Journal of affective disorders · 2026
Association between complete blood count-derived inflammatory markers and ADHD symptom trajectories in childhood: A prospective cohort study.
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Tang Qidi, Xie Xinyan, Xiong Ping, He Yuyang, Yang Yangyang, Tang Ruohan, Xiang Bing, Zhu Hongmin
Аннотация
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.
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.