{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T08:01:50Z","timestamp":1793088110675,"version":"4.5.0"},"reference-count":53,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003447","name":"Greece and the European Union (European Social Fund-ESF)","doi-asserted-by":"publisher","award":["MIS-5000432"],"award-info":[{"award-number":["MIS-5000432"]}],"id":[{"id":"10.13039\/501100003447","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammatory (SII) index, which provide a simple, rapid, inexpensive method to measure the level of inflammation, have been examined as potential inflammatory biomarkers of bipolar disorder (BD) in several studies. We conducted a case-control study recruiting 180 BD patients and 407 healthy controls. BD patients who met the inclusion criteria and were hospitalized due to BD at the psychiatry clinic of the University General Hospital of Larisa, Greece, until September 2021 were included in the study. Among them, 111 patients experienced a manic episode and 69 patients experienced a depressive episode. Data including a complete blood count were retrieved from their first admission to the hospital. Bipolar patients had a higher NLR, MLR and SII index compared to healthy controls when they were experiencing a manic episode (p &lt; 0.001) and a depressive episode (p &lt; 0.001). MLR was increased with large effect size only in patients expressing manic episodes. Neutrophils and NLR had the highest area under the curve with a cutoff of 4.38 and 2.15 in the ROC curve, respectively. Gender-related differences were mainly observed in the SII index, with males who were expressing manic episodes and females expressing depressive episodes having an increased index compared to healthy controls. The NLR, MLR and SII index were significantly higher in patients with BD than in healthy controls, which implies a higher grade of inflammation in BD patients.<\/jats:p>","DOI":"10.3390\/brainsci12081034","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T21:52:48Z","timestamp":1659649968000},"page":"1034","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte Ratio and Systemic Immune-Inflammatory Index in Different States of Bipolar Disorder"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8821-0795","authenticated-orcid":false,"given":"Katerina","family":"Dadouli","sequence":"first","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1776-0009","authenticated-orcid":false,"given":"Michel B.","family":"Janho","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3128-8695","authenticated-orcid":false,"given":"Apostolia","family":"Hatziefthimiou","sequence":"additional","affiliation":[{"name":"Laboratory of Physiology, Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-0934","authenticated-orcid":false,"given":"Ioanna","family":"Voulgaridi","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantina","family":"Piaha","sequence":"additional","affiliation":[{"name":"Primary Health Care Centre of Larisa, 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lemonia","family":"Anagnostopoulos","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagiotis","family":"Ntellas","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University Hospital of Ioannina, 45500 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2535-3596","authenticated-orcid":false,"given":"Varvara A.","family":"Mouchtouri","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Bonotis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Christodoulou","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, University of Thessaly, 41100 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1287-7734","authenticated-orcid":false,"given":"Matthaios","family":"Speletas","sequence":"additional","affiliation":[{"name":"Department of Immunology and Histocompatibility, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Hadjichristodoulou","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, 41222 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18008","DOI":"10.1038\/nrdp.2018.8","article-title":"Bipolar disorders","volume":"4","author":"Vieta","year":"2018","journal-title":"Nat. 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