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. 2024 Dec 17;9(1):e001744.
doi: 10.1136/bmjophth-2024-001744.

Novel immunoinflammatory blood markers in Graves' orbitopathy: insights into activity and severity

Mahdi Abounoori  1   2 , Mohsen Pourazizi  3 , Mohsen Bahmani Kashkouli  4   5 , Ozra Akha  6 , Reza Jafari  7 , Marzieh Movahedirad  8
Affiliations

Novel immunoinflammatory blood markers in Graves' orbitopathy: insights into activity and severity

Mahdi Abounoori et al. BMJ Open Ophthalmol. .

Abstract

Objective: This prospective case-control study examined the novel immunoinflammatory markers obtained from blood counts of patients with Graves' orbitopathy (GO), Graves' disease (GD) and healthy subjects.

Methods: Demographic data, white cell count parameters, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), platelet-to-neutrophil ratio (PNR), red cell distribution width (RDW), RDW-to-platelet ratio (RDW/PLT), MPV-to-lymphocyte ratio (MPV/ALC), eosinophil-to-lymphocyte ratio (ELR) and systemic immune-inflammatory index (SII) were evaluated. The European Group on Graves Orbitopathy scale and Clinical Activity Score were used for clinical activity and severity assessment.

Results: The GO group showed significantly higher mean MPV (p˂0.001) and MPV/ALC (p=0.03) than the GD group. The PLR (p=0.02), MPV/ALC (p=0.04) and SII (p=0.04) were significantly higher in the GO than healthy group. A significantly higher absolute neutrophil count (p=0.005), NLR (p=0.001), MPV (p=0.001), MPV/ALC (p=0.003), MPV/PLT (p=0.04), RDW (p˂0.001), RDW/PLT (p=0.02) and SII (p=0.01) as well as lower ALC (p=0.01) and PNR (p˂0.001) was observed in the active than inactive GO. Moderate to severe GO group had a significantly higher NLR (p=0.006), PLR (p=0.04), ELR (p=0.006), MPV (p=0.03), MPV/ALC (p=0.002), RDW (p˂0.001), RDW/PLT (p=0.02) and SII (p=0.03) as well as a lower ALC (p=0.01) and PNR (p=0.01) than mild GO.

Conclusions: The MPV/ALC ratio and MPV levels may identify GD patients at risk of GO. The MPV, MPV/ALC, ALC, NLR, PLR, PNR, RDW, RDW/PLT, MPV/PLT and SII may help distinguish the GO activity and severity. However, the study's small sample size and single-centre design may limit the generalisability of the results. Furthermore, the lack of longitudinal follow-up precludes assessing marker evolution over time.

Keywords: Inflammation; Orbit.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362:726–38. doi: 10.1056/NEJMra0905750. - DOI - PMC - PubMed
    1. Eshraghi B, Pourazizi M, Abbasi M, et al. A comparison between bilateral and unilateral thyroid eye disease. Int Ophthalmol. 2023;43:2957–62. doi: 10.1007/s10792-023-02702-5. - DOI - PubMed
    1. Eshraghi B, Moayeri M, Pourazizi M, et al. Decreased Bell’s phenomenon after inferior and medial orbital wall decompression in thyroid-associated ophthalmopathy: a double-edged sword in management of the patients. Graefes Arch Clin Exp Ophthalmol . 2022;260:1701–5. doi: 10.1007/s00417-021-05509-1. - DOI - PubMed
    1. Khatavi F, Nasrollahi K, Zandi A, et al. A Promising Modified Procedure for Upper Eyelid Retraction-Associated Graves’ Ophthalmopathy: Transconjunctival Lateral Levator Aponeurectomy. Med Hypothesis Discov Innov Ophthalmol. 2017;6:44–8. - PMC - PubMed
    1. Taylor PN, Zhang L, Lee RWJ, et al. New insights into the pathogenesis and nonsurgical management of Graves orbitopathy. Nat Rev Endocrinol. 2020;16:104–16. doi: 10.1038/s41574-019-0305-4. - DOI - PubMed

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