SynthesisEuropean psychiatry : the journal of the Association of European Psychiatrists2026
Complete blood count-based inflammatory ratios in people with bipolar disorder: a systematic review and meta-analysis of neutrophil-to-lymphocyte, monocyte-to-lymphocyte, and platelet-to-lymphocyte ratios.
Synthesis in European psychiatry : the journal of the Association of European Psychiatrists, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Complete blood count-derived inflammatory markers in schizophrenia: towards an integrated framework.European archives of psychiatry and clinical neuroscience · 2026Article
- The significance of blood indicators in distinguishing bipolar disorder depressive episodes from major depression in teenagers.Frontiers in psychiatry · 2026Article
Corrections and comments
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Authors and funding
7 authors.
Funding
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Abstract
backgroundBipolar disorder (BD) involves immune-inflammatory dysregulation. This systematic review and meta-analysis assessed complete blood count-based inflammatory indices - neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR) ratios - in BD versus healthy controls (HCs), major depressive disorder (MDD), and across BD mood states.
methodsDatabases were searched through June 2025 for observational studies reporting at least one ratio in adults with BD and including as comparators either HCs, MDD, or within-BD mood-state contrasts (mania, bipolar depression, euthymia). Quality was appraised using BIOCROSS. Random-effects meta-analyses, sensitivity analyses, and meta-regressions were performed. GRADE was adapted to rate evidence certainty.
resultsFifty-one studies (38,309 participants) met the inclusion criteria. Compared to HCs, BD showed higher NLR (SMD = 0.44,
conclusionsNLR, MLR, and PLR emerge as non-specific, group-level correlates of immune-inflammatory dysregulation in BD, however offering limited discrimination between bipolar and unipolar depression. Notwithstanding their potential role as trait- and state-related markers in BD, further studies are needed to support translation into clinically useful biomarkers.
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