Hostname: page-component-6bb9c88b65-9c7xm Total loading time: 0 Render date: 2025-07-24T11:56:00.882Z Has data issue: false hasContentIssue false
  • English
  • Français

Exploring the role of serum lipid profile and neutrophil-to-lymphocyte ratio in violent suicide attempters: a cross sectional study

Published online by Cambridge University Press:  10 December 2020

Enrico Capuzzi Open the ORCID record for Enrico Capuzzi [Opens in a new window] ,
Alice Caldiroli Open the ORCID record for Alice Caldiroli [Opens in a new window] ,
Martina Capellazzi ,
Ilaria Tagliabue ,
Annamaria Auxilia ,
Giulia Ghilardi ,
Massimiliano Buoli Open the ORCID record for Massimiliano Buoli [Opens in a new window]  and
Massimo Clerici
Enrico Capuzzi*
Affiliation:
Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
Alice Caldiroli
Affiliation:
Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
Martina Capellazzi
Affiliation:
Department of Medicine and Surgery, University of Milan Bicocca, via Cadore, Monza (MB), Italy
Ilaria Tagliabue
Affiliation:
Department of Medicine and Surgery, University of Milan Bicocca, via Cadore, Monza (MB), Italy
Annamaria Auxilia
Affiliation:
Department of Medicine and Surgery, University of Milan Bicocca, via Cadore, Monza (MB), Italy
Giulia Ghilardi
Affiliation:
Department of Medicine and Surgery, University of Milan Bicocca, via Cadore, Monza (MB), Italy
Massimiliano Buoli
Affiliation:
Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza, Milan, Italy Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
Massimo Clerici
Affiliation:
Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy Department of Medicine and Surgery, University of Milan Bicocca, via Cadore, Monza (MB), Italy
*
*Author for correspondence: Dr. Enrico Capuzzi, PhD, Email: e.capuzzi1@campus.unimib.it
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Suicidality is one of the most common complications of mental disorders, so that the identification of potential biomarkers may be relevant in clinical practice. To date, the role of serum lipids and neutrophil/lymphocyte ratio (NLR) has been explored albeit with conflicting results. To the best of our knowledge, no study has explored lipid levels concomitantly with NLR in relation to violent suicide attempts. Therefore, we aimed to investigate whether serum lipid levels and NLR might be associated with the violent method of suicide attempts.

Methods

The study group consisted of 163 inpatients who attempted suicide. Blood samples were collected at the beginning of hospitalization to measure total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, very-low-density lipoprotein (VLDL), triglycerides, and NLR. Descriptive analyses of the total sample were performed. The included patients were divided into two groups according to violent/nonviolent method. Groups were compared in terms of lipid (MANCOVAs).

Results

Plasma levels of total cholesterol (F = 5.66; P = .02), LDL (F = 4.94; P = .03), VLDL (F = 5.66; P = .02), and NLR (F = 8.17; P < .01) resulted to be significantly lower in patients that used a violent method compared to patients who attempted suicide with a nonviolent method.

Conclusions

Low cholesterol, LDL, and VLDL levels as well as low NLR value were associated with a violent method of suicide attempt in patients with mental disorders. Further studies are needed to confirm these results.

