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Published in: BMC Neurology 1/2023

Open Access 01-12-2023 | Multiple Sclerosis | Research

The role of systemic ımmune ınflammatory ındex in showing active lesion ın patients with multiple sclerosis

SII and other inflamatuar biomarker in radiological active multiple sclerosis patients

Authors: Seyda Figul Gokce, Asli Bolayır, Burhanettin Cigdem, Bulent Yildiz

Published in: BMC Neurology | Issue 1/2023

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Abstract

Background

Multiple sclerosis (MS) has two pathophysiological processes, one inflammatory and the other degenerative. We investigated the relationship between active lesions on magnetic resonance imaging showing the inflammatory phase in MS patients and serum parameters that can be used as inflammatory biomarkers. Thus, we aim to detect the inflammatory period in clinical and radiological follow-up and to reveal the period in which disease-modifying treatments are effective with serum parameters.

Methods

One hundred eighty-six MS patients presented to our hospital between January 2016 and November 2021 and 94 age- and sex-matched healthy volunteers were recruited for our study. While 99 patients had active lesions on magnetic resonance imaging, 87 patients did not have any active lesions. Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR) were determined. The SII (systemic immune inflammatory index) value was calculated according to the platelet X neutrophil/lymphocyte ratio formula.

Results

NLR, MLR, PLR and SII values were found to be statistically significantly higher in MS patients than in the control group. The NLR, MLR, PLR and SII were higher in the active group with gadolonium than in the group without active lesions. In addition, the cutoff values that we can use to determine the presence of active lesions were 1.53, 0.18, 117.15, and 434.45 for NLR, MLR PLR and SII, respectively.

