Systemic Immune-Inflammation Index and Hematological Ratios as Indicators of Hepatic Dysfunction in Thalassemia-Associated Liver Disease

Tavga Ahmed Aziz; Shvan Burhan Rafiq; Hozan Jaza Hama Salh; Hero Khurshid Rashid; Lena Nawzad  Amin

doi:10.54133/ajms.v10i2.2883

Authors

Tavga Ahmed Aziz Department of Pharmacology and Toxicology, College of Pharmacy, University of Sulaimani, Kurdistan Region, Iraq https://orcid.org/0000-0003-2742-6127
Shvan Burhan Rafiq Department of Basic Science, College of Pharmacy, University of Sulaimani, Kurdistan Region, Iraq https://orcid.org/0009-0003-9657-5908
Hozan Jaza Hama Salh Department of Clinical Pharmacy, College of Pharmacy, University of Sulaimani, Kurdistan Region, Iraq https://orcid.org/0009-0003-1173-5512
Hero Khurshid Rashid Department of Basic Science, College of Pharmacy, University of Sulaimani, Kurdistan Region, Iraq https://orcid.org/0009-0000-2284-9847
Lena Nawzad Amin Department of Basic Science, College of Pharmacy, University of Sulaimani, Kurdistan Region, Iraq

DOI:

https://doi.org/10.54133/ajms.v10i2.2883

Keywords:

Liver disease, Neutrophil-to-lymphocyte ratio, Prothrombin time , Systemic inflammation, Systemic immune-inflammation index, Thalassemia

Abstract

Objective: This study aimed to investigate the relationship between systemic inflammatory biomarkers and clinical and biochemical indicators of liver dysfunction in patients with thalassemia-associated liver disease. Methods: A cross-sectional study was conducted involving 50 patients with thalassemia-associated liver disease. Demographic characteristics, hematological parameters, inflammatory biomarkers, and liver function tests were collected. Inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) were calculated from routine complete blood count parameters. Pearson correlation analysis was performed to evaluate associations between inflammatory biomarkers and indicators of hepatic dysfunction, including prothrombin time (PT) and international normalized ratio (INR). Multivariate regression analysis was applied to identify independent predictors of symptom burden. Results: The mean age of participants was 52.1±19.7 years, with a predominance of female patients. C-reactive protein (CRP) showed significant positive correlations with NLR (r=0.45, p=0.001), PLR (r=0.41, p=0.003), and SII (r=0.50, p<0.001) and a significant inverse correlation with LMR (r=−0.50, p<0.001). NLR exhibited a strong correlation with SII (r=0.91, p<0.0001). However, leukocyte-derived indices were not significantly associated with PT or INR. Both PT and INR correlated significantly with CRP and LMR. Multivariate analysis identified PT as the only independent predictor of symptom burden (p<0.0001). Conclusions: Inflammatory biomarkers reflect systemic immune activation in thalassemia-associated liver disease, whereas PT remains the most reliable indicator of disease severity. Integrating inflammatory indices with conventional liver function markers may improve clinical assessment.

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