Keywords

Biomarkerslipidmental disordersNLRsuicide

Information

Type
Original Research
Information
CNS Spectrums , Volume 27 , Issue 3 , June 2022 , pp. 362 - 368
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Kim, S, Lee, KU. Research on potential biomarker correlates for suicidal behavior: a review. Asia Pac Psychiatry. 2017;9(4):e12291. doi:10.1111/appy.12291.CrossRefGoogle ScholarPubMed
Muldoon, MF, Manuck, SB, Mendelsohn, AB, Kaplan, JR, Belle, SH. Cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials. BMJ. 2001;322(7277):11–15. doi:10.1136/bmj.322.7277.11.CrossRefGoogle ScholarPubMed
Köhler-Forsberg, O, Otte, C, Gold, SM, Østergaard, SD. Statins in the treatment of depression: hype or hope? [published online ahead of print, 2020 Jul 8]. Pharmacol Ther. 2020;215:107625. doi:10.1016/j.pharmthera.2020.107625.CrossRefGoogle Scholar
O'Neil, A., Sanna, L., Redlich, C., et al. The impact of statins on psychological wellbeing: a systematic review and meta-analysis. BMC Med. 2012;10:154. doi:10.1186/1741-7015-10-154.CrossRefGoogle ScholarPubMed
Yang, C, Jick, S, Jick, H. Lipid-lowering drugs and the risk of depression and suicidal behavior. Arch Intern Med. 2003;163:1926–1932. doi:10.1001/archinte.163.16.1926.CrossRefGoogle ScholarPubMed
Tatley, M, & Savage, R. Psychiatric adverse reactions with statins, fibrates and ezetimibe: implications for the use of lipid-lowering agents. Drug Saf. 2007;30(3):195–201. doi:10.2165/00002018-200730030-00003.CrossRefGoogle ScholarPubMed
Conklin, SM, & Stanford, MS. Premeditated aggression is associated with serum cholesterol in abstinent drug and alcohol dependent men. Psychiatry Res.. 2008;157(1–3):283–287. doi:10.1016/j.psychres.2007.02.006.CrossRefGoogle ScholarPubMed
Leppien, E, Mulcahy, K, Demler, TL, Trigoboff, E, Opler, L. Effects of statins and cholesterol on patient aggression: is there a connection? Innov Clin Neurosci. 2018;15(3–4):24–27.Google ScholarPubMed
Freemantle, E, Mechawar, N, Turecki, G. Cholesterol and phospholipids in frontal cortex and synaptosomes of suicide completers: relationship with endosomal lipid trafficking genes. J Psychiatr Res. 2013;47(2):272–279. doi:10.1016/j.jpsychires.2012.10.019.CrossRefGoogle ScholarPubMed
Vevera, J, Fisar, Z, Kvasnicka, T, et al. Cholesterol-lowering therapy evokes time-limited changes in serotonergic transmission. Psychiatry Res. 2005;133(2–3):197–203. doi:10.1016/j.psychres.2004.11.005.CrossRefGoogle ScholarPubMed
da Graça Cantarelli, M, Nardin, P, Buffon, A, et al. Serum triglycerides, but not cholesterol or leptin, are decreased in suicide attempters with mood disorders. J Affect Disord. 2015;172:403–409. doi:10.1016/j.jad.2014.10.033.CrossRefGoogle ScholarPubMed
Wu, S, Ding, Y, Wu, F, Xie, G, Hou, J, Mao, P. Serum lipid levels and suicidality: a meta-analysis of 65 epidemiological studies. J Psychiatry Neurosci. 2016;41(1):56–69. doi:10.1503/jpn.150079.CrossRefGoogle ScholarPubMed
Atmaca, M, Kuloglu, M, Tezcan, E, Ustundag, B. Serum leptin and cholesterol values in violent and nonviolent suicide attempters. Psychiatry Res. 2008;158(1):87–91. doi:10.1016/j.psychres.2003.05.002.CrossRefGoogle Scholar
Capuzzi, E, Bartoli, F, Crocamo, C, Malerba, MR, Clerici, M, Carrà, G. Recent suicide attempts and serum lipid profile in subjects with mental disorders: a cross-sectional study. Psychiatry Res. 2018;270:611–615. doi:10.1016/j.psychres.2018.10.050.CrossRefGoogle ScholarPubMed
D'Ambrosio, V, Salvi, V, Bogetto, F, Maina, G. Serum lipids, metabolic syndrome and lifetime suicide attempts in patients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2012;37(1):136–140. doi:10.1016/j.pnpbp.2011.12.009.CrossRefGoogle ScholarPubMed
Shaker, NM, Sultan, M, Mohamed, MY, Helal, SA, Abd El Moneam, MHE. Lipid profile and impulsivity in suicidal patients with major depressive disorder [published online ahead of print, 2020 Apr 6]. Arch Suicide Res. 2020;1–16. doi:10.1080/13811118.2020.1746456.CrossRefGoogle Scholar
