{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:04:36Z","timestamp":1772118276277,"version":"3.50.1"},"reference-count":29,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Duchenne Muscular Dystrophy (DMD) is an X-linked recessive neuromuscular disorder that is characterized by progressive muscle weakness, musculoskeletal limitations, and pulmonary involvement, with cardiomyopathy and cardiovascular complications being a primary cause of morbidity and mortality. With advances in respiratory care, cardiac involvement has become the leading cause of death. There is growing interest in systemic inflammatory indices as potential predictors of cardiovascular involvement. This study aimed to evaluate the prognostic value of inflammatory markers\u2014neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and pan-immune inflammation value (PIV)\u2014in children with DMD and to explore their association with cardiac findings. Methods: In this retrospective study, 25 male patients diagnosed with DMD and 25 age-matched healthy male controls were evaluated between January 2021 and July 2024. Demographic and clinical data, hematologic and biochemical parameters, and inflammatory indices were recorded. Cardiovascular involvement was assessed using electrocardiography (ECG) and transthoracic echocardiography (TTE). Group comparisons were performed using independent t-tests, while ROC and Pearson correlation analyses were used for diagnostic performance and associations. Results: Pathological Q waves were the most frequent ECG abnormality (24%), and 16% of patients had echocardiographic abnormalities. While most systemic inflammatory indices (NLR, MLR, SIRI, SII, PIV) did not significantly distinguish cardiovascular involvement, PLR demonstrated a strong positive correlation with Pro-BNP levels (r = 0.86, p &lt; 0.05), suggesting a potential link between systemic inflammation and subclinical cardiac stress. Conclusions: Although the overall diagnostic utility of inflammatory indices in predicting cardiovascular complications in DMD was limited, PLR showed a correlation with Pro-BNP in our cohort. However, given the small sample size and limited number of patients with ventricular dysfunction, this finding should be interpreted with caution. PLR may warrant further investigation as a potential marker of cardiovascular involvement in DMD, but larger prospective studies are needed to validate its clinical significance.<\/jats:p>","DOI":"10.3390\/children12091164","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T13:27:44Z","timestamp":1756733264000},"page":"1164","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Role of Systemic Inflammatory Indices in Predicting Cardiovascular Involvement in Children with Duchenne Muscular Dystrophy"],"prefix":"10.3390","volume":"12","author":[{"given":"Ecem \u0130pek","family":"Alt\u0131nok","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Ordu University, 52200 Ordu, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taner","family":"Kasar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology, Faculty of Medicine, Ordu University, 52200 Ordu, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S0140-6736(02)07815-7","article-title":"The muscular dystrophies","volume":"359","author":"Emery","year":"2002","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1002\/ana.23528","article-title":"Evidence-based path to newborn screening for Duchenne muscular dystrophy","volume":"71","author":"Mendell","year":"2012","journal-title":"Ann. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s13023-020-01430-8","article-title":"Global epidemiology of Duchenne muscular dystrophy: An updated systematic review and meta-analysis","volume":"15","author":"Crisafulli","year":"2020","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1161\/CIRCULATIONAHA.114.015151","article-title":"Contemporary cardiac issues in Duchenne muscular dystrophy","volume":"131","author":"McNally","year":"2015","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Adorisio, R., Mencarelli, E., Cantarutti, N., Calvieri, C., Amato, L., Cicenia, M., Silvetti, M., D\u2019Amico, A., Grandinetti, M., and Drago, F. (2020). Duchenne dilated cardiomyopathy: Cardiac management from prevention to advanced cardiovascular Therapies. J. Clin. Med., 9.","DOI":"10.3390\/jcm9103186"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"27089","DOI":"10.31083\/RCM27089","article-title":"Arrhythmic Risk stratification and sudden cardiac Death prevention in Duchenne muscular dystrophy: A Critical Appraisal","volume":"26","author":"Arcudi","year":"2025","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1186\/s13023-022-02473-9","article-title":"Electrocardiographic features of children with Duchenne muscular dystrophy","volume":"17","author":"Tang","year":"2022","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Hao, C., Bo, X., Lu, Z., Qian, H., and Chen, L. (2022). The prognostic value of admission lymphocyte-to-monocyte ratio in critically ill patients with acute myocardial infarction. BMC Cardiovasc. Disord., 22.","DOI":"10.1186\/s12872-022-02745-z"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Zhang, C., Li, M., Liu, L., Deng, L., Yulei, X., Zhong, Y., Liao, B., Yu, L., and Feng, J. (2024). Systemic immune-inflammation index as a novel predictor of major adverse cardiovascular events in patients undergoing percutaneous coronary intervention: A meta-analysis of cohort studies. