Inflammatory Markers in Women with Infertility: A Cross-Sectional Study

Figures & data

Table 1 Baseline Characteristics of the Study Population

Characteristics	Total	Low-BMI Group	High-BMI Group	P-value
Quantity, n	320	158	162
Age (years, mean ± SD)	35.76 ± 4.69	35.66 ± 4.73	35.86 ± 4.67	0.704
BMI (kg/m^2, mean ± SD)	24.54 ± 3.85	21.59 ± 1.73	27.41 ± 3.11	<0.001
Menstrual pattern n (%)				0.161
Regularly	318 (99.38%)	158 (100.00%)	160 (98.77%)
Irregularly	2 (0.62%)	0 (0.00%)	2 (1.23%)
Menstrual flow volume n (%)				0.694
Light	3 (0.94%)	2 (1.27%)	1 (0.62%)
Moderate	314 (98.12%)	154 (97.47%)	160 (98.77%)
Heavy	3 (0.94%)	2 (1.27%)	1 (0.62%)
Dysmenorrhea n (%)				0.380
No	309 (96.56%)	154 (97.47%)	155 (95.68%)
Yes	11 (3.44%)	4 (2.53%)	7 (4.32%)
WBC (10^9/L, mean ± SD)	5.44 ± 1.65	5.16 ± 1.43	5.70 ± 1.80	0.003
Platelet Count (10^9/L, mean ± SD)	271.27 ± 62.97	258.96 ± 61.54	283.28 ± 62.20	<0.001
Lymphocyte Count (10^9/L, mean ± SD)	1.96 ± 0.54	1.86 ± 0.46	2.05 ± 0.58	0.002
Neutrophil Count (10^9/L, mean ± SD)	3.84 ± 1.60	3.48 ± 1.67	4.19 ± 1.46	<0.001
PLR	147.49 ± 49.13	148.25 ± 53.48	146.75 ± 44.64	0.786
NLR	2.12 ± 1.19	2.01 ± 1.18	2.22 ± 1.19	0.109

Abbreviations: BMI, body mass index; CI, confidence interval; WBC, white blood cell count; PLR, Platelet-Lymphocyte Ratio; NLR, Neutrophil-Lymphocyte Ratio; PCOS, polycystic ovary syndrome; TNF, tumor necrosis factor; CRP, C-reactive protein; MCP-1, monocyte chemoattractant protein-1; MIP-1α, macrophage inflammatory protein-1α; NOX, NADPH oxidases; SOD, superoxide dismutase.

Figure 1 Inclusion and exclusion criteria process.

Table 2 Univariate Analysis of PLR

Variable	Total β (95% CI) P-value	Low-BMI Group β (95% CI) P-value	High-BMI Group β (95% CI) P-value
Age (years, mean ± SD)	−0.34 (−1.49, 0.82) 0.5676	−1.18 (−2.94, 0.59) 0.1926	0.51 (−0.97, 1.99) 0.5020
BMI (kg/m^2, mean ± SD)	1.34 (−0.80, 3.48) 0.2198	−1.05 (−5.90, 3.80) 0.6719	2.06 (−0.14, 4.26) 0.0679
Menstrual pattern n (%)
Regularly	Reference		Reference
Irregularly	−30.99 (−99.63, 37.65) 0.3769		−30.99 (−93.25, 31.27) 0.3307
Menstrual flow volume n (%)
Light	Reference	Reference	Reference
Moderate	68.30 (12.67, 123.94) 0.0167	72.33 (−1.83, 146.50) 0.0578	60.41 (−27.40, 148.21) 0.1794
Heavy	60.44 (−17.82, 138.71) 0.1311	56.10 (−48.12, 160.31) 0.2930	69.13 (−54.65, 192.92) 0.2753
Dysmenorrhea n (%)
No	Reference	Reference	Reference
Yes	12.30 (−17.34, 41.94) 0.4166	7.12 (−46.12, 60.37) 0.7935	15.32 (−18.51, 49.15) 0.3762
WBC (10^9/L, mean ± SD)	−1.37 (−4.69, 1.96) 0.4206	−0.56 (−6.42, 5.30) 0.8517	−1.87 (−5.71, 1.97) 0.3413
Platelet Count (10^9/L, mean ± SD)	0.43 (0.36, 0.50) <0.0001	0.56 (0.45, 0.66) <0.0001	0.31 (0.21, 0.41) <0.0001
Lymphocyte Count (10^9/L, mean ± SD)	−62.83 (−70.39, −55.28) <0.0001	−81.12 (−93.94, −68.30) <0.0001	−51.59 (−60.30, −42.87) <0.0001
Neutrophil Count (10^9/L, mean ± SD)	4.09 (0.65, 7.52) 0.0203	6.99 (2.08, 11.90) 0.0059	0.36 (−4.39, 5.11) 0.8819
NLR	19.49 (15.46, 23.53) <0.0001	23.46 (17.36, 29.56) <0.0001	15.72 (10.45, 20.99) <0.0001

