Changes in EASIX scores between acute psychotic episode and remission in patients with schizophrenia

Endothelial dysfunction and systemic inflammation are increasingly implicated in the pathophysiology of schizophrenia. The Endothelial Activation and Stress Index (EASIX), a composite marker derived from lactate dehydrogenase, creatinine and platelet count, reflects both processes but has not previously been investigated in schizophrenia. We aimed to investigate how EASIX and complete blood count-derived inflammatory indices changed between the acute psychotic and remission phases in the same patients.

In this retrospective study, the acute psychotic and remission phases of 83 patients with schizophrenia were evaluated. EASIX, sEASIX, their log₂-transformed values, and the NLR, PLR, MLR, SII and AISI values were compared between the two clinical states using paired-sample t-tests and Wilcoxon signed-rank tests.

Both EASIX and sEASIX were significantly higher in the acute psychotic episode compared with remission and stayed significant after Bonferroni correction (adjusted p = 0.018 and p = 0.014, respectively). Of the inflammatory indices, NLR remained significant after adjustment (adjusted p = 0.015) while SII was only significant in the unadjusted analysis (p = 0.037). There was no significant difference in PLR, MLR and AISI between the two clinical states.

EASIX and the selected inflammatory indices were at higher levels during the acute psychotic episode and decreased during the remission phase. EASIX may be a readily obtainable, low-cost candidate biomarker for disease activity in schizophrenia; however, a prospective validation study is required.