(7):e2622.
2. 2. Ercan ES, Polanczyk G, Akyol Ardıc U, Yuce D, Karacetın G, Tufan AE, et al. The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T). Nord J Psychiatry. 2019;73(2):132-140.
3. 3. Essau CA, Conradt J, Petermann F. Frequency, comorbidity, and psychosocial impairment of anxiety disorders in German adolescents. J Anxiety Disord 2000;14:263–279.
4. 4. Cole DA, Peeke LG, Martin JM, Truglio R, Seroczynski AD. A longitudinal look at the relation between depression and anxiety in children and adolescents. J Consult Clin Psychol 1998;66:451–460.
5. 5. Renna ME, O'Toole MS, Spaeth PE, Lekander M, Mennin DS. The association between anxiety, traumatic stress, and obsessive–compulsive disorders and chronic inflammation: A systematic review and meta‐analysis. Depression and anxiety. 2018;35(11):1081-1094.
6. 6. Felger JC. Imaging the Role of Inflammation in Mood and Anxiety-related Disorders. Curr Neuropharmacol. 2018;16(5):533-558.
7. 7. Miller BJ, Goldsmith DR. Towards an immunophenotype of schizophrenia: progress, potential mechanisms, and future directions. Neuropsychopharmacology. 2017;42(1):299-317.
8. 8. Bankier B, Barajas J, Martinez-Rumayor A, Januzzi JL. Association between C-reactive protein and generalized anxiety disorder in stable coronary heart disease patients. Eur Heart J. 2008;29(18):2212-2217.

9. 9. Mazza MG, Rossetti A, Clerici M. A review of neutrophil-lymphocyte, monocyte-lymphocyte, and platelet-lymphocyte ratios use in psychiatric disorders. World J Depress Anxiety 2018: 1(1):1002.
10. 10. Özyurt G, Binici NC. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in adolescent obsessive-compulsive disorder: Does comorbid anxiety disorder affect inflammatory response?. Psychiatry Res. 2019;272:311-315.
11. 11. Walss-Bass C, Suchting R, Olvera RL, Williamson DE. Inflammatory markers as predictors of depression and anxiety in adolescents: Statistical model building with component-wise gradient boosting. J Affect Disord. 2018;234:276-281.
12. 12. Almis Behice Han, Aksoy Ihsan. Mean platelet volume level in patients with generalized anxiety disorder. Psychiatry and Clinical Psychopharmacology, 2018; 28(1): 43-47.
13. 13. Kokacya MH, Copoglu US, Kivrak Y, Ari M, Sahpolat M, Ulutas KT. Increased mean trombosit volume in patients with panic disorder. Neuropsychiatr Dis Treat. 2015;11:2629–2633.
14. 14. Asoglu M, Aslan M, Imre O, Kivrak Y, Akil O, Savik E, et al. Mean trombosit volume and red cell distribution width levels in initial evaluation of panic disorder. Neuropsychiatr Dis Treat. 2016;12:2435–2438.
15. 15. Bondade Swapna, Manjula Adinarayan, Parineetha P. Bhat. Mean platelet volume in anxiety disorder: a case-control study. Open Journal of Psychiatry & Allied Sciences 2019;10(2): 115-119.
16. 16. Göğçegöz Gül I, Eryılmaz G, Ozten E, Hızlı Sayar G. Decreased mean platelet volume in panic disorder. Neuropsychiatr Dis Treat. 2014;10:1665-1669.
17. 17. Ransing RS, Patil B, Grigo O. Mean platelet volume and platelet distribution width level in patients with panic disorder. J Neurosci Rural Pract. 2017;8 (2):174–178.
18. 18. Gündüz N, Timur Ö, Erzincan E,Tural Ü. Panik bozukluğu hastalarında ortalama trombosit hacmi, nötrofil lenfosit oranı, platelet lenfosit oranı ve eritrosit dağılım genişliği. Anatolian Journal of Psychiatry/Anadolu Psikiyatri Dergisi. 2018;19(1): 5-12.
19. 19. Wysokinski A, SzczepockaE. Platelet parameters (PLT, MPV, P-LCR) in patients with schizophrenia, unipolar depression and bipolar disorder. Psychiatry Res. 2016;237:238–245.
20. 20. Inanli I, Aydin M, Çaliskan AM, Eren I. Neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and mean platelet volume as systemic inflammatory markers in different states of bipolar disorder. Nord J Psychiatry. 2019;73(6):372-379.
