{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:19:15Z","timestamp":1792412355475,"version":"4.4.0"},"reference-count":46,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T00:00:00Z","timestamp":1649721600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: In women of reproductive age, leukocytosis is a risk factor that bridges low-grade chronic inflammation (metabolic inflammation), metabolic changes, and polycystic ovary syndrome (PCOS) and is a potential early predictor of PCOS. This study aims to explore the predictive role of quantitative changes in white blood cells (WBCs) and neutrophils in PCOS-associated metabolic changes. Materials and Methods: A total number of 176 blood samples were obtained from age-matched women of the reproductive period, comprising 88 PCOS cases and 88 healthy controls. Hematological, metabolic, and anthropometric indices and ultrasonic assessment were recorded. Results: Elevated levels of luteinizing hormone, testosterone, and lipid parameters except HDL-C levels, and the prevalence of metabolic syndrome in PCOS were statistically significant (p &lt; 0.001). The neutrophil count and neutrophil\u2013lymphocyte ratio (NLR) in PCOS patients were significantly higher (p &lt; 0.001) than their counterparts. The predictive ability of the neutrophil count and neutrophil\u2013lymphocyte ratio (NLR) for PCOS, and possibly its associating subclinical inflammation at optimum cut-off values for the neutrophil count and NLR of &gt;46.62% (sensitivity 94.32% and specificity 74.42%) and &gt;1.23 (sensitivity 71.59% and specificity 100%), respectively. With regard to the areas under the curve (AUC) and Youden indices, they constituted 0.922 and 0.697 for neutrophil count and 0.926 and 0.716 for NLR, respectively. The comparative ROC z-statistic value was 2.222 and a p = 0.026. The multiple linear regression analysis revealed no significant influence for hormonal and metabolic independent variables on the neutrophil count in PCOS cases, but, as can be expected, revealed a significant negative relationship with the other components of WBCs. Conclusion: In conclusion, relative neutrophilia and elevated NLR are potential cost-effective, sensitive, and specific predictors of PCOS that may also shed light on the mechanism of chronic low-grade inflammation that is characteristic of the disease.<\/jats:p>","DOI":"10.3390\/medicina58040535","type":"journal-article","created":{"date-parts":[[2022,4,12]],"date-time":"2022-04-12T21:15:35Z","timestamp":1649798135000},"page":"535","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Quantitative Changes in White Blood Cells: Correlation with the Hallmarks of Polycystic Ovary Syndrome"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9267-2637","authenticated-orcid":false,"given":"Abdulrahman H.","family":"Almaeen","sequence":"first","affiliation":[{"name":"Department of Pathology, College of Medicine, Jouf University, Sakaka 70214, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman Abdulwahab","family":"Alduraywish","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, College of Medicine, Jouf University, Sakaka 70214, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mudasar","family":"Nabi","sequence":"additional","affiliation":[{"name":"Department Biochemistry, Kashmir University, Srinagar 190006, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveed Nazir","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Chest Diseases Hospital, Government Medical College Srinagar, Srinagar 190001, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahiman","family":"Shaik","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Ex-Faculty, Jouf University, Sakaka 70214, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal Ahmad","family":"Tantry","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Government Medical College Srinagar, Srinagar 190001, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1210\/jc.2003-032046","article-title":"The prevalence and features of the polycystic ovary syndrome in an unselected population","volume":"89","author":"Azziz","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1093\/humrep\/deh098","article-title":"Rotterdam ESHRE\/ASRM-Sponsored PCOS consensus workshop group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS)","volume":"19","author":"Rotteredam","year":"2004","journal-title":"Hum Reprod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.fertnstert.2013.02.011","article-title":"Ontogeny of the ovary in polycystic ovary syndrome","volume":"100","author":"Dumesic","year":"2013","journal-title":"Fertil. Steril."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.fertnstert.2010.11.036","article-title":"Circulating inflammatory markers in polycystic ovary syndrome: A systematic review and metaanalysis","volume":"95","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1210\/jc.2004-0628","article-title":"The increase of leukocytes as a new putative marker of low-grade chronic inflammation and early cardiovascular risk in polycystic ovary syndrome","volume":"90","author":"Orio","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2265.2012.04454.x","article-title":"Leucocytosis in women with polycystic ovary syndrome (PCOS) is incompletely explained by obesity and insulin resistance","volume":"78","author":"Phelan","year":"2013","journal-title":"Clin. Endocrinol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.fertnstert.2011.11.023","article-title":"Is PCOS an inflammatory process?","volume":"97","author":"Duleba","year":"2012","journal-title":"Fertil. Steril."