Abbreviations: BMI, body mass index; CI, confidence interval; WBC, white blood cell count; PLR, Platelet-Lymphocyte Ratio; NLR, Neutrophil-Lymphocyte Ratio; PCOS, polycystic ovary syndrome; TNF, tumor necrosis factor; CRP, C-reactive protein; MCP-1, monocyte chemoattractant protein-1; MIP-1α, macrophage inflammatory protein-1α; NOX, NADPH oxidases; SOD, superoxide dismutase.

Table 3 Relationship Between NLR and PLR in Different Models

Variable	Crude Model β (95% CI) P-value	Model I β (95% CI) P-value
Total	19.49 (15.46, 23.53) <0.0001	19.48 (15.43, 23.53) <0.0001
Low-BMI group	23.46 (17.36, 29.56) <0.0001	23.24 (17.11, 29.36) <0.0001
High-BMI group	15.72 (10.45, 20.99) <0.0001	15.83 (10.56, 21.11) <0.0001

Note: Model I adjusted for age.

Abbreviations: BMI, body mass index; CI, confidence interval; WBC, white blood cell count; PLR, Platelet-Lymphocyte Ratio; NLR, Neutrophil-Lymphocyte Ratio; PCOS, polycystic ovary syndrome; TNF, tumor necrosis factor; CRP, C-reactive protein; MCP-1, monocyte chemoattractant protein-1; MIP-1α, macrophage inflammatory protein-1α; NOX, NADPH oxidases; SOD, superoxide dismutase.

Table 4 Threshold Effect Analysis of the Relationship Between NLR and PLR

Adjusted Indicators	NLR β (95% CI) P-value
Model I
One linear effect	19.26 (15.23, 23.30) <0.0001
Model II
Break point (k)	2.69
<k segment effect 1	33.38 (23.93, 42.82) <0.0001
>k segment effect 2	9.89 (2.95, 16.83) 0.0056
Effect difference between 2 and 1	−23.49 (−37.75, −9.23) 0.0014
Predicted value of equation at break point	173.02 (162.82, 183.22)
LRT test	0.001

Notes: (P < 0.05 denotes that Model II significantly differs from Model I, revealing a nonlinear relationship) Adjusted variables: age. P<0.05 is significant.

Abbreviations: Model I, linear analysis; Model II, nonlinear analysis; LRT test, logarithmic likelihood ratio test.

Figure 2 Association between NLR and PLR in the total study population (mmol/L). Figure 2 shows the smooth fitting curve of NLR and PLR. The solid red line represents the smooth curve fit between the variables. Blue bands represent the 95% confidence interval of the fit. The model was adjusted for age.

Figure 3 Association between NLR and PLR in the Low-BMI group study population (mmol/L). Figure 3 shows the smooth fitting curve of NLR and PLR. The solid red line represents the smooth curve fit between the variables. Blue bands represent the 95% confidence interval of the fit. The model was adjusted for age.

Figure 4 Association between NLR and PLR in the High-BMI group study population (mmol/L). Figure 4 shows the smooth fitting curve of NLR and PLR. The solid red line represents the smooth curve fit between the variables. Blue bands represent the 95% confidence interval of the fit. The model was adjusted for age.