The Role of Inflammatory Markers in Predicting Treatment Response in Adolescents Using Lithium and Being Treated as Inpatients for Bipolar Disorder

Öz

Objective: To investigate whether baseline and discharge inflammatory markers predict lithium treatment response in adolescents with bipolar disorder. Methods: Ninety-three adolescents hospitalized for an acute manic episode were retrospectively analyzed. Young Mania Rating Scale (YMRS) change was the primary outcome. Multivariate linear regression models were constructed for neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR), adjusting for age, sex, lithium dose, antipsychotic equivalent dose, psychotic symptoms, and hospitalization duration. Results: The mean patient age was 16.1 ± 1.5 years. 41 (44.1%) patients were female and 52 (55.9%) were male. The mean lithium discharge dose was 1103 ± 284 mg/day. Functional outcomes improved significantly, with a mean GAF increase of 25.2 points. YMRS scores decreased from 28.4 ± 8.7 at baseline to 8.2 ± 6.1 at discharge. The mean improvement was -20.2 ± 9.3 points, and 83.9% of patients had a ≥50% reduction. Baseline NMR (β = -0.162, p = 0.043) and LMR (β = -0.269, p = 0.040) were significantly associated with YMRS improvement. Discharge values did not show any predictive value. The explanatory power of all models was low (adjusted R² < 0.12). Conclusion: Elevated baseline NMR and LMR may modestly predict lithium response in adolescents with bipolar disorder, but their predictive utility is limited.

Anahtar Kelimeler

• lithium
• Bipolar disorder
• Adolescent
• Inflammatory markers

Bipolar Bozukluk Nedeniyle Lityum Kullanan Ve Yatarak Tedavi Edilen Ergenlerde İnflamatuar Belirteçlerin Tedavi Yanıtını Öngörmedeki Yeri

Öz

Amaç: Bipolar bozukluğu olan ergenlerde başlangıç ve taburculuk dönemindeki inflamasyon belirteçlerinin lityum tedavisine yanıtı öngörüp öngörmediğini araştırmak. Yöntemler: Akut manik atak nedeniyle hastaneye yatırılan doksan üç ergen retrospektif olarak analiz edildi. Young Mani Derecelendirme Ölçeği (YMRS) değişimi birincil çıktıyı oluşturdu. Nötrofil-lenfosit oranı (NLR), nötrofil-monosit oranı (NMR), lenfosit-monosit oranı (LMR) ve trombosit-lenfosit oranı (PLR) için çok değişkenli doğrusal regresyon modelleri oluşturuldu ve yaş, cinsiyet, lityum dozu, olanzapin eşdeğer dozu, psikotik semptomlar ve hastanede kalış süresine göre ayarlandı. Bulgular: Hastaların ortalama yaş 16,1 ± 1,5 yıl idi. Hastaların 41’i (%44,1) kadın iken 52’si (%55.9) erkek idi. Ortalama lityum taburculuk dozu 1103 ± 284 mg/gündü. GAF'ın ortalama 25,2 puan artmasıyla fonksiyonelite sonuçları önemli ölçüde iyileşti. YMRS puanları başlangıçtaki 28,4 ± 8,7'den taburculukta 8,2 ± 6,1'e düştü. Ortalama iyileşme -20,2 ± 9,3 puandı ve hastaların %83,9'unda ≥%50 azalma izlendi. Başlangıçtaki NMR (β = -0,162, p = 0,043) ve LMR (β = -0,269, p = 0,040), YMRS iyileşmesiyle anlamlı şekilde ilişkiliydi. Taburculuk değerleri herhangi bir öngörü değeri göstermedi. Tüm modellerin açıklayıcı gücü düşüktü (ayarlanmış R² < 0,12). Sonuç: Yükselmiş başlangıç NMR ve LMR, bipolar bozukluğu olan ergenlerde lityum yanıtını orta düzeyde tahmin edebilir, ancak öngörücü faydaları sınırlıdır.

Anahtar Kelimeler

• lityum
• ergen
• bipolar bozukluk
• inflamatuar belirteçler

Kaynakça

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