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.biochi.2014.10.028","article-title":"Higher circulating leukocytes in women with PCOS is reversed by aerobic exercise","volume":"124","author":"Covington","year":"2016","journal-title":"Biochimie"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Aboeldalyl, S., James, C., Seyam, E., Ibrahim, E.M., Shawki, H.E., and Amer, S. (2021). The Role of Chronic Inflammation in Polycystic Ovarian Syndrome-A Systematic Review and Meta-Analysis. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22052734"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000083634","article-title":"Erythrocyte signal transduction pathways, their oxygenation dependence and functional significance","volume":"15","author":"Barvitenko","year":"2005","journal-title":"Cell. Physiol. Biochem."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S1567-5769(00)00031-X","article-title":"Neutrophil neutral endopeptidase variation and its regulation by opioid peptides","volume":"1","author":"Balog","year":"2001","journal-title":"Int. Immunopharmacol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3389\/fmed.2018.00217","article-title":"The Role of Neutrophils and Neutrophil Elastase in Pulmonary Arterial Hypertension","volume":"5","author":"Taylor","year":"2018","journal-title":"Front. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s40618-016-0446-4","article-title":"The inflammatory markers in polycystic ovary syndrome: Association with obesity and IVF outcomes","volume":"39","author":"Vural","year":"2016","journal-title":"J. Endocrinol. Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s40618-015-0335-2","article-title":"The mean platelet volume and neutrophil to lymphocyte ratio in obese and lean patients with polycystic ovary syndrome","volume":"39","author":"Yilmaz","year":"2016","journal-title":"J. Endocrinol. Investig."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ijwd.2015.04.003","article-title":"Endocrine evaluation of hirsutism","volume":"1","author":"Mihailidis","year":"2015","journal-title":"Int. J. Women\u2019s Dermatol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001). Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA, 285, 2486.","DOI":"10.1001\/jama.285.19.2486"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"146","DOI":"10.4103\/2356-8062.200908","article-title":"High-normal thyroid stimulating hormone is a predictor of metabolic syndrome among young polycystic ovary syndrome women","volume":"2","author":"Salama","year":"2016","journal-title":"Egypt. J. Obes. Diabetes Endocrinol."},{"key":"ref_18","unstructured":"World Health Organization\u2014Regional Office for the Western Pacific (2000). The Asia-Pacific Perspective: Redefining Obesity and Its Treatment, Health Communications."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1136\/jcp.2003.015271","article-title":"Cardiovascular risk in women with polycystic ovarian syndrome (PCOS)","volume":"58","author":"Bickerton","year":"2005","journal-title":"J. Clin. Pathol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1093\/humrep\/15.4.785","article-title":"Increased risk of non-insulin dependent diabetes mellitus, arterial hypertension and coronary artery disease in perimenopausal women with a history of the polycystic ovary syndrome","volume":"15","author":"Cibula","year":"2000","journal-title":"Hum. Reprod."},{"key":"ref_21","first-page":"583","article-title":"Role of Androgen Excess on Metabolic Aberrations and Cardiovascular Risk in Women with Polycystic Ovary Syndrome","volume":"4","author":"Christakou","year":"2008","journal-title":"Women\u2019s Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1210\/jcem.86.6.7580","article-title":"Low grade chronic inflammation in women with polycystic ovarian syndrome","volume":"86","author":"Kelly","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_23","first-page":"2446","article-title":"Levels of neopterin and other inflammatory markers in obese and non-obese patients with polycystic ovary syndrome","volume":"21","author":"Agacayak","year":"2015","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s00404-014-3199-3","article-title":"The effect of obesity on inflammatory markers in patients with PCOS: A BMI-matched case\u2013control study","volume":"290","author":"Okyay","year":"2014","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1160\/TH11-02-0096","article-title":"Neutrophils and clinical outcomes in patients with acute coronary syndromes and\/or cardiac revascularisation. A systematic review on more than 34,000 subjects","volume":"106","author":"Guasti","year":"2011","journal-title":"Thromb. Haemost."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"217","DOI":"10.3109\/10641963.2013.804547","article-title":"Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension","volume":"36","author":"Sunbul","year":"2014","journal-title":"Clin. Exp. Hypertens."