Conclusions

We found that all parameters correlated with radiological activity. In addition, we showed that we can detect the inflammatory period with high sensitivity and specificity with the cutoff value used for SII and PLR. Among these easily accessible and inexpensive evaluations, we concluded that SII, including the values in the PLR formula, can come to the fore.
Literature
1.
2.
3.
4.
go back to reference Tintore M, Angela VJ, Sastre-Garriga J. Treatment of multiple sclerosis-success from bench to bedside. Nature Reviews Neurology. 2019;15(1):53–8.CrossRefPubMed Tintore M, Angela VJ, Sastre-Garriga J. Treatment of multiple sclerosis-success from bench to bedside. Nature Reviews Neurology. 2019;15(1):53–8.CrossRefPubMed
5.
go back to reference Confavreux C, Vukusic S, Moreau T, Adeleine P. Relapses and progression of disability in multiple sclerosis. N Engl J Med. 2000;343(20):1430–8.CrossRefPubMed Confavreux C, Vukusic S, Moreau T, Adeleine P. Relapses and progression of disability in multiple sclerosis. N Engl J Med. 2000;343(20):1430–8.CrossRefPubMed
6.
go back to reference Frohman EM, Racke MK, Raine CS. Multiple sclerosis-the plaque and its pathogenesis. N Engl J Med. 2006;354(9):942–55.CrossRefPubMed Frohman EM, Racke MK, Raine CS. Multiple sclerosis-the plaque and its pathogenesis. N Engl J Med. 2006;354(9):942–55.CrossRefPubMed
7.
go back to reference Perry VH, Cunningham C, Holmes C. Systemic infections and inflammation affect chronic neurodegeneration. Nat Rev Immunol. 2007;7(2):161–7.CrossRefPubMed Perry VH, Cunningham C, Holmes C. Systemic infections and inflammation affect chronic neurodegeneration. Nat Rev Immunol. 2007;7(2):161–7.CrossRefPubMed
9.
go back to reference Guzel I, Mungan S, Oztekin ZN, Fikri Ak. Is there an association between the Expanded Disability Status Scale and inflammatory markers in multiple sclerosis? J Chin Med Assoc. 2016;79(2):54–7.CrossRefPubMed Guzel I, Mungan S, Oztekin ZN, Fikri Ak. Is there an association between the Expanded Disability Status Scale and inflammatory markers in multiple sclerosis? J Chin Med Assoc. 2016;79(2):54–7.CrossRefPubMed
10.
go back to reference Gong P, Liu Y, Gong Y, Chen G, Zhang X, Wang S, et al. The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke. J Neuroinflammation. 2021;18(1):51.CrossRefPubMedPubMedCentral Gong P, Liu Y, Gong Y, Chen G, Zhang X, Wang S, et al. The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke. J Neuroinflammation. 2021;18(1):51.CrossRefPubMedPubMedCentral
11.
go back to reference Wang L, Wang C, Jia X, Yang M, Yu J. Relationship between Neutrophil-to-Lymphocyte Ratio and Systemic Lupus Erythematosus: A Meta-analysis. Clinics (Sao Paulo). 2020;17(75):e1450.CrossRef Wang L, Wang C, Jia X, Yang M, Yu J. Relationship between Neutrophil-to-Lymphocyte Ratio and Systemic Lupus Erythematosus: A Meta-analysis. Clinics (Sao Paulo). 2020;17(75):e1450.CrossRef
12.
go back to reference Lianos GD, Alexiou GA, Exarchos C, Rausei S, Mitsis M, Voulgaris S. Prognostic significance of neutrophil-to-lymphocyte ratio in several malignancies: where do we stand? Biomark Med. 2020;14(3):169–72.CrossRefPubMed Lianos GD, Alexiou GA, Exarchos C, Rausei S, Mitsis M, Voulgaris S. Prognostic significance of neutrophil-to-lymphocyte ratio in several malignancies: where do we stand? Biomark Med. 2020;14(3):169–72.CrossRefPubMed
13.
go back to reference Gelibter S, Pisa M, Croese T, Dalla Costa G, Orrico M, Preziosa P, et al. Neutrophil-to-lymphocyte ratio: a marker of neuro-inflammation in multiple sclerosis? J Neurol. 2021;268(2):717–23.CrossRefPubMed Gelibter S, Pisa M, Croese T, Dalla Costa G, Orrico M, Preziosa P, et al. Neutrophil-to-lymphocyte ratio: a marker of neuro-inflammation in multiple sclerosis? J Neurol. 2021;268(2):717–23.CrossRefPubMed
14.
go back to reference Hemond CC, Glanz BI, Bakshi R, Chitnis T, Healy BC. The neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are independently associated with neurological disability and brain atrophy in multiple sclerosis. BMC Neurology. 2019;19(1):1–10.CrossRef Hemond CC, Glanz BI, Bakshi R, Chitnis T, Healy BC. The neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are independently associated with neurological disability and brain atrophy in multiple sclerosis. BMC Neurology. 2019;19(1):1–10.CrossRef
15.