21. 21. Kirlioglu SS, Balcioglu YH, Kalelioglu T, Erten E, Karamustafalioglu N. Comparison of the complete blood count-derived inflammatory markers in bipolar patients with manic and mixed episodes. Bratisl Lek Listy. 2019;120(3):195-199.
22. 22. Mert DG, Terzi H. Mean platelet volume in bipolar disorder: the search for an ideal biomarker. Neuropsychiatr Dis Treat. 2016;12:2057-2062. 23. Ataoglu A, Canan F. Mean platelet volume in patients with major depression: effect of escitalopram treatment. J Clin Psychopharmacol. 2009;29(4):368-371.
23. 24. Canan F, Dikici S, Kutlucan A, Celbek G, Coskun H, Gungor A, et al. Association of mean trombosit volume with DSM-IV majör depression in a large community-based population: the MELEN study. J Psychiatr Res. 2012;46(3):298–302.
24. 25. Özyurt G, Binici NC. Increased neutrophil-lymphocyte ratios in depressive adolescents is correlated with the severity of depression. Psychiatry Res. 2018;268:426-431.
25. 26. Tsiara S, Elisaf M, Jagroop IA, Mikhailidis DP. Platelets as predictors of vascular risk: is there a practical index of platelet activity?. Clin Appl Thromb Hemost. 2003;9(3):177-190.
26. 27. Koudouovoh-Tripp P, Sperner-Unterweger B. Influence of mental stress on platelet bioactivity. World J Psychiatry. 2012;2:134–147.
27. 28. Pohjavaara P, Telaranta T, Väisänen E. The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block?. Nord J Psychiatry. 2003;57(1):55-60.
28. 29. Gordon JA, Hen R. The serotonergic system and anxiety. Neuromolecular Med. 2004;5(1):27-40.
29. 30. Durmaz T, Özdemir Ö, Keleş T. Trombosits and sympathetic activity in MI. Turk J Med Sci. 2009;39 (2):259–265.
30. 31. Thompson CB, Eaton KA, Princiotta SM, Rushin CA, Valeri CR. Size dependent trombosit subpopulations: relationship of trombosit volume to ultrastructure, enzymatic activity, and function. Br J Haematol. 1982;50(3):509–519.
31. 32. Garvey MJ, Noyes R Jr, Woodman C, Laukes C. The association of urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid in patients with generalized anxiety. Neuropsychobiology. 1995;31(1):6–9.
32. 33. Galan AM, Lopez-Vilchez I, Diaz-Ricart M, Navalon F, Gomez E, Gasto C, et al. Serotonergic mechanisms enhance trombosit mediated thrombogenicity. Thromb Haemost. 2009;102(3):511–519.
33. 34. Bessman JD, Williams LJ, Gilmer PR Jr. Mean platelet volume. The inverse relation of platelet size and count in normal subjects, and an artifact of other particles. Am J Clin Pathol. 1981;76(3):289–293.
34. 35. Wendland AE, Farias MG, Manfroi WC. Mean platelet volume and cardiovascular disease. J Bras Patol Med Lab. 2009;45:371–378.
35. 36. Shen J, Ran ZH, Zhang Y, Cai Q, Yin HM, Zhou XT, et al. Biomarkers of altered coagulation and fibrinolysis as measures of disease activity in active inflammatory bowel disease: A gender-stratified, cohort analysis. Thromb Res. 2009;123:604–611.
36. 37. Slavka G, Perkmann T, Haslacher H, Greisenegger S, Marsik C, Wagner OF, et al. Mean trombosit volume may represent a predictive parameter for overall vascular mortality and ischemic heart disease. Arterioscler Thromb Vasc Biol. 2011;31(5):1215–1218.
37. 38. Can MM, Guler G, Guler E, Ozveren O, Turan B, DiNicolantinio JJ, et al. Enhanced platelet reactivity in pediatric depression: an observational study. Blood Coagul Fibrinolysis. 2015;26(7):731-735.
38. 39. Zafar MU, Paz-Yepes M, Shimbo D, Vilahur G, Burg MM, Chaplin W, et al. Anxiety is a better predictor of trombosit reactivity in coronary artery disease patients than depression. Eur Heart J. 2010;31(13):1573–1582.
39. 40. Jenne CN, Kubes P. Platelets in inflammation and infection. Platelets. 2015;26(4):286-292.