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Association between complete blood count-derived inflammatory markers and ADHD symptom trajectories in childhood: A
Qidi Tang1, Xinyan Xie1, Ping Xiong2
1Research Center for Health Promotion in Women, Youth and Children, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan, China.
Objective:
This study aimed to identify distinct trajectories of inattention (IA), hyperactivity-impulsivity (HI), and oppositional defiant (OD) symptoms in children with ADHD and examine their associations with complete blood count (CBC)-derived inflammatory markers.
Methods:
A total of 757 children aged 6-16 years with ADHD were followed for two years. ADHD symptoms were assessed using the SNAP-IV parent rating scale at baseline, 12, and 24 months. Group-based trajectory modeling (GBTM) identified distinct trajectories. Fasting venous blood was used to calculate inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII). Multivariable logistic regression examined associations between these markers and trajectories.
Results:
Four trajectories were identified per domain. IA: moderate-declining (58%), stable-moderate (22%), persistent-mild (15%), and persistent-severe (5%). HI: moderate-high declining (37%), stable-mild (34%), sub-clinical stable (22%), and rapidly-improving (7%). OD: asymptomatic (28.3%), high-severity declining (27.9%), stable-moderate (25.6%), and persistent-mild (18.2%). Compared to the persistent-mild trajectory, both stable-moderate and persistent-severe IA trajectories were associated with higher baseline NLR (stable-moderate: OR = 1.58, 95% CI: 1.11, 2.26; persistent-severe: OR = 1.74, 95% CI: 1.06, 2.85) and SII (stable-moderate: OR = 1.47, 95% CI: 1.02, 2.11; persistent-severe: OR = 1.81, 95% CI: 1.07, 3.05). For OD, the stable-moderate trajectory (vs. asymptomatic) was associated with higher MLR (OR = 1.70, 95% CI: 1.01, 2.88) and SII (OR = 1.52, 95% CI: 1.01, 2.31). No significant associations were observed for HI trajectories (all P > 0.05).
Conclusion:
Distinct ADHD symptom trajectories were identified. NLR and SII were associated with specific IA trajectories, suggesting a potential link between systemic inflammation and ADHD symptom persistence.
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