go back to reference López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Lazaro L, et al. Platelet-to-lymphocyte ratio differs between MS and NMOSD at disease onset and predict disability. Mult Scler Relat Disord. 2022;58:103507.CrossRefPubMed López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Lazaro L, et al. Platelet-to-lymphocyte ratio differs between MS and NMOSD at disease onset and predict disability. Mult Scler Relat Disord. 2022;58:103507.CrossRefPubMed
16.
go back to reference Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212–22.CrossRefPubMed Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212–22.CrossRefPubMed
17.
go back to reference Kim Y, Choi H, Jung SM, Song JJ, Park YB, Lee SW. Systemic immune-inflammation index could estimate the cross-sectional high activity and the poor outcomes in immunosuppressive drug-naïve patients with antineutrophil cytoplasmic antibody-associated vasculitis. Nephrology (Carlton). 2019;24(7):711–7.CrossRefPubMed Kim Y, Choi H, Jung SM, Song JJ, Park YB, Lee SW. Systemic immune-inflammation index could estimate the cross-sectional high activity and the poor outcomes in immunosuppressive drug-naïve patients with antineutrophil cytoplasmic antibody-associated vasculitis. Nephrology (Carlton). 2019;24(7):711–7.CrossRefPubMed
18.
go back to reference Pasquini L, Napolitano A, Visconti E, Longo D, Romano A, Tomà P, et al. Gadolinium-based contrast agent-related toxicities. CNS Drugs. 2018;32(3):229–40.CrossRefPubMed Pasquini L, Napolitano A, Visconti E, Longo D, Romano A, Tomà P, et al. Gadolinium-based contrast agent-related toxicities. CNS Drugs. 2018;32(3):229–40.CrossRefPubMed
19.
go back to reference Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–73.CrossRefPubMed Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162–73.CrossRefPubMed
20.
go back to reference Paty DW, Li DK. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology. 1993;43(4):655–61. Paty DW, Li DK. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis. I. Clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. The IFNB Multiple Sclerosis Study Group. Neurology. 1993;43(4):655–61.
21.
go back to reference Kolcava J, Hulova M, Rihova L, Bednarik J, Stourac P. The impact of lymphocytosis and CD4/CD8 ratio on the anti-JCV antibody index and clinical data in patients treated with natalizumab. Neurol Sci. 2021;42(7):2847–53.CrossRefPubMed Kolcava J, Hulova M, Rihova L, Bednarik J, Stourac P. The impact of lymphocytosis and CD4/CD8 ratio on the anti-JCV antibody index and clinical data in patients treated with natalizumab. Neurol Sci. 2021;42(7):2847–53.CrossRefPubMed
22.
go back to reference Demirci S, Demirci S, Kutluhan S, Koyuncuoglu HR, Yurekli VA. The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis. Int J Neurosci. 2016;126(8):700–6.PubMed Demirci S, Demirci S, Kutluhan S, Koyuncuoglu HR, Yurekli VA. The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis. Int J Neurosci. 2016;126(8):700–6.PubMed
23.
go back to reference Faul F, Erdfelder E, Buchner A, et al. Statistical power analyses using G*Power 31: Tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149–60.CrossRefPubMed Faul F, Erdfelder E, Buchner A, et al. Statistical power analyses using G*Power 31: Tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149–60.CrossRefPubMed
24.
go back to reference Giovannoni G, Miller D, Losseff N, Sailer M, Lewellyn-Smith N, Thompson AJ, et al. Serum inflammatory markers and clinical/MRI markers of disease progression in multiple sclerosis. J Neurol. 2001;248:487–95.CrossRefPubMed Giovannoni G, Miller D, Losseff N, Sailer M, Lewellyn-Smith N, Thompson AJ, et al. Serum inflammatory markers and clinical/MRI markers of disease progression in multiple sclerosis. J Neurol. 2001;248:487–95.CrossRefPubMed
25.
go back to reference Bisgaard AK, Pihl-Jensen G, Frederiksen JL. The neutrophil-to-lymphocyte ratio as disease actvity marker in multiple sclerosis and optic neuritis. Mult Scler Relat Disord. 2017;18:213–7.CrossRefPubMed Bisgaard AK, Pihl-Jensen G, Frederiksen JL. The neutrophil-to-lymphocyte ratio as disease actvity marker in multiple sclerosis and optic neuritis. Mult Scler Relat Disord. 2017;18:213–7.CrossRefPubMed
26.
go back to reference D’Amico E, Zanghì A, Romano A, Sciandra M, Palumbo GAM, Patti F. The Neutrophil-to-Lymphocyte Ratio is Related to Disease Activity in Relapsing Remitting Multiple Sclerosis. Cells. 2019;8(10):1114.CrossRefPubMedPubMedCentral D’Amico E, Zanghì A, Romano A, Sciandra M, Palumbo GAM, Patti F. The Neutrophil-to-Lymphocyte Ratio is Related to Disease Activity in Relapsing Remitting Multiple Sclerosis. Cells. 2019;8(10):1114.CrossRefPubMedPubMedCentral
27.
