Prognostic Factors Associating with Pro-oxidant-antioxidant Balance; Neutrophils to Lymphocytes Ratio, Vitamin D, Heat Shock Protein 27, and Red Cell Distribution Width

Abstract

Background: Several chronic diseases are mediated by oxidative stress. Oxidative stress affects cell morphology and function and is associated with alterations in the serum protein component. In the current study, we analyzed four individual prognostic factors associating with serum Pro-Oxidant-Antioxidant Balance (PAB): neutrophil to lymphocyte ratio (NLR), Vitamin D, anti-heat shock protein 27 (anti-hsp27) antibody titer, and red blood cell distribution width (RDW) to evaluate them as the potential prognostic markers. In the current study, we attempted to investigate the relationship between serum PAB, RDW, NLR, serum vitamin D and anti-hsp27 concentration.

Methods: A total of 852 participants (438 males and 414 females) aged 47.64 ± 7.77 years were recruited in a cross-sectional study based on the Mashhad stroke and heart atherosclerotic disorders (MASHAD) cohort study data. Hematological parameters, and vitamin D, PAB and anti-hsp27 antibody titers were measured using the Sysmex auto analyzer system and enzyme-linked immune sorbent assay (ELISA), respectively.

Results: The results showed a significant correlation between Vitamin D and anti-hsp27 antibody titers (r = -0.13 and p <0.001) as well as between RDW and serum PAB (r = 0.120 and p <0.001). Moreover, we found that serum PAB was positively associated with serum anti hsp27 antibody titers. The results showed increasing 1 unit of serum vitamin D can cause 3% decreases in anti hsp 27 values (OR = 0.97; CI 95% (0.96-0.99); p = 0.004). While this association was not significant for RDW, NLR and PAB (p >0.05) we found a significant association between serum PAB and serum anti hsp-27 antibody titers. Subjects with PAB levels 36.31-82.63 had a higher risk (1.83 fold) of having an increased anti-hsp27 antibody titers in comparison to the reference group (PAB level <36.31) (OR = 1.83 (95% CI = 1.33-2.52), p <0.001).

Conclusion: The present study shows that serum vitamin D can be associated with reduction in inflammatory status probably by decreasing levels of serum anti-hsp27 antibody titers, reduction in oxidative stress and therefore may reduce the risk of cardiovascular diseases. Anti-hsp27 antibody titers are associated with oxidative stress through the serum PAB, therefore these factors may be of prognostic values in detecting oxidative stress and risk of atherosclerosis. The evaluation of these factors in a larger population may help further confirm these findings.

Keywords: Neutrophil to lymphocyte ratio (NLR); Pro-oxidant-antioxidant balance (PAB); Red blood cell distribution width (RDW); Vitamin D; anti-hsp27.