Value of Neutrophil (Lymphocyte Ratio), Red Blood Cell Distribution Width, Mean Platelet Volume and C - Reactive Protein in the Assessment of Major Depressive Disorder

Research Article

Austin J Clin Pathol. 2017; 4(2): 1051.

Value of Neutrophil (Lymphocyte Ratio), Red Blood Cell Distribution Width, Mean Platelet Volume and C - Reactive Protein in the Assessment of Major Depressive Disorder

Kanti Paul T¹, Paul D², Shamsun Nahar J³, Ahmed S4, Saiful Islam M², Ferdoushi S2, Saiful Islam M2,5, Sultana T6, Quddusur Rahman M7, Uddin Ahmed M8* and Nashimuddin Ahmed AN9

1OSD, DGHS, Mohakhali, Bangladesh

2Associate Professor, Department of Laboratory Medicine, BSMMU, Bangladesh

3Professor and Chairman, Department of Psychiatry, BSMMU, Bangladesh

4Lecturer in Microbiology, Anower Khan Modern Medical College, Bangladesh

5Medical officer, Department of Laboratory Medicine, BSMMU, Bangladesh

6Associate Professor, Department of Psychiatry, BSMMU, Bangladesh

7Professor and Chairman, Department of Laboratory Medicine, BSMMU, Bangladesh

8Master of Microbiology, Bangladesh University of Health Sciences, Bangladesh

9Professor, Department of Laboratory Medicine, BSMMU, Bangladesh

*Corresponding author: Uddin Ahmed M, Master of Microbiology, Bangladesh University of Health Sciences, Bangladesh

Received: August 22, 2017; Accepted: October 13, 2017; Published: October 20, 2017

Abstract

Major Depressive Disorder (MDD) is a common psychological problem in the world. In Bangladesh prevalence of MDD is about 4.6%. MDD is associated with reduced quality of life as well as high level of social and occupational impairment. This case control study was conducted at the Department of Laboratory Medicine (Clinical Pathology) in collaboration with the Department of Psychiatry, BSMMU, Dhaka, from March’ 2016 to February’ 2017. Total 130 patients were enrolled in this study and divided into Group I (cases) and Group II (controls). Each group was consisted of 65 subjects. The patients who fulfilled the criteria of MDD were determined as cases in this study. This study measured Complete Blood Count (CBC) with Peripheral Blood Film (PBF) including differential count of WBC, Neutrophil/Lymphocyte Ratio (NLR), Red Blood Cell Distribution Width (RDW), Mean Platelet Volume (MPV) and C-Reactive Protein (CRP) in MDD diagnosed patients and healthy controls. CBC was measured by automated hematology analyzer (SYSMEX-XT 4000i) and CRP was measured by biochemistry auto analyzer (Dimension RxL Max). The mean age was 33.06 ± 12.23 years for patients with MDD and 33.05 ± 11.43 years for the control group. There was no significant difference between the age for groups (P>0.05). Female [43(66.2%)] were predominant in both groups. NLR, RDW-CV, MPV and CRP levels were found to be 2.36 ± 0.38, 14.20 ± 1.08 %, 10.93 ± 0.54 fl and 5.25 ± 1.84 mg/L in patients with MDD respectively and 1.77 ± 0.24, 13.03 ± 0.61 %, 9.39 ± 0.91 fl and 2.56 ± 1.16 mg/L in controls respectively. NLR, RDW, MPV and CRP levels were significantly higher in patients with MDD compared to the control group (P<0.05). In ROC analysis, cut off value of NLR was (>1.98) with sensitivity 84.6% and specificity 73.8%. Cut off value of RDW-CV level was (>13.45%) with sensitivity 73.8% and specificity 72.7%. Cut off value of MPV was (>10.25 fl) with sensitivity 89.2% and specificity 81.5%. Cut off value of CRP was (>3.58 mg/L) with sensitivity 83.1% and specificity 72.3%.This findings of the study revealed that NLR, RDW-CV, MPV and CRP trend to be higher in MDD. So these markers may be useful tool for assessing MDD.

Introduction

Major Depressive Disorder (MDD) is one of the common psychological problems in the world [1]. In 2000, depressive disorders were the 4th leading cause of burden as well as of disability in world [2]. According to World Health Organization depressive disorders will be the second leading cause of morbidity worldwide by the year of 2020 [3] (Figure 1). The prevalence of major depressive disorder is about 5% worldwide [4]. In Bangladesh prevalence of MDD is about 4.6% [5]. It is associated with reduced quality of life as well as high level of social and occupational impairment. Diagnosis of MDD is done by clinical criteria. There is no serum marker available for detection of MDD [6]. Tumor necrosis factor-α (TNF-α), interleukine-6 (IL-6), interleukine1β (IL-1β), CD4/CD8 ratio, haptoglobin, Prostaglandin-E2 (PGE2), Corticotrophin-Releasing Hormone (CRH) are useful biomarkers [7,8]. These tests are expensive and time consuming not easily available [9] (Tables 1-3). Neutrophil/ lymphocyte Ratio (NLR), Red blood cell Distribution Width (RDW), Mean Platelet Volume (MPV) and C - Reactive Protein (CRP) have been suspected as the predictors of various diseases [6,10]. NLR, RDW and MPV are derived from Complete Blood Count (CBC). CBC and CRP are less expensive and mostly available test all over the world as well as in Bangladesh. The impact of Neutrophil/Lymphocyte Ratio, Red Blood Cell Distribution Width, Mean Platelet Volume and C - reactive protein in major depressive disorder is to prevent unnecessary delay and to start treatment as early as possible and thereby to reduce morbidity and depression related complications. Therefore, the purpose of the study was to evaluate the value of NLR, RDW, MPV and CRP in the assessment of major depressive disorder.