go back to reference Yetkin MF, Mirza M. Neutrophil to-lymphocyte ratio as a possible predictor of prognosis in recently diagnosed multiple sclerosis patients. J Neuroimmunol. 2020;26(346):577307.CrossRef Yetkin MF, Mirza M. Neutrophil to-lymphocyte ratio as a possible predictor of prognosis in recently diagnosed multiple sclerosis patients. J Neuroimmunol. 2020;26(346):577307.CrossRef
28.
go back to reference Huang WC, Lin HC, Yang YH, Hsu CW, Chen NC, Tsai WC, et al. Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are associated with a 2-year relapse in patients with multiple sclerosis. Mult Scler Relat Disord. 2022;58:103514.CrossRefPubMed Huang WC, Lin HC, Yang YH, Hsu CW, Chen NC, Tsai WC, et al. Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio are associated with a 2-year relapse in patients with multiple sclerosis. Mult Scler Relat Disord. 2022;58:103514.CrossRefPubMed
29.
go back to reference Li B, Zhou P, Liu Y, Wei H, Yang X, Chen T, et al. Platelet-to-lymphocyte ratio in advanced Cancer: Review and meta-analysis. Clin Chim Acta. 2018;483:48–56.CrossRefPubMed Li B, Zhou P, Liu Y, Wei H, Yang X, Chen T, et al. Platelet-to-lymphocyte ratio in advanced Cancer: Review and meta-analysis. Clin Chim Acta. 2018;483:48–56.CrossRefPubMed
30.
go back to reference Ravindra R, Ramamurthy P, Aslam SSM, Kulkarni AKS, Ramamurthy PS. Platelet Indices and Platelet to Lymphocyte Ratio (PLR) as Markers for Predicting COVID-19 Infection Severity. Cureus. 2022;14(8):e28206.PubMedPubMedCentral Ravindra R, Ramamurthy P, Aslam SSM, Kulkarni AKS, Ramamurthy PS. Platelet Indices and Platelet to Lymphocyte Ratio (PLR) as Markers for Predicting COVID-19 Infection Severity. Cureus. 2022;14(8):e28206.PubMedPubMedCentral
31.
go back to reference Dendrou CA, Fugger L, Friese MA. Immunopathology of multiple sclerosis. Nat Rev Immunol. 2015;15(9):545–58.CrossRefPubMed Dendrou CA, Fugger L, Friese MA. Immunopathology of multiple sclerosis. Nat Rev Immunol. 2015;15(9):545–58.CrossRefPubMed
33.
go back to reference Trapp BD, Nave KA. Multiple sclerosis: an immune or neurodegenerative disorder? Annu Rev Neurosci. 2008;31:247–69.CrossRefPubMed Trapp BD, Nave KA. Multiple sclerosis: an immune or neurodegenerative disorder? Annu Rev Neurosci. 2008;31:247–69.CrossRefPubMed
34.
go back to reference Naegele M, Tillack K, Reinhardt S, Schippling S, Martin R, Sospedra M. Neutrophils in multiple sclerosis are characterized by a primed phenotype. J Neuroimmunol. 2012;242(1–2):60–71.CrossRefPubMed Naegele M, Tillack K, Reinhardt S, Schippling S, Martin R, Sospedra M. Neutrophils in multiple sclerosis are characterized by a primed phenotype. J Neuroimmunol. 2012;242(1–2):60–71.CrossRefPubMed
35.
go back to reference Schett G. Rheumatoid arthritis and multiple sclerosis: direful siblings, different strategies. FEBS letters. 2011;585(239):3601–2.CrossRefPubMed Schett G. Rheumatoid arthritis and multiple sclerosis: direful siblings, different strategies. FEBS letters. 2011;585(239):3601–2.CrossRefPubMed
36.
go back to reference Gianni M, Annunziata P. Sjögren syndrome and multiple sclerosis: Two sides of the same coin? Autoimmunity Reviews. 2016;15(5):457–61.CrossRef Gianni M, Annunziata P. Sjögren syndrome and multiple sclerosis: Two sides of the same coin? Autoimmunity Reviews. 2016;15(5):457–61.CrossRef
37.
go back to reference Pierson ER, Wagner CA, Goverman JM. The contribution of neutrophils to CNS autoimmunity. Clin Immunol. 2018;189:23–8.CrossRefPubMed Pierson ER, Wagner CA, Goverman JM. The contribution of neutrophils to CNS autoimmunity. Clin Immunol. 2018;189:23–8.CrossRefPubMed
38.
go back to reference Prineas JW, Kwon EE, Cho ES, Sharer LR, Barnett MH, Oleszak EL, et al. Immunopathology of secondary-progressive multiple sclerosis. Ann Neurol. 2001;50(5):646–57.CrossRefPubMed Prineas JW, Kwon EE, Cho ES, Sharer LR, Barnett MH, Oleszak EL, et al. Immunopathology of secondary-progressive multiple sclerosis. Ann Neurol. 2001;50(5):646–57.CrossRefPubMed
39.
go back to reference Filippi M, Bar-Or A, Piehl F, Preziosa P, Solari A, Vukusic S, et al. Multiple sclerosis. Nat Rev Dis Primers. 2018;4:43.CrossRefPubMed Filippi M, Bar-Or A, Piehl F, Preziosa P, Solari A, Vukusic S, et al. Multiple sclerosis. Nat Rev Dis Primers. 2018;4:43.CrossRefPubMed
40.
go back to reference Kihara Y, Ishii S, Kita Y, Toda A, Shimada A, Shimizu T. Dual phase regulation of experimental allergic encephalomyelitis by platelet-activating factor. J Exp Med. 2005;202(6):853–63.CrossRefPubMedPubMedCentral Kihara Y, Ishii S, Kita Y, Toda A, Shimada A, Shimizu T. Dual phase regulation of experimental allergic encephalomyelitis by platelet-activating factor. J Exp Med. 2005;202(6):853–63.CrossRefPubMedPubMedCentral
