The relationship of vitamin D levels with hemogram indices and metabolic parameters in patients with type 2 diabetes mellitus

To study haemogram derived inflammatory indices, mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil to lymphocyte ratio (NLR) in vitamin D deficient patients and to compare to those subjects with normal vitamin D levels. Descriptive study. Abant Izzet Baysal University Hospital, Bolu, Turkey, from March to May 2017. Patients' data visiting the outpatient clinics of the institution was retrospectively obtained from patients' files and computerised database. Subjects were grouped into normal vitamin D and vitamin D deficiency groups, according to the serum Vitamin D levels. Seasonal threshold value for vitamin D in Bolu region was set as 10 ng/ml. General characteristics and laboratory data of the study population were recorded and compared. Vitamin D deficiency was more common in subjects working inside as compared to those working outside (p=0.02), and in subjects with comorbidities compared to those without comorbidities (p=0.31). Body mass index (BMI), MPV, NLR were significantly higher in vitamin D deficient group as compared to subjects with normal vitamin D levels. A MPV greater than 6.22 has 89% sensitivity and 55% specifity for vitamin D deficiency, and NLR greater than 1.69 has 76% sensitivity and 55% specifity for vitamin D deficiency. Elevated MPV and NLR may be the indicator of underlying serious vitamin D deficiency. Physicians should be alert and order a vitamin D assay in patients with elevated MPV or NLR, especially in endemic areas for vitamin D deficiency.

Background The purpose of our study is to evaluate the association of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) with hormonal and metabolic parameters in patients with polycystic ovarian syndrome (PCOS) in order to assess whether these ratios may become useful tools during the evaluation of the severity of low grade inflammation. Methods The present study is based in secondary outcomes from a prospectively collected patient database. A total of 266 women with PCOS participated in this study and blood a complete blood count examination (CBC) that was used for the calculation of PLR and NLR was available in 182 patients. Results Association statistics revealed that PLR had a significant correlation to 17-OH progesterone (r = -0.177, p = 0.024) and Matsuda index values (r = 0.234, p = 0.009), whereas NLR was correlated with follicle stimulating hormone (FSH) (r = -0.204, p = 0.007), free testosterone (r = 320, p < 0.001), Δ4-androstendione (r = 0.234, p = 0.003), sex hormone binding globulin (SHBG) (r = -0.350, p < 0.002) and high-density lipoprotein (HDL) (r = -0.171, p = 0.039). Conclusion According to the findings of our study, both PLR and NLR seem to be correlated with some hormonal and metabolic indices. This association is clearer in the case of NLR and serum androgens as it seems to be positively affected by their levels. PLR and NLR were not affected by the presence of obesity.

BackgroundSystemic inflammation is predictive of the overall survival in cancer patients and is related to the density of immune cells in the tumor microenvironment of cancer, which in turn correlates with 18F -fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) metabolic parameters (MPs). The density of tumor-infiltrating lymphocytes (TILs) in the microenvironment has the potential to be a biomarker that can be used clinically to optimize patient selection in oropharyngeal head and neck squamous cell carcinoma (HNSCC). There is little to no data regarding the association of systemic inflammation with PET/CT-MPs, especially in HNSCC. This study aimed to evaluate the correlation between markers of host inflammation, namely blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), with the PET/CT-MPs standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor, derived from FDG-PET/CT in patients with nonmetastatic (cM0) HNSCC before treatment. We hypothesized that NLR and PLR at baseline are positively correlated with PET/CT-MPs.MethodsA retrospective review of consecutive patients with HNSCC with a pretreatment PET/CT was performed. NLR and PLR were computed using complete blood counts measured within 10 days before the start of any treatment. The correlation between NLR and PLR with PET/CT-MPs was evaluated with Spearman's rho test.ResultsSeventy-one patients were analyzed. Overall survival (OS) at 1, 2, and 3 years was 86%, 76%, and 68%. PLR was found to be correlated with MTV (rho = 0.26, P = .03) and TLG (rho = 0.28, P = .02) but not with maximum SUV or mean SUV. There was no correlation between NLR and the analyzed PET/CT-MPs. TLG was associated with worse survival in uni- and multivariable analysis, but no other PET/CT-MPs were associated with either OS or disease-specific survival (DSS). NLR and PLR were associated with OS and DSS on uni- and multivariable analysis.ConclusionsIn patients with HNSCC before any treatment such as definitive radio (chemo)therapy or oncologic surgery followed by adjuvant RT, baseline PLR correlated with MTV and TLG but not with SUV. NLR was not correlated with any PET/CT-MPs analyzed in our study. Confirmatory studies are needed, and a potential interaction between tumor microenvironment, host inflammation, and FDG-PET/CT measures warrants further investigation.

