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Letters to the editor
Relationship between complete blood count parameters and suicide: The role of neutrophil to lymphocyte ratio
M.H. Orum
Elazig Mental Health and Diseases Hospital, Psychiatry Outpatient Clinic, Elazığ, 23200, Turkey
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    "titulo" => "Relationship between complete blood count parameters and suicide&#58; The role of neutrophil to lymphocyte ratio"
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    "saludo" => "Dear Editor&#44;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Complete blood count &#40;CBC&#41; is among the most frequently ordered diagnostic tests in medicine due to its features such as being inexpensive&#44; easily accessible and applicable&#44; and fast results&#46; In recent years&#44; many studies have been conducted in the field of psychiatry&#44; as in all other medical fields&#44; dealing with the relationship of CBC with psychiatric disorders or situations&#46; The investigation of the relationship between CBC parameters and different stages of suicide is based on recent years&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The studies show that history of suicide attempts is associated with increased neutrophil to lymphocyte ratio &#40;NLR&#41;&#46; In addition&#44; it is suggested that the NLR could be a valuable&#44; repeatable&#44; easily accessible&#44; and cost-effective strategy in revealing the risk of suicide&#46; On the other hand&#44; some studies did not detect a difference between NLR and severity of depression symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A study compared the patient groups diagnosed with major depressive disorder &#40;MDD&#41; with and without a history of suicide attempt with a healthy control group and reported that the red blood cell value of MDD patients with a history of suicide attempt was lower than those of MDD patients without a history of suicide attempt&#44; while mean corpuscular hemoglobin and platelet count values &#8203;&#8203;were found to be higher&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> On the other hand&#44; while monocyte to lymphocyte ratio&#44; mean platelet volume&#44; monocyte count&#44; and red cell distribution width values of patients with a history of suicide attempt were lower than healthy controls&#44; basophil count&#44; and eosinophil count were found to be higher&#46; Apart from this&#44; the relationship between mean platelet volume and various CBC parameters with suicide was investigated in different studies&#46; These studies demonstrated that white blood cell&#44; mean platelet volume&#44; NLR&#44; monocyte to lymphocyte ratio&#44; and platelet to lymphocyte ratio values were significantly higher in individuals who attempted suicide compared to healthy controls&#44; and the lymphocyte count value was lower&#46; Some studies investigating the relationship between suicide and CBC have focused on the effect of suicide violence on CBC&#46; It is found that NLR and mean platelet volume were significantly higher in violent suicide attempts than non-violent suicide attempts and healthy controls&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Another study reported that neutrophil count&#44; percentage of neutrophil&#44; and NLR were significantly higher in violent suicide attempt than non-violent suicide attempt and healthy controls&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A study found that violent suicide attempt was associated with an increased neutrophil count&#44; mean platelet volume&#44; platelet to lymphocyte ratio&#44; NLR values and decreased lymphocyte count values compared to a non-violent suicide attempt and healthy controls&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In contrast to the studies mentioned above&#44; no significant relationship was found between suicide and some CBC parameters in one study&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This study compared the NLR&#44; mean platelet volume&#44; platelet to lymphocyte ratio&#44; platelet count&#44; and white blood cell levels of patients who were admitted to the emergency department with SA and those who were followed up in a psychiatry outpatient clinic with a diagnosis of MDD and found no significant difference&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In conclusion&#44; all of the studies investigating the relationship between CBC and suicide have been published over four years&#46; In some of the studies&#44; MDD patients with and without a history of suicide attempts were compared among themselves and with healthy control groups&#46; In some studies&#44; suicide attempts were divided into violent and non-violent and compared among themselves and with healthy control groups&#46; The majority of studies focused on white blood cells and lymphocyte-related ratios&#44; based on the relationship between suicide and inflammatory processes&#46; NLR has been associated with depressive symptoms&#44; MDD with a history of suicide attempts&#44; and violent suicide attempts&#46; In this sense&#44; the NLR has become an important candidate parameter for use in predicting suicide attempts&#46; However&#44; what we know about NLR is not at the desired level for making clinical decisions&#46; The major limitation of the studies in this field is that they are retrospective and cross-sectional&#46; The case of suicide has been investigated in different psychiatric disorders&#44; which makes it difficult to compare studies among themselves&#46; Most of the blood analyses were performed following the suicide attempt&#46; Although difficult&#44; longitudinal studies and blood analyses taken before suicide attempts are required&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0020" class="elsevierStylePara elsevierViewall">Ethical approval was not required for this research article and any discussion is fully anonymized&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">There was no funding for this work&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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