Cantarelli Mda, G, Tramontina, AC, Leite, MC, Gonçalves, CA. Potential neurochemical links between cholesterol and suicidal behavior. Psychiatry Res. 2014;220(3):745–751. doi:10.1016/j.psychres.2014.10.017.CrossRefGoogle ScholarPubMed
Maes, M, Smith, R, Christophe, A, et al. Lower serum high-density lipoprotein cholesterol (HDL-C) in major depression and in depressed men with serious suicidal attempts: relationship with immune-inflammatory markers. Acta Psychiatr Scand. 1997;95(3):212–221. doi:10.1111/j.1600-0447.1997.tb09622.x.CrossRefGoogle ScholarPubMed
Capuzzi, E, Caldiroli, A, Capellazzi, M, Tagliabue, I, Buoli, M, Clerici, M. Biomarkers of suicidal behaviors: a comprehensive critical review. Adv Clin Chem. 2020;96:179–216. doi:10.1016/bs.acc.2019.11.005.CrossRefGoogle ScholarPubMed
Howard, R, Kanetsky, PA, Egan, KM. Exploring the prognostic value of the neutrophil-to-lymphocyte ratio in cancer. Sci Rep. 2019;9(1):19673. doi:10.1038/s41598-019-56218-z.CrossRefGoogle ScholarPubMed
Ekinci, O, Ekinci, A. The connections among suicidal behavior, lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio. Nord J Psychiatry. 2017;71(8):574–580. doi:10.1080/08039488.2017.1363285.CrossRefGoogle ScholarPubMed
Mazza, MG, Lucchi, S, Tringali, AGM, Rossetti, A, Botti, ER, Clerici, M. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in mood disorders: a meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2018;84(Pt A):229–236. doi:10.1016/j.pnpbp.2018.03.012.CrossRefGoogle ScholarPubMed
Ivković, M, Pantović-Stefanović, M, Dunjić-Kostić, B, et al. Neutrophil-to-lymphocyte ratio predicting suicide risk in euthymic patients with bipolar disorder: moderatory effect of family history. Compr Psychiatry. 2016;66:87–95. doi:10.1016/j.comppsych.2016.01.005.CrossRefGoogle ScholarPubMed
Velasco, Á, Rodríguez-Revuelta, J, Olié, E, et al. Neutrophil-to-lymphocyte ratio: a potential new peripheral biomarker of suicidal behavior. Eur Psychiatry. 2020;63(1):e14. doi:10.1192/j.eurpsy.2019.20.CrossRefGoogle ScholarPubMed
Gundogdu Meydaneri, G, Meydaneri, S. Can neutrophil lymphocyte ratio predict the likelihood of suicide in patients with major depression?. Cureus. 2018;10(4):e2510. doi:10.7759/cureus.2510.Google ScholarPubMed
Orum, MH, Kara, MZ, Egilmez, OB. Mean platelet volume and neutrophil to lymphocyte ratio as parameters to indicate the severity of suicide attempt. J Immunoassay Immunochem. 2018;39(6):647–659. doi:10.1080/15321819.2018.1529682.CrossRefGoogle ScholarPubMed
Kara, M. Z., Orum, M. H., & Egilmez, O. B. Relationship between immune cells and violent/nonviolent suicide attempts and controls: what about the lymphocyte-related ratios and neutrophil-related parameters?. Kaohsiung J Med Sci . 2019;35(5):315–316. doi:10.1002/kjm2.12049.CrossRefGoogle ScholarPubMed
von Elm, E, Altman, DG, Egger, M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–349. doi:10.1016/j.jclinepi.2007.11.008.CrossRefGoogle ScholarPubMed
Nock, MK, Borges, G, Bromet, EJ, Cha, CB, Kessler, RC, Lee, S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30(1):133–154. doi:10.1093/epirev/mxn002.CrossRefGoogle ScholarPubMed
Aguglia, A, Solano, P, Giacomini, G, et al. The association between dyslipidemia and lethality of suicide attempts: a case-control study. Front Psychiatry. 2019;10:70. doi:10.3389/fpsyt.2019.00070.CrossRefGoogle ScholarPubMed
Bartoli, F, Crocamo, C, Dakanalis, A, et al. Association between total serum cholesterol and suicide attempts in subjects with major depressive disorder: exploring the role of clinical and biochemical confounding factors. Clin Biochem. 2017;50(6):274–278. doi:10.1016/j.clinbiochem.2016.11.035.CrossRefGoogle ScholarPubMed
Papadopoulou, A, Markianos, M, Christodoulou, C, Lykouras, L. Plasma total cholesterol in psychiatric patients after a suicide attempt and in follow-up. J Affect Disord. 2013;148(2–3):440–443. doi:10.1016/j.jad.2012.11.032.CrossRefGoogle ScholarPubMed
