The diagnostic value of white blood cell, neutrophil, neutrophilto-lymphocyte ratio, and lymphocyte-to-monocyte ratio in patients with primary angle closure glaucoma

Objective: Inflammatory mechanisms may have a role in the pathogenesis of primary angle closure glaucoma (PACG). The objective of this study was to investigate the diagnostic value of white blood cell (WBC), neutrophil, neutrophil to lymphocyte ratio (NLR), and lymphocyte to monocyte ratio (LMR) in patients with PACG and its association with glaucoma severity. Method: The study was retrospectively assessed in 771 consecutive PACG patients and 770 control subjects, laboratory parameters and clinical parameters were obtained from a medical data platform. Patients were divided into three groups with different severity based on perimetry, i.e. mild (mean deviation (MD) <= 6.00 dB), moderate (12 dB=MD>6 dB) and severe (MD>12 dB). We developed a nomogram to specifically identify individual patient's risk. Results: The mean levels of neutrophil, NLR and WBC was higher in PACG than control group, and lowest in the mild PACG group, followed by moderate PACG and severe PACG (p< 0.05). The AUROC value of NLR and LMR was found to be 0.719, 0.699, respectively. Multiple linear regressions showed that there was a significant correlation between WBC and MD (B=0.151, p< 0.001), neutrophil and MD (B=0.143, p=0.003), NLR and MD (B=0.144, p=0.001), LMR and MD (B=-0.100, p=0.034). Logistic regression analyses revealed that WBC (OR=1.208, 95% CI=1.179-1.238), neutrophil (OR=1.598, 95% CI=1.541-1.656), NLR (OR=2.313, 95% CI=2.200-2.431), and LMR (OR=0.682, 95% CI=0.666-0.699) were associated with PACG. Conclusion: Our study suggested that WBC, neutrophil, NLR, and LMR was related with PACG, and NLR and LMR may be useful as biomarkers.