ArticleFrontiers in immunology2026
Dynamic changes in CBC-derived inflammatory indices before and during acute coronary syndrome in patients with rheumatoid arthritis: a within-patient paired study.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Rheumatoid arthritis (RA) is associated with excess cardiovascular risk, but within-patient changes in complete blood count (CBC)-derived inflammatory indices at the onset of acute coronary syndrome (ACS) are not well described. We compared pre-event and acute-phase values in the same patients and contextualized pre-event values against a healthy cohort. Methods: This retrospective, single-center, within-patient paired study reviewed hospital records from July 1, 2018, to December 30, 2025 (approximately 90 months). Among 3,960 hospitalized patients with RA, 89 had clinician-confirmed ACS and qualifying paired CBC measurements. Acute-phase CBCs were obtained within 24 hours after symptom onset, and pre-event CBCs were the most recent routine measurements obtained more than 14 days before the event. The neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated and natural log-transformed. Pre-event values were also compared with a healthy cohort (n = 110), with age- and sex-adjusted analyses used because residual demographic imbalance was present. Results: Pre-event log(NLR), log(SII), and log(SIRI) were higher in the RA cohort than in healthy controls and remained higher after adjustment for age and sex (all P< 0.001). Within-patient analyses showed increases during ACS, with mean Δlog values of 0.466 for NLR, 0.508 for SII, and 0.381 for SIRI (all Benjamini-Hochberg-adjusted q< 0.001). Neutrophilia increased from 11.2% before the event to 41.6% during ACS (McNemar P< 0.001). Exploratory subgroup estimates were heterogeneous and non-monotonic across several small strata; changes did not differ materially between remission/low and moderate/high RA activity groups. Conclusion: Among patients with RA who developed ACS, CBC-derived inflammatory indices were higher than in a healthy comparison cohort before the event and increased further within the first 24 hours of ACS. The paired design quantifies change relative to each patient's own pre-event value. Without a non-RA ACS comparator, however, the study cannot establish RA-specific inflammatory priming or a causal chronic-to-acute mechanism. Prospective studies with serial sampling and clinical outcomes are needed.
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