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Peer-reviewedCC BYFrontiers in immunology

Dynamic changes in CBC-derived inflammatory indices before and during acute coronary syndrome in patients with rheumatoid arthritis: a within-patient paired study

  • Yuwei Wang1
  • Yuying Zhang2
  • Jing Zhang3
  • Weiduo Nie4
  • Xiaolong Wang1
  • Fangcheng Su1
  • Sheng-Guang Li3
  • Yuanyuan Tang5
  • Di Jin2
5 affiliations
  1. 1Department of Emergency Internal Medicine, Weifang People’s Hospital , , ,
  2. 2Department of Rheumatology, Weifang People’s Hospital , ,
  3. 3Department of Rheumatology and Immunology, Peking University International Hospital , ,
  4. 4Dongfang Hospital, Beijing University of Chinese Medicine , ,
  5. 5Department of Rheumatology, Yidu Central Hospital of Weifang , , ,
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Abstract

Background: Rheumatoid arthritis (RA) is associated with excess cardiovascular risk, but within-patient changes in complete blood count (CBC)-derived inflammatory indices at the onset of acute coronary syndrome (ACS) are not well described. We compared pre-event and acute-phase values in the same patients and contextualized pre-event values against a healthy cohort.

Methods: This retrospective, single-center, within-patient paired study reviewed hospital records from July 1, 2018, to December 30, 2025 (approximately 90 months). Among 3,960 hospitalized patients with RA, 89 had clinician-confirmed ACS and qualifying paired CBC measurements. Acute-phase CBCs were obtained within 24 hours after symptom onset, and pre-event CBCs were the most recent routine measurements obtained more than 14 days before the event. The neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated and natural log-transformed. Pre-event values were also compared with a healthy cohort (n = 110), with age- and sex-adjusted analyses used because residual demographic imbalance was present.

Results: Pre-event log(NLR), log(SII), and log(SIRI) were higher in the RA cohort than in healthy controls and remained higher after adjustment for age and sex (all P< 0.001). Within-patient analyses showed increases during ACS, with mean Δlog values of 0.466 for NLR, 0.508 for SII, and 0.381 for SIRI (all Benjamini–Hochberg-adjusted q< 0.001). Neutrophilia increased from 11.2% before the event to 41.6% during ACS (McNemar P< 0.001). Exploratory subgroup estimates were heterogeneous and non-monotonic across several small strata; changes did not differ materially between remission/low and moderate/high RA activity groups.

Conclusion: Among patients with RA who developed ACS, CBC-derived inflammatory indices were higher than in a healthy comparison cohort before the event and increased further within the first 24 hours of ACS. The paired design quantifies change relative to each patient’s own pre-event value. Without a non-RA ACS comparator, however, the study cannot establish RA-specific inflammatory priming or a causal chronic-to-acute mechanism. Prospective studies with serial sampling and clinical outcomes are needed.

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Cite

BibTeXRIS
BibTeX
@article{wang2026dynamic,
  title = {{Dynamic changes in CBC-derived inflammatory indices before and during acute coronary syndrome in patients with rheumatoid arthritis: a within-patient paired study}},
  author = {Yuwei Wang and Yuying Zhang and Jing Zhang and Weiduo Nie and Xiaolong Wang and Fangcheng Su and Sheng-Guang Li and Yuanyuan Tang and Di Jin},
  journal = {Frontiers in immunology},
  year = {2026},
  month = sep,
  doi = {10.3389/fimmu.2026.1833991},
  url = {https://europepmc.org/article/PMC/PMC13662112},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Dynamic changes in CBC-derived inflammatory indices before and during acute coronary syndrome in patients with rheumatoid arthritis: a within-patient paired study
AU  - Yuwei Wang
AU  - Yuying Zhang
AU  - Jing Zhang
AU  - Weiduo Nie
AU  - Xiaolong Wang
AU  - Fangcheng Su
AU  - Sheng-Guang Li
AU  - Yuanyuan Tang
AU  - Di Jin
PY  - 2026
DA  - 2026/09/30
JO  - Frontiers in immunology
DO  - 10.3389/fimmu.2026.1833991
UR  - https://europepmc.org/article/PMC/PMC13662112
AB  - Background: Rheumatoid arthritis (RA) is associated with excess cardiovascular risk, but within-patient changes in complete blood count (CBC)-derived inflammatory indices at the onset of acute coronary syndrome (ACS) are not well described. We compared pre-event and acute-phase values in the same patients and contextualized pre-event values against a healthy cohort.  Methods: This retrospective, single-center, within-patient paired study reviewed hospital records from July 1, 2018, to December 30, 2025 (approximately 90 months). Among 3,960 hospitalized patients with RA, 89 had clinician-confirmed ACS and qualifying paired CBC measurements. Acute-phase CBCs were obtained within 24 hours after symptom onset, and pre-event CBCs were the most recent routine measurements obtained more than 14 days before the event. The neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated and natural log-transformed. Pre-event values were also compared with a healthy cohort (n = 110), with age- and sex-adjusted analyses used because residual demographic imbalance was present.  Results: Pre-event log(NLR), log(SII), and log(SIRI) were higher in the RA cohort than in healthy controls and remained higher after adjustment for age and sex (all P< 0.001). Within-patient analyses showed increases during ACS, with mean Δlog values of 0.466 for NLR, 0.508 for SII, and 0.381 for SIRI (all Benjamini–Hochberg-adjusted q< 0.001). Neutrophilia increased from 11.2% before the event to 41.6% during ACS (McNemar P< 0.001). Exploratory subgroup estimates were heterogeneous and non-monotonic across several small strata; changes did not differ materially between remission/low and moderate/high RA activity groups.  Conclusion: Among patients with RA who developed ACS, CBC-derived inflammatory indices were higher than in a healthy comparison cohort before the event and increased further within the first 24 hours of ACS. The paired design quantifies change relative to each patient’s own pre-event value. Without a non-RA ACS comparator, however, the study cannot establish RA-specific inflammatory priming or a causal chronic-to-acute mechanism. Prospective studies with serial sampling and clinical outcomes are needed.
SN  - 1664-3224
ER  -