EVALUATION OF PERIPHERAL INFLAMMATION PARAMETERS IN ADOLESCENTS WITH SUICIDE ATTEMPTS

Öz

OBJECTIVE: Haematological parameters are peripheral inflammation markers that can be used to demonstrate the relationship between psychopathology and inflammation. In this study, we aimed to compare adolescents who attempted suicide with healthy adolescents in terms of haematological parameters.
MATERIAL AND METHODS: The haemogram records of 765 adolescents admitted to the Paediatric Emergency Service between October 2018 and March 2020 were retrospectively evaluated. The control group was created from the haemogram records of adolescents who had similar age and sex characteristics, who had been examined in paediatric outpatient clinics during the above-mentioned period and who did not have any organic or psychopathological disorder. After implementation of the exclusion criteria, 95 adolescents with suicide attempts and 95 healthy adolescents were included in the study. The case and control groups were statistically compared in terms of neutrophil/lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), mean platelet volume (MPV) and red cell distribution width (RDW) parameters.
RESULTS: It was found that in adolescents with suicide attempts, NLR and MLR values were significantly higher than in the control group. There was no significant difference between the groups in terms of other parameters. In terms of NLR and MLR parameters, there was no statistical difference among the three subgroups of the case group separated according to the psychiatric diagnoses. However, NLR was found to be significantly higher in comparison with the control group of these three subgroups.
CONCLUSIONS: The NLR and MLR parameters of adolescents who attempted suicide were higher than those of the control group. There is a need for more comprehensive studies on the evaluation of inflammatory parameters in adolescents who have attempted suicide.

Anahtar Kelimeler

• Adolescent
• Suicide attempt
• NLR

İNTİHAR GİRİŞİMİ OLAN ERGENLERDE PERİFERİK İNFLAMASYON PARAMETRELERİNİN DEĞERLENDİRİLMESİ

Öz

AMAÇ: Hematolojik parametreler, psikopatoloji ve inflamasyon arasındaki ilişkiyi göstermek için kullanılabilen periferik inflamasyon belirteçleridir. Bu çalışmada intihar girişiminde bulunan ergenleri sağlıklı ergenlerle hematolojik parametreler açısından karşılaştırmayı amaçladık.
GEREÇ VE YÖNTEM: Ekim 2018 - Mart 2020 tarihleri arasında Çocuk Acil Servisine başvuran 765 ergenin hemogram kayıtları geriye dönük olarak değerlendirildi. Kontrol grubu, benzer yaş ve cinsiyet özelliklerine sahip, yukarıda belirtilen dönemde çocuk hastalıkları polikliniğinde muayene edilen, organik veya psikopatolojik herhangi bir tanısı olmayan ergenlerin hemogram kayıtlarından oluşturuldu. Dışlama kriterleri uygulandıktan sonra intihar girişimi olan 95 vaka ve 95 kontrol grubu çalışmaya dahil edildi. Vaka ve kontrol grupları istatistiksel olarak nötrofil/lenfosit oranı (NLR), trombosit-lenfosit oranı (PLR), monosit/lenfosit oranı (MLR), ortalama trombosit hacmi (MPV) ve eritrosit dağılım genişliği (RDW) parametreleri açısından karşılaştırıldı.
BULGULAR: İntihar girişimi olan ergenlerde NLR ve MLR değerleri kontrol grubuna göre anlamlı olarak yüksek saptandı. Diğer parametreler açısından gruplar arasında istatistiksel olarak anlamlı bir fark saptanmadı. NLR ve MLR parametreleri açısından ek psikiyatrik tanılara göre ayrılan olgu grubunun üç alt grubu arasında istatistiksel olarak fark yoktu. Ancak NLR, bu üç alt grupta kontrol grubuna göre anlamlı olarak daha yüksek bulundu.
SONUÇ: İntihar girişiminde bulunan ergenlerin NLR ve MLR parametreleri kontrol grubuna göre daha yüksek saptandı. İntihar girişimi olan ergenlerde inflamatuar parametrelerin değerlendirilmesi ile ilgili daha kapsamlı araştırmalara ihtiyaç vardır.

Anahtar Kelimeler

• Ergen
• İntihar girişimi
• NLR.

Kaynakça

1. 1. World Health Organization. Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2016. 2018.
2. 2. World Health Organization. Preventing suicide: A global imperative. 2014.
3. 3. Turecki G, Brent DA. Suicide and suicidal behaviour. The Lancet. 2016;387:1227-39.
4. 4. World Health Organization. Public health action for the prevention of suicide: a framework. 2012.
5. 5. Bertolote JM, Fleischmann A, Leo DD, et al. Repetition of suicide attempts. Crisis. 2015;31:194-201.
6. 6. Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry. 2004;4:37.
7. 7. McGirr A, Renaud J, Bureau A, et al. Impulsive-aggressive behaviours and completed suicide across the life cycle: a predisposition for younger age of suicide. Psychol Med. 2008;38:407-17.
8. 8. King CA, O'Mara RM, Hayward CN, et al. Adolescent suicide risk screening in the emergency department. Acad Emerg Med. 2009;16:1234-41.