De Berardis, D, Marini, S, Piersanti, M, et al. The relationships between cholesterol and suicide: an update. ISRN Psychiatry. 2012;2012:387901. doi:10.5402/2012/387901.CrossRefGoogle ScholarPubMed
Lutz, PE, Mechawar, N, Turecki, G. Neuropathology of suicide: recent findings and future directions. Mol Psychiatry. 2017;22(10):1395–1412. doi:10.1038/mp.2017.141.CrossRefGoogle ScholarPubMed
Stenbacka, M, Jokinen, J. Violent and nonviolent methods of attempted and completed suicide in Swedish young men: the role of early risk factors. BMC Psychiatry. 2015;15:196. doi:10.1186/s12888-015-0570-2.CrossRefGoogle Scholar
Asellus, P, Nordström, P, Nordström, AL, Jokinen, J. Cholesterol and the "Cycle of Violence" in attempted suicide. Psychiatry Res. 2014;215(3):646–650. doi:10.1016/j.psychres.2014.01.009.CrossRefGoogle Scholar
Zatti, C, Rosa, V, Barros, A, et al. Childhood trauma and suicide attempt: a meta-analysis of longitudinal studies from the last decade. Psychiatry Res. 2017;256:353–358. doi:10.1016/j.psychres.2017.06.082.CrossRefGoogle ScholarPubMed
Asellus, P, Nordström, P, Nordström, AL, Jokinen, J. Plasma apolipoprotein E and severity of suicidal behaviour. J Affect Disord. 2016;190:137–142. doi:10.1016/j.jad.2015.09.024.CrossRefGoogle ScholarPubMed
Asellus, P, Nordström, P, Nordström, AL, Jokinen, J. CSF Apolipoprotein E in attempted suicide. J Affect Disord. 2018;225:246–249. doi:10.1016/j.jad.2017.08.019.CrossRefGoogle ScholarPubMed
Chatzittofis, A, Nordström, P, Hellström, C, Arver, S, Åsberg, M, Jokinen, J. CSF 5-HIAA, cortisol and DHEAS levels in suicide attempters. Eur Neuropsychopharmacol. 2013;23(10):1280–1287. doi:10.1016/j.euroneuro.2013.02.002.CrossRefGoogle ScholarPubMed
Walker, DJ, Spencer, KA. Glucocorticoid programming of neuroimmune function. Gen Comp Endocrinol. 2018;256:80–88. doi:10.1016/j.ygcen.2017.07.016.CrossRefGoogle ScholarPubMed
Song, K, Li, Y, Zhang, H, et al. Oxidative stress-mediated Blood-Brain Barrier (BBB) disruption in neurological diseases. Oxid Med. Cell Longev. 2020;2020:1–27. doi:10.1155/2020/4356386.Google Scholar
Pandey, GN, Rizavi, HS, Ren, X, et al. Proinflammatory cytokines in the prefrontal cortex of teenage suicide victims. J Psychiatr Res. 2012;46(1):57–63.CrossRefGoogle ScholarPubMed
Ucuz, İ, Kayhan Tetik, B. Can suicide behavior and seasonality of suicide be predicted from inflammatory parameters in adolescents? [published online ahead of print, 2020 Jul 4]. Med Hypotheses. 2020;143:110061. doi:10.1016/j.mehy.2020.110061.CrossRefGoogle ScholarPubMed
Keaton, SA, Madaj, ZB, Heilman, P, et al. An inflammatory profile linked to increased suicide risk. J Affect Disord. 2019;247:57–65. doi:10.1016/j.jad.2018.12.100.CrossRefGoogle ScholarPubMed
Buoli, M, Caldiroli, A, Guenzani, D, et al.; DREAM Project Group. Associations Between Cholesterol and Fatty Acid Profile on the Severity of Depression in Older Persons with Non-dialysis Chronic Kidney Disease. 2020 J Ren Nutr; In press.Google Scholar
Barzilay, R, Lobel, T, Krivoy, A, Shlosberg, D, Weizman, A, Katz, N. Elevated C-reactive protein levels in schizophrenia inpatients is associated with aggressive behavior. Eur Psychiatry. 2016;31:8–12. doi:10.1016/j.eurpsy.2015.09.461.CrossRefGoogle ScholarPubMed
Shields, GS, Moons, WG, Slavich, GM. Inflammation, self-regulation, and health: an immunologic model of self-regulatory failure. Perspect Psychol Sci. 2017;12(4):588–612. doi:10.1177/1745691616689091.CrossRefGoogle ScholarPubMed
Gassen, J, Prokosch, ML, Eimerbrink, MJ, et al. Inflammation predicts decision-making characterized by impulsivity, present focus, and an inability to delay gratification. Sci Rep. 2019;9(1):4928. doi:10.1038/s41598-019-41437-1.CrossRefGoogle Scholar
Gotovac, K, Vidović, A, Vukusić, H, et al. Natural killer cell cytotoxicity and lymphocyte perforin expression in veterans with posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34(4):597–604. doi:10.1016/j.pnpbp.2010.02.018.CrossRefGoogle ScholarPubMed
