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. 2024 Nov 11;19(11):e0313484.
doi: 10.1371/journal.pone.0313484. eCollection 2024.

Association between complete blood-count-based inflammatory scores and hypertension in persons living with and without HIV in Zambia

Lackson Mwape  1 , Benson M Hamooya  1 , Emmanuel L Luwaya  1 , Danny Muzata  2 , Kaole Bwalya  1 , Chileleko Siakabanze  1 , Agness Mushabati  2 , Sepiso K Masenga  1   3
Affiliations

Association between complete blood-count-based inflammatory scores and hypertension in persons living with and without HIV in Zambia

Lackson Mwape et al. PLoS One. .

Abstract

Background: Hypertension is a risk factor for cardiovascular events. Inflammation plays an important role in the development of essential hypertension. Studies assessing the association between complete blood count-based inflammatory scores (CBCIS) and hypertension are scarce. Therefore, this study aimed to determine the relationship between CBCIS and hypertension among individuals with and without human immunodeficiency virus (HIV).

Method: This was a cross-sectional study among 344 participants at Serenje District Hospital and Serenje Urban Clinic. We used structured questionnaires to collect sociodemographic, clinical and laboratory characteristics. CBCIS included lymphocyte-monocyte ratio (LMR), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), derived neutrophil-lymphocyte ratio (d-NLR), and differential white blood cells. The primary outcome variable was hypertension defined as systolic and diastolic blood pressure higher than or equal to 140/90 mmHg. Logistic regression was used to estimate the association between hypertension and CBCIS in statistical package for social science (SPSS) version 22.0.

Results: The participants had a median age of 32 years (interquartile range (IQR) 24-42) and 65.1% (n = 224) were female. The prevalence of hypertension was 10.5% (n = 36). Among those with hypertension, 55.6% (n = 20) were female and 44.4% (n = 16) were male. The CBCIS significantly associated with hypertension in people living with HIV (PLWH) was PLR (adjusted odds ratio (AOR) 0.98; 95% confidence interval (CI) 0.97-0.99, p = 0.01) while in people without HIV, AMC (AOR 15.40 95%CI 3.75-63.26), ANC (AOR 1.88 95%CI 1.05-3.36), WBC (AOR 0.52 95%CI 0.31-0.87) and PLR (AOR 0.98 95%CI 0.97-0.99) were the factors associated with hypertension. Compared to people without HIV, only WBC, ANC, NLR, and d-NLR were good predictors of hypertension among PLWH.