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-024-03849-4"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e40904","DOI":"10.1097\/MD.0000000000040904","article-title":"New systemic inflammatory indices as predictors of ascending aortic dilation in children with bicuspid aortic valve: A retrospective cross-sectional study","volume":"103","author":"Arslan","year":"2024","journal-title":"Medicine"},{"key":"ref_11","first-page":"945","article-title":"Diagnosis and management of Duchenne muscular dystrophy, part 1: Diagnosis, and pharmacologic management","volume":"371","author":"Bushby","year":"2010","journal-title":"Lancet"},{"key":"ref_12","first-page":"1","article-title":"The 6-minute walk test as a functional endpoint in DMD clinical trials: A systematic review","volume":"261","author":"McDonald","year":"2014","journal-title":"J. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Pane, M., Mazzone, E.S., Sivo, S., Fanelli, L., De Sanctis, R., D\u2019Amico, A., Messina, S., Battini, R., Bianco, F., and Scutifero, M. (2014). The 6 minute walk test and performance of upper limb in ambulant Duchenne muscular dystrophy boys. PLoS Curr., 6, ecurrents.md.a93d9904d57dcb08936f2ea89bca6fe6.","DOI":"10.1371\/currents.md.a93d9904d57dcb08936f2ea89bca6fe6"},{"key":"ref_14","first-page":"1623","article-title":"Evaluation of early cardiomyopathy in Duchenne muscular dystrophy using echocardiography and cardiac magnetic resonance imaging","volume":"103","author":"Hor","year":"2009","journal-title":"Am. J. Cardiol."},{"key":"ref_15","first-page":"786","article-title":"Cardiac involvement in Becker muscular dystrophies","volume":"24","author":"Finsterer","year":"2008","journal-title":"Can. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1097\/CM9.0000000000002385","article-title":"Prevalence and associated factors of myocardial involvement in Duchenne muscular dystrophy patients in the first decade of life","volume":"136","author":"Xu","year":"2023","journal-title":"Chin. Med. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1007\/s00246-014-0929-z","article-title":"Predictive value of myocardial delayed enhancement in Duchenne muscular dystrophy","volume":"35","author":"Menon","year":"2014","journal-title":"Pediatr. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Power, A., Poonja, S., Disler, D., Myers, K., Patton, D.J., Mah, J.K., Fine, N.M., and Greenway, S.C. (2017). Echocardiographic image quality deteriorates with age in children and young adults with Duchenne muscular dystrophy. Front. Cardiovasc. Med., 4.","DOI":"10.3389\/fcvm.2017.00082"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jjcc.2023.07.003","article-title":"Electrocardiographic R wave amplitude in V6 lead as a predictive marker of cardiac dysfunction in Duchenne muscular dystrophy","volume":"82","author":"Yamamoto","year":"2023","journal-title":"J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"552","DOI":"10.4103\/aian.aian_988_23","article-title":"Cardiac MRI in Duchenne and Becker Muscular Dystrophy","volume":"27","author":"Girija","year":"2024","journal-title":"Ann. Indian Acad. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1515\/jpem-2025-0061","article-title":"Pubertal induction therapy in pediatric patients with Duchenne muscular dystrophy","volume":"38","author":"Sodero","year":"2025","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1161\/CIR.0000000000001151","article-title":"Treatment Strategies for Cardiomyopathy in Children: A Scientific Statement From the American Heart Association","volume":"148","author":"Bogle","year":"2023","journal-title":"Circulation"},{"key":"ref_23","unstructured":"Parent Project Muscular Dystrophy (2025, July 07). Cardiac Care and Duchenne Workshop Report. Available online: https:\/\/www.parentprojectmd.org\/wp-content\/uploads\/2023\/03\/Cardiac_meeting_report_PAGES_lores.pdf."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cruz-Guzm\u00e1n, O.R., Rodr\u00edguez-Cruz, M., and Escobar Cedillo, R.E. (2015). Systemic Inflammation in Duchenne muscular dystrophy: Association with muscle function and nutritional status. Biomed. Res. Int., 2015.","DOI":"10.1155\/2015\/891972"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ye, G.L., Chen, Q., Chen, X., Liu, Y.Y., Yin, T.T., Meng, Q.H., Liu, Y.C., Wei, H.Q., and Zhou, Q.H. (2019). The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-47143-2"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Cristescu, L., Tilea, I., Iancu, D.G., Stoica, F., Moldovan, D.A., Capriglione, V., and Varga, A. (2024). Insights into the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio as predictors for the length of stay and readmission in chronic heart failure patients. Diagnostics, 14.","DOI":"10.3390\/diagnostics14182102"},{"key":"ref_27","first-page":"124","article-title":"Predictive value of early neutrophil-to-lymphocyte ratio and C-reactive protein in pediatric steroid-sensitive nephrotic syndrome","volume":"49","author":"Maimaititusun","year":"2023","journal-title":"Ital. J. Pediatr."},{"key":"ref_28","first-page":"e95339","article-title":"Are Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Predictors of Steroid Therapy in Children with Nephrotic Syndrome?","volume":"29","author":"Jamee","year":"2019","journal-title":"Iran J. Pediatr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"68","DOI":"10.4103\/aihb.aihb_44_22","article-title":"A Correlational Study on Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Bronchial Asthma","volume":"13","author":"Tahseen","year":"2023","journal-title":"Adv. Hum. Biology"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/9\/1164\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:37:07Z","timestamp":1760035027000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/9\/1164"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":29,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["children12091164"],"URL":"https:\/\/doi.org\/10.3390\/children12091164","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,1]]}}}