Gouty arthritis (GA) is an inflammatory disease, and renal impairment may occur to varying degrees with the progress of disease. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker. In this study, we aimed to explore the association between NLR and renal impairment in GA. The subjects comprised 499 patients with gouty arthritis (GA) (473 men, 26 women; age range, 39-61years old) from our hospital. They were divided into a chronic kidney disease (CKD) group (n = 206) and non-CKD group (n = 293) according to the glomerular filtration rate. Blood samples were collected during the gout flares. The differences in NLR, general data, and laboratory indexes of patients with GA between the two groups were compared, such as serum uric acid (SUA), serum creatinine (SCREA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). NLR (3.38 vs. 2.38 (p < 0.001)) was higher in the CKD group, compared to the non-CKD group. Similarly, both SUA (527 vs. 507 (p < 0.05)) and SCREA (122 vs. 87 (p < 0.001)) were higher in the CKD group than in the non-CKD group. Multivariate logistic regression analysis showed that NLR (OR = 1.122, p < 0.05), age, hypertension, and SUA were risk factors for CKD in patients with GA, although HDL and HGB were protective factors. The receiver operating characteristic (ROC) curve analysis indicated that the area under the curve of NLR for predicting CKD in patients with GA was 0.646 (95% CI 0.597-0.694). Our data showed that NLR might be an important potential factor for evaluating renal impairment in GA during flares.

Aim Hemogram indices were proposed as novel inflammatory markers in chronic conditions and inflammation has substantial role in the pathogenesis of type 2 diabetes mellitus (T2DM). We aimed to observe hemogram parameters of type 2 diabetic male subjects with various age groups in well and poorly controlled subsets. Methods Data of type 2 diabetic men enrolled to the study were recorded from patient files of the institution. Study population were grouped into three according to the age. Group A was consisted of patients younger than 55 years, Group B was consisted of patients aged between 55 and 64 years, and Group C was consisted of patients aged 65 years or older. Data of the study groups were compared. Results Study population was consisted of 130 subjects; 44 in Group A and 43 in each of Groups B and C. Median red cell distribution width (RDW) (p = .04), mean RDW to platelet ratio (RPR) (p = .006), median mean platelet volume to platelet ratio (MPR) (p = .02) levels of the study groups were statistically different. HbA1c level was significantly and positively correlated with RDW (r = 0.45, p < .001), neutrophil to lymphocyte ratio (NLR) (r = 0.47, p < .001), mean platelet volume to lymphocyte ratio (MLR) (r = 0.35, p < .001), MPR (r = 0.26, p = .003), and RPR (r = 0.37, p < .001) levels. Conclusion Elevated RDW, NLR, MLR, MPR, and RPR levels in diabetic men should trigger the measurement of HbA1c since each were strongly correlated with HbA1c level. Moreover, elevated RDW, NLR, MLR, and RPR could be marker of worse diabetic control in men with T2DM.

Correlation of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with metabolic parameters in patients undergoing sleeve gastrectomy.