Conclusion: Our study indicates a notable HIV-status driven association between CBCIS and hypertension, suggesting the use of CBICS as potential biomarkers for hypertension risk with substantial implications for early detection and preventive measures.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Clinical and laboratory characteristics between persons with and without hypertension.
Showing median (interquartile range, IQR) between persons with and without hypertension, respectively, followed by the overall median (IQR) for the population: A). Age, 38 (24–42) vs. 32 (24–42) years; 32 years, p = 0.03. B). BMI, 22 (20.00–24.00) vs. 21 (20.00–24.00) kg/m2; 21.00 kg/m2, p = 0.04. C). WBC, 7.49 (4.49–8.46) vs. 6.19 (4.49–8.46) x 103/Ul; 6.27 x 103/Ul, p = 0.29. D). ANC, 5.19 (3.43–7.21) vs. 3.41 (3.43–7.21) x 103/Ul; 3.64 x 103/Ul, p = 0.003. E). ALC, 1.82 (1.21–2.15) vs. 1.63 (1.21–2.15) x103/Ul; 1.65 x103/Ul, p = 0.39. F). AMC, 0.72 (0.48–1.00) vs. 0.53 (0.40–0.78) x103/Ul; 0.56 x103/Ul, p = 0.02. G). HbG,12.9 (11.20–14.50) vs. 13.1 (11.20–14.50) g/dl; 13.10 g/dl, p = 0.32. H). APC, 193.50 (158.00–251.00) vs. 202.00 (158.00–251.00) x103/Ul; 199.0 x103/Ul, p = 0.60. I). ABC, 0.01 (0.01–0.02) vs. 0.01 (0.01–0.02) x103/Ul; 0.01, p = 0.37. J). AEC, 0.04 (0.01–0.13) vs. 0.04 (0.01–0.15) x103/Ul; 0.04, p = 0.68. K). NLR, 3.20 (1.19–3.17) vs. 2.05 (1.19–3.17); 2.10, p = 0.06. L). LMR, 2.56 (2.04.-4.63) vs. 2.93 (2.04.-4.63); 2.88, p = 0.29. M). PLR, 111.48 (95.97–167.17) vs.122.81 (95.97–167.17); 120.63, p = 0.20. N). d-NLR, 2.38 (1.19–3.17) vs. 1.43 (1.19–3.17); 1.50, p = 0.03. WBC, white blood cell; AMC, absolute monocyte count; ALC, absolute lymphocyte; ANC, absolute neutrophil count; APC, absolute platelet count; HBG, hemoglobin; AEC, absolute eosinophil count; ABC, absolute basophil count; LMR, lymphocyte-monocyte ratio; NLR, neutrophil-lymphocyte ratio; PLR, platelet-lymphocyte ratio; d-NLR, derived neutrophil-lymphocyte ratio.
Fig 2
Fig 2. Comparison of demographic and CBCIS between people with and without HIV.
Showing median (interquartile range, IQR) between persons without and with HIV, respectively: A). Age, 31 (23–39) vs. 36 (27–48) years, p = 0.001. B). BMI, 21 (20–23) vs. 21 (20–23) kg/m2, p = 0.83. C). WBC, 6.36 (4.60–8.73) vs. 6.07 (4.49–8.97) x 103/Ul, p = 0.64. D). ANC, 3.74 (2.43–5.92) vs. 3.38 (2.09–5.92) x 103/Ul, p = 0.23. E). ALC, 1.59 (1.15–2.13) vs. 1.73 (1.29–2.25) x103/Ul, p = 0.15. F). AMC, 0.60 (0.43–0.86) vs. 0.50 (0.37–0.74) x103/Ul, p = 0.01. G). HbG,13.10 (11.10–14.40) vs. 13.20 (11.25–14.70) g/dl, p = 0.46. H). APC, 199 (151–255) vs. 199 (161–264) x103/Ul, p = 0.43. I). ABC, 0.01 (0.01–0.02) vs. 0.01 (0.01–0.02) x103/Ul, p = 0.37. J). AEC, 0.03 (0.01–0.12) vs. 0.05 (0.02–0.17) x103/Ul, p = 0.004. K). NLR, 2.48 (1.37–4.54) vs. 1.88 (1.01–3.82), p = 0.05. L). LMR, 2.56 (1.66–3.96) vs. 3.31 (2.08–5.17), p<0.001 M). PLR, 123 (95–168) vs.115 (96–159), p = 0.31. N). d-NLR, 1.60 (0.94–2.96) vs. 1.35 (0.84–2.56), p = 0.22. WBC, white blood cell; AMC, absolute monocyte count; ALC, absolute lymphocyte; ANC, absolute neutrophil count; APC, absolute platelet count; HBG, hemoglobin; AEC, absolute eosinophil count; ABC, absolute basophil count; LMR, lymphocyte-monocyte ratio; NLR, neutrophil-lymphocyte ratio; PLR, platelet-lymphocyte ratio; d-NLR, derived neutrophil-lymphocyte ratio.
Fig 3
Fig 3. ROC curve for predictors of hypertension in the whole population.
Use of the receiver operating characteristic curve to see which CBCIS score best predicts hypertension in the whole population. The area under the curve (95%CI, p = value) for WBC = 0.55 (0.44–0.66, p = 0.30), ALC = 0.53 (95%CI 0.44–0.62, p = 0.45), AMC = 0.61 (95%CI 0.50–0.71, p = 0.029), ANC = 0.65 (95%CI 0.56–0.73, p = 0.004), APC = 0.47 (95%CI 0.38–0.57, p = 0.67), NLR = 0.59 (95%CI 0.51–0.68, p = 0.05), PLR = 0.44 (95%CI 0.35–0.53, p = 0.26), d-NLR = 0.61 (95%CI 0.50–0.71, p = 0.032) and LMR = 0.43 (95%CI 0.34–0.52). WBC, white blood cell; AMC, absolute monocyte count; ALC, absolute lymphocyte; ANC, absolute neutrophil count; APC, absolute platelet count; HBG, hemoglobin; LMR, lymphocyte-monocyte ratio; NLR, neutrophil-lymphocyte ratio; PLR, platelet-lymphocyte ratio; d-NLR, derived neutrophil-lymphocyte ratio.
Fig 4
Fig 4. ROC curve for predictors of hypertension in persons with and without HIV.
A) Persons without HIV. B). Persons with HIV. WBC, white blood cell; AMC, absolute monocyte count; ALC, absolute lymphocyte; ANC, absolute neutrophil count; APC, absolute platelet count; HBG, hemoglobin; LMR, lymphocyte-monocyte ratio; NLR, neutrophil-lymphocyte ratio; PLR, platelet-lymphocyte ratio; d-NLR, derived neutrophil-lymphocyte ratio.
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