9. 9. Brundin L, Bryleva EY, Rajamani KT. Role of inflammation in suicide: from mechanisms to treatment. Neuropsychopharmacology. 2017;42:271-83.
10. 10. Uçar HN, Murat D, Eray Ş. Simple Peripheral Markers For Inflammation In Drug- Naive, Comorbidity-Free Adolescents With Obsessive-Compulsive Disorder. East J Med. 2019;24:23-9.
11. 11. Inanlı I, Aydin M, Çalışkan AM, et al. Neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and mean platelet volume as systemic inflammatory markers in different states of bipolar disorder. Nord J Psychiatry. 2019;73:372-79.
12. 12. Demir S, Atli A, Bulut M, et al. Neutrophil–lymphocyte ratio in patients with major depressive disorder undergoing no pharmacological therapy. Neuropsychiatr Dis Treat. 2015;11:2253-8.
13. 13. Çakır U, Tuman TC, Yıldırım O. Increased neutrophil/lymphoctye ratio in patients with bipolar disorder: a preliminary study. Psychiatr Danub. 2015;27:180-4.
14. 14. Semiz M, Yıldırım O, Canan F, et al. Elevated neutrophil/lymphocyte ratio in patients with schizophrenia. Psychiatr Danub. 2014;26:220-5.
15. 15. Velasco Á, Rodríguez-Revuelta J, Olié E, et al. Neutrophil-to-lymphocyte ratio: A potential new peripheral biomarker of suicidal behavior. Eur Psychiatry. 2020;63:14.
16. 16. Ekinci O, Ekinci A. The connections among suicidal behavior, lipid profile and low- grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio. Nord J Psychiatry. 2017;71:574-80.
17. 17. Gasparyan AY, Ayvazyan L, Mikhailidis DP, et al. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17:47-58.
18. 18. Förhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009;158:659-66.
19. 19. Kutlu A, Binici NC. Does increased neutrophil-lymphocyte ratio predict autism spectrum disorder? Anatolian Journal of Psychiatry. 2018;19:607-14.
20. 20. Uzun AD, Sapmaz ŞY, Çakır B, et al. Could neutrophil-to-lymphocyte ratio be an important parameter in children and adoles-cents with obsessive compulsive disorder? Turkish J Clinical Psychiatry. 2020;23:101-5.
21. 21. Binici NC, Kutlu A. Is ADHD an inflammation-related disorder? Anatolian Journal of Psychiatry. 2019;20:313-321.
22. 22. Uçar HN, Eray Ş, Murat D. Simple peripheral markers for inflammation in adolescents with major depressive disorder. Psychiatry and Clinical Psychopharmacology. 2018;28:254-60.
23. 23. Önder A, Sürer Adanır A, Gizli Çoban Ö, et al. Elevated Neutrophil/Lymphocyte Ratio in Adolescents with Early-onset Schizophrenia. Neurochemical Journal. 2020;14(4):444-8.
24. 24. Önder A, Gizli Çoban Ö, Sürer Adanır A. Elevated neutrophil-to-lymphocyte ratio in children and adolescents with attention-deficit/hyperactivity disorder. Int J Psychiatry Clin Pract. 2020;25(1):1-6.
25. 25. Özdin S, Sarisoy G, Böke Ö. A comparison of the neutrophil-lymphocyte, platelet- lymphocyte and monocyte-lymphocyte ratios in schizophrenia and bipolar disorder patients–a retrospective file review. Nord J Psychiatry. 2017;71:509-12.
26. 26. Arabska J, Lucka A, Magierski R, et al. Neutrophil-lymphocyte ratio is increased in elderly patients with first episode depression, but not in recurrent depression. Psychiatry Res. 2018;263:35-40.
27. 27. Rodríguez RFO, Fernández JD, Mira NO, et al. Neutrophil/lymphocyte ratio: Can a non-specific marker of inflammation helps to confirm the inflammatory hypothesis of the serious mental diseases? A case-control study. Med Hypotheses. 2019;130:109279.
28. 28. Ucuz İ, Tetik BK. Can suicide behavior and seasonality of suicide be predicted from inflammatory parameters in adolescents? Med Hypotheses. 2020;143:110061.
29. 29. Serafini G, Pompili M, Seretti ME, et al. The role of inflammatory cytokines in suicidal behavior: a systematic review. Eur Neuropsychopharmacol. 2013;23:1672-86.
30. 30. Miná VAL, Lacerda Pinheiro SF, Maia LC, et al. The influence of inflammatory cytokines in physiopathology of suicidal behavior. J Affect Disord. 2015;172:219-30.
31. 31. Le-Niculescu H, Levey DF, Ayalew M, et al. Discovery and validation of blood biomarkers for suicidality. Mol Psychiatry. 2013;18:1249-64.
32. 32. Ayhan MG, Dağıstan AA, Tanrıkulu CŞ, et al. Increased neutrophil/lymphocyte ratio in suicide attempters. Anatolian Journal of Psychiatry. 2019;20:305-13.
33. 33. Meydaneri GG, Meydaneri S. Can Neutrophil Lymphocyte Ratio Predict the Likelihood of Suicide in Patients with Major Depression? Cureus. 2018;10:2510.
34. 34. Orum MH, Kara MZ, Egilmez OB. Mean platelet volume and neutrophil to lymphocyte ratio as parameters to indicate the severity of suicide attempt. J Immunoassay Immunochem. 2018;39:647-59.
35. 35. Peng YF, Zhong SM, Luo B, et al. Evaluation of red blood cell distribution width and neutrophil to lymphocyte ratio in patients with major depressive disorder. Int J Clin Exp Med. 2016;9:3242-6.
36. 36. Özer S, Yılmaz R, Sönmezgöz E, et al. Simple markers for subclinical inflammation in patients with Familial Mediterranean Fever. Med Sci Monit. 2015;21:298-303.
37. 37. Canan F, Dikici S, Kutlucan A, et al. Association of mean platelet volume with DSM-IV major depression in a large community-based population: the MELEN study. J Psychiatr Res. 2012;46:298-302.
38. 38. Garipardic M, Doğan M, Bala KA, et al. Association of attention deficit hyperactivity disorder and autism spectrum disorders with mean platelet volume and vitamin D. Med Sci Monit. 2017;23:1378-84.