Bellavance, MA, Rivest, S. The HPA - immune axis and the immunomodulatory actions of glucocorticoids in the brain. Front Immunol. 2014;5:136. doi:10.3389/fimmu.2014.00136.CrossRefGoogle Scholar
Meng, X, Chang, Q, Liu, Y, et al. Determinant roles of gender and age on SII, PLR, NLR, LMR and MLR and their reference intervals defining in Henan, China: a posteriori and big-data-based. J Clin Lab Anal. 2018;32(2):e22228. doi:10.1002/jcla.22228.CrossRefGoogle ScholarPubMed
Demir, S, Atli, A, Bulut, M, et al. Neutrophil-lymphocyte ratio in patients with major depressive disorder undergoing no pharmacological therapy. Neuropsychiatr Dis Treat. 2015;11:2253–2258. doi:10.2147/NDT.S89470.Google ScholarPubMed
Tulgar, YK, Cakar, S, Tulgar, S, Dalkilic, O, Cakiroglu, B, Uyanik, BS. The effect of smoking on neutrophil/lymphocyte and platelet/lymphocyte ratio and platelet ındices: a retrospective study. Eur Rev Med Pharmacol Sci. 2016;20(14):3112–3118.Google ScholarPubMed
Zhao, L, Xu, T, Li, Y, et al. Variability in blood lipids affects the neutrophil to lymphocyte ratio in patients undergoing elective percutaneous coronary intervention: a retrospective study. Lipids Health Dis. 2020;19(1):124. doi:10.1186/s12944-020-01304-9.CrossRefGoogle ScholarPubMed
Vogelzangs, N, Beekman, AT, van Reedt Dortland, AK, et al. Inflammatory and metabolic dysregulation and the 2-year course of depressive disorders in antidepressant users. Neuropsychopharmacology. 2014;39(7):1624–1634.CrossRefGoogle ScholarPubMed
Furuncuoğlu, Y, Tulgar, S, Dogan, AN, Cakar, S, Tulgar, YK, Cakiroglu, B. How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study. Eur Rev Med Pharmacol Sci. 2016;20(7):1300–1306.Google ScholarPubMed
Roohafza, H, Khani, A, Afshar, H, Garakyaraghi, M, Amirpour, A, Ghodsi, B. Lipid profile in antipsychotic drug users: a comparative study. ARYA Atheroscler. 2013;9(3):198–202.Google ScholarPubMed
Pillinger, T, McCutcheon, RA, Vano, L, et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. Lancet Psychiatry. 2020;7(1):64–77. doi:10.1016/S2215-0366(19)30416-X.CrossRefGoogle ScholarPubMed
Chokka, P, Tancer, M, Yeragani, VK. Metabolic syndrome: relevance to antidepressant treatment. J Psychiatry Neurosci: JPN. 2006;31(6):414 Google ScholarPubMed
Post, RM, Ketter, TA, Uhde, T, & Ballenger, JC. 2007; Thirty years of clinical experience with carbamazepine in the treatment of bipolar illness: principles and practice. CNS Drugs. 21(1):47–71. doi:10.2165/00023210-200721010-00005.CrossRefGoogle ScholarPubMed
Spuch, C, López-García, M, Rivera-Baltanás, T, Rodrígues-Amorím, D, & Olivares, JM. Does lithium deserve a place in the treatment against COVID-19? A preliminary observational study in six patients, case report. Front Pharmacol. 2020;11:557629. doi:10.3389/fphar.2020.557629.CrossRefGoogle ScholarPubMed
Diaz-Sastre, C, Baca-Garcia, E, Perez-Rodriguez, MM, et al. Low plasma levels in suicidal males: a gender and body mass index-matched case-control study of suicide attempters and nonattempters. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2007;31:901–905.CrossRefGoogle ScholarPubMed
Xanthakis, V, Sung, JH, Samdarshi, TE, et al. Relations between subclinical disease markers and type 2 diabetes, metabolic syndrome, and incident cardiovascular disease: the Jackson Heart Study. Diabetes Care. 2015;38(6):1082–1088. doi:10.2337/dc14-2460.CrossRefGoogle ScholarPubMed
Liu, XL, He, S, Zhang, SF, et al. Alteration of lipid profile in subclinical hypothyroidism: a meta-analysis. Med. Sci. Mon Int Med J Exp Clin Res. 2014;20:1432–1441. doi:10.12659/MSM.891163.Google ScholarPubMed
Onalan, E, & Dönder, E Neutrophil and platelet to lymphocyte ratio in patients with hypothyroid Hashimoto's thyroiditis. Acta Bio-med Atenei Parmensis. 2020;91(2):310–314. doi:10.23750/abm.v91i2.8592.Google ScholarPubMed
Brinn, A, Stone, J. Neutrophil-lymphocyte ratio across psychiatric diagnoses: a cross-sectional study using electronic health records. BMJ Open. 2020;10(7):e036859. doi:10.1136/bmjopen-2020-036859.CrossRefGoogle ScholarPubMed