41.
go back to reference Callea L, Arese M, Orlandini A, Bargnani C, Priori A, Bussolino F. Platelet activating factor is elevated in cerebral spinal fluid and plasma of patients with relapsing-remitting multiple sclerosis. J Neuroimmunol. 1999;94(1–2):212–21.CrossRefPubMed Callea L, Arese M, Orlandini A, Bargnani C, Priori A, Bussolino F. Platelet activating factor is elevated in cerebral spinal fluid and plasma of patients with relapsing-remitting multiple sclerosis. J Neuroimmunol. 1999;94(1–2):212–21.CrossRefPubMed
42.
go back to reference Lock C, Hermans G, Pedotti R, Brendolan A, Schadt E, Garren H, et al. Genemicroarray analysis of multiple sclerosis lesions yields new targets validated in autoimmune encephalomyelitis. Nat Med. 2002;8(5):500–8.CrossRefPubMed Lock C, Hermans G, Pedotti R, Brendolan A, Schadt E, Garren H, et al. Genemicroarray analysis of multiple sclerosis lesions yields new targets validated in autoimmune encephalomyelitis. Nat Med. 2002;8(5):500–8.CrossRefPubMed
43.
go back to reference Sotnikov I, Veremeyko T, Starossom SC, Barteneva N, Weiner HL, Ponomarev ED. Platelets Recognize Brain-Specific Glycolipid Structures, Respond to Neurovascular Damage and Promote. Neuroinflammation. 2014;9(1):10.1371. Sotnikov I, Veremeyko T, Starossom SC, Barteneva N, Weiner HL, Ponomarev ED. Platelets Recognize Brain-Specific Glycolipid Structures, Respond to Neurovascular Damage and Promote. Neuroinflammation. 2014;9(1):10.1371.
44.
go back to reference Hou D, Wang C, Luo Y, Ye X, Han X, Feng Y, et al. Systemic immune inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci. 2021;131(12):1203–8.CrossRefPubMed Hou D, Wang C, Luo Y, Ye X, Han X, Feng Y, et al. Systemic immune inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci. 2021;131(12):1203–8.CrossRefPubMed
45.
go back to reference Trifan G, Testai FD. Systemic immune-inflammation (SII) index predicts poor outcome after spontaneous supratentorial intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2020;29(9):105057.CrossRefPubMed Trifan G, Testai FD. Systemic immune-inflammation (SII) index predicts poor outcome after spontaneous supratentorial intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2020;29(9):105057.CrossRefPubMed
46.
go back to reference Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, et al. Prognostic value of systemic immune–inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol. 2020;5(4):368–73.CrossRefPubMedPubMedCentral Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, et al. Prognostic value of systemic immune–inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol. 2020;5(4):368–73.CrossRefPubMedPubMedCentral
47.
go back to reference Wu X, Wang H, Xie G, Lin S, Ji C. Increased systemic immune-inflammation index can predict respiratory failure in patients with Guillain-Barré syndrome. Neurol Sci. 2022;43(2):1223–31.CrossRefPubMed Wu X, Wang H, Xie G, Lin S, Ji C. Increased systemic immune-inflammation index can predict respiratory failure in patients with Guillain-Barré syndrome. Neurol Sci. 2022;43(2):1223–31.CrossRefPubMed
48.
go back to reference Li S, Zhang Q, Gao Y, Nie K, Liang Y, Zhang Y, et al. Serum Folate, Vitamin B12 Levels, and Systemic Immune-Inflammation Index Correlate With Motor Performance in Parkinson Disease: A Cross-Sectional Study. Front Neurol. 2021;12:665075.CrossRefPubMedPubMedCentral Li S, Zhang Q, Gao Y, Nie K, Liang Y, Zhang Y, et al. Serum Folate, Vitamin B12 Levels, and Systemic Immune-Inflammation Index Correlate With Motor Performance in Parkinson Disease: A Cross-Sectional Study. Front Neurol. 2021;12:665075.CrossRefPubMedPubMedCentral
49.
go back to reference Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB. Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol. 2017;16(7):564–70.CrossRefPubMed Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB. Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol. 2017;16(7):564–70.CrossRefPubMed
Metadata
Title
The role of systemic ımmune ınflammatory ındex in showing active lesion ın patients with multiple sclerosis
SII and other inflamatuar biomarker in radiological active multiple sclerosis patients
Authors
Seyda Figul Gokce
Asli Bolayır
Burhanettin Cigdem
Bulent Yildiz
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2023
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-023-03101-0

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