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.amjcard.2008.05.006","article-title":"Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome","volume":"102","author":"Tamhane","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3126\/njog.v6i2.6748","article-title":"Biochemical parameters in women with polycystic ovary syndrome in Ajman, UAE","volume":"6","author":"Gomathi","year":"2011","journal-title":"Nepal J. Obstet. Gynaecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.fra.2013.03.001","article-title":"Importance of elevated insulin resistance, dyslipidemia and status of antioxidant vitamins in polycystic ovary disease","volume":"3","author":"Naidu","year":"2013","journal-title":"Free Radic. Antioxid."},{"key":"ref_30","first-page":"14","article-title":"Anthropometric measurements in PCOS & Non PCO Infertile patients","volume":"3","author":"Rasool","year":"2015","journal-title":"Int. J. Chem. Environ. Biol. Sci."},{"key":"ref_31","first-page":"22","article-title":"Metabolic and endocrine characteristics of Indian women with polycystic ovary syndrome","volume":"10","author":"Kumar","year":"2016","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_32","first-page":"5","article-title":"Association of hormonal status with anthropometric & biochemical parameters in women with polycystic ovarian syndrome","volume":"3","author":"Shah","year":"2017","journal-title":"Hypertension"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1080\/09513590.2017.1379498","article-title":"Adropin levels in women with polycystic ovaries undergoing ovarian stimulation: Correlation with lipoprotein lipid profiles","volume":"34","author":"Bousmpoula","year":"2018","journal-title":"Gynecol. Endocrinol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1093\/humrep\/deu361","article-title":"Polycystic ovary syndrome susceptibility single nucleotide polymorphisms in women with a single PCOS clinical feature","volume":"30","author":"Cui","year":"2015","journal-title":"Hum. Reprod."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1093\/humrep\/des424","article-title":"Genotype\u2013phenotype correlations of PCOS susceptibility SNPs identified by GWAS in a large cohort of Han Chinese women","volume":"28","author":"Cui","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_36","first-page":"27","article-title":"Lipid parameters in patients with polycystic ovary syndrome","volume":"31","author":"Iuhas","year":"2012","journal-title":"Appl. Med. Inform."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1530\/eje.1.02187","article-title":"Oxidised low-density lipoprotein concentration\u2013early marker of an altered lipid metabolism in young women with PCOS","volume":"155","author":"Macut","year":"2006","journal-title":"Eur. J. Endocrinol."},{"key":"ref_38","first-page":"935","article-title":"Lipid lipoprotein profile alterations in Greek infertile women with polycystic ovaries: Influence of adipocytokines levels","volume":"28","author":"Tsouma","year":"2014","journal-title":"Vivo"},{"key":"ref_39","first-page":"S34","article-title":"Subtle metabolic alterations in adolescents with obesity and polycystic ovarian syndrome","volume":"153","year":"2017","journal-title":"Gac. Med. De Mex."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1210\/jcem-21-11-1440","article-title":"Clinical assessment of body hair growth in women","volume":"21","author":"Ferriman","year":"1961","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2567","DOI":"10.1084\/jem.20160723","article-title":"Adrenergic control of the adaptive immune response by diurnal lymphocyte recirculation through lymph nodes","volume":"213","author":"Suzuki","year":"2016","journal-title":"J. Exp. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1161\/CIRCHEARTFAILURE.112.970525","article-title":"Predictive value of low relative lymphocyte count in patients hospitalized for heart failure with reduced ejection fraction: Insights from the EVEREST trial","volume":"5","author":"Vaduganathan","year":"2012","journal-title":"Circ. Heart Fail."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1177\/1076029615569568","article-title":"The relation between atherosclerosis and the neutrophil\u2013lymphocyte ratio","volume":"22","author":"Balta","year":"2016","journal-title":"Clin. Appl. Thromb.\/Hemost."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2098","DOI":"10.1016\/j.dsx.2019.05.003","article-title":"Elevated fasting insulin is associated with cardiovascular and metabolic risk in women with polycystic ovary syndrome","volume":"13","author":"Rasool","year":"2019","journal-title":"Diabetes Metab. Syndr. Clin. Res. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1007\/s12020-021-02894-9","article-title":"Androgen receptor coregulator long noncoding RNA CTBP1-AS is associated with polycystic ovary syndrome in Kashmiri women","volume":"75","author":"Nabi","year":"2022","journal-title":"Endocrine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"12942","DOI":"10.1038\/s41598-021-92265-1","article-title":"Impact of rs2414096 polymorphism of CYP19 gene on susceptibility of polycystic ovary syndrome and hyperandrogenism in Kashmiri women","volume":"11","author":"Ashraf","year":"2021","journal-title":"Sci. Rep."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/4\/535\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:52:49Z","timestamp":1760136769000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/4\/535"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,12]]},"references-count":46,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["medicina58040535"],"URL":"https:\/\/doi.org\/10.3390\/medicina58040535","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,12]]}}}