Gender differences in complete blood count and inflammatory ratios among patients with bipolar disorder

Laura Fusar-Poli, Andrea Amerio, Patriciu Cimpoesu, Pietro Grimaldi Filioli, Antimo Natale, Guendalina Zappa, Eugenio Aguglia, Mario Amore, Gianluca Serafini, Andrea Aguglia

Research output: Contribution to journalArticlepeer-review


Background: Evidence suggested that inflammation may be involved in the etiopathogenesis of bipolar disorder (BD), a chronic psychiatric condition affecting around 2-3% of the general population. However, little is known regarding potential gender differences in peripheral biomarkers of BD, such as neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and monocyte-to-lymphocyte (MLR) ratios. Methods: In total, 197 females and 174 males with BD in different phases (i.e., (hypo)mania, depression, euthymia) were recruited. A blood sample was drawn to perform a complete blood count (CBC). NLR, PLR, and MLR were subsequently calculated, and differences were computed according to the illness phase and gender. Results: PLR was consistently higher in (hypo)manic than depressed patients, in both males and females. No significant gender differences in PLR value were found when considering only (hypo)mania. Conversely, NLR was increased in (hypo)mania only among males, and gender differences were retrieved in the (hypo)manic subgroup. The findings related to MLR were only marginally significant. Higher platelets values were associated with (hypo)mania only in the female group. Basophils and eosinophils appeared gender-but not state-dependent. Conclusions: Our findings provide further evidence that increased PLR levels may be associated with (hypo)mania in bipolar patients, regardless of gender. Moreover, the usefulness of NLR as a peripheral biomarker of BD appeared limited to males while the role of platelets to females. As CBC represents a low-cost and easily accessible test, researchers should investigate in-depth its potential usefulness as a biomarker of BD and other psychiatric disorders.

Original languageEnglish
Article number363
JournalBrain Sciences
Issue number3
Publication statusPublished - Mar 2021


  • Biomarkers
  • Bipolar disorder
  • Eosinophils
  • Gender
  • Inflammation
  • Monocyte
  • Monocyte-to-lymphocyte
  • Neutrophil-to-lymphocyte
  • Platelet-to-lymphocyte
  • Platelets
  • Red blood cells

ASJC Scopus subject areas

  • Neuroscience(all)


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