Objective To evaluate the value of plasma soluble suppression of tumotigenicity 2 (sST2) combined with Gensini score in patients with acute coronary syndrome (ACS). Methods From January to May 2018, 135 patients to be diagnosed with ACS in Xuzhou Central Hospital were selected as the subjects. They were divided into an ACS group (108 cases) and a control group (27 cases) according to their clinical manifestations, electrocardiogram, myocardial necrosis markers and coronary angiography results. Patients in the ACS group were further divided into an unstable angina (UA) group (21 cases), a non-ST-segment elevation myocardial infarction (NSTEMI) group (26 cases) and a ST-segment elevation myocardial infarction (STEMI) group (61 cases). The general data, creatinine, lipoprotein a, high density lipoprotein (HDL), low density lipoprotein (LDL), cystatin, Gensini score, uric acid, neutrophil to lymphocyte ratio (NLR) and sST2 of patients were compared. The predictive values of Gensini score, NLR, sST2, and sST2 combined with Gensini score for ACS patients were analyzed using the receiver operating characteristic (ROC) curve, and the areas under the curve (AUC) were compared using the Z-test. Results There were significant differences in the levels of Gensini score [(66 ± 43) vs. (21 ± 6)], NLR [(4.8 ± 2.8) vs. (2.2 ± 0.8)] and sST2 [(61.2 ± 44.8) mg/L vs. (31.0 ± 8.7) mg/L] between the ACS group and control group (t = 9.385, 6.323, 5.563; all P < 0.001). In addition, the Gensini score [(28 ± 11), (59 ± 23), (82 ± 48)], NLR [(2.3 ± 0.9), (4.6 ± 2.6), (5.7 ± 2.8)] and sST2 [(30.2 ± 1.4) mg/L, (51.5 ± 1.6) mg/L, (72.7 ± 2.1) mg/L] in the UA group, NSTEMI group and STEMI group were significantly different (F = 16.655, 14.678, 7.498; all P < 0.001). Further pairwise comparison showed that the Gensini score, NLR and sST2 in NSTEMI and STEMI groups were all significantly higher than those in the UA group (all P < 0.05). The Gensini score and sST2 in the STEMI group were significantly higher than those in the NSTEMI group (both P < 0.05). The Gensini score, NLR, sST2, and sST2 combined with Gensini score were included in the ROC curve which showed that the Gensini score [AUC = 0.903, 95% confidence interval (CI) (0.874, 0.980)], NLR [AUC = 0.825, 95%CI (0.724, 0.926)], sST2 [AUC = 0.799, 95%CI (0.667, 0.931)], and sST2 combined with Gensini score [AUC = 0.933, 95%CI (0.884, 0.981)] all had predictive values for ACS (all P < 0.001). Furthermore, there were significant differences in AUCs between sST2 combined with Gensini score and Gensini score, NLR, sST2 (Z = 3.783, 5.271, 5.682; P = 0.036, 0.013, 0.004). Conclusion sST2 combined with Gensini score can enhance the predictive value for ACS patients, which is better than using the sST2 or Gensini score alone. Key words: Acute coronary syndrome; Acute myocardial infarction; Soluble suppression of tumotigenicity 2; Gensini score

Background Non-alcoholic fatty liver disease (NAFLD) is a chronic inflammatory disease with excessive fat accumulation in the liver. Fibroscan with controlled attenuation parameter (CAP), a noninvasive imaging procedure in diagnosis of NAFLD patients. Also Neutrophil / lymphocyte ratio (NLR) is a simple marker for inflammation, may be used to predict disease outcome. Objectives Is to determine whether there is a correlation between NLR and the degree of steatosis and fibrosis measured by fibroscan with CAP, FIB-4 and FIB-5 score. Patients and Methods This was a cross sectional study involving 2 groups, group (1): included 115 patients of NAFLD and group (2): included 30 healthy controls. All participants were supjected to complete personal and medical history (history of other comorbidities as DM, Hypertension syndrome and drug/herb intake). Complete physical examination including anthropometric measurements, vital signs, local examination and general examination of any signs of liver dysfunction as hepatomegaly, Jaundice, ascites, splenomegaly and varices. Laboratory tests including (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), Bilirubin, hemoglobin A1c, fasting glucose level, Lipid profile, Antinuclear antibody (ANA) test (to exclude autoimmune hepatitis), serum Uric acid and viral markers (HBsAg &amp; Hcv Ab), Abdominal ultrasound, Fibroscan with CAP and FIB-4 and FIB -5 scoring, complete blood count with calculation of neutrophils /lymphocytes ratio(NLR). Results Both studied groups were comparable in age and sex distribution. Out of NAFLD cases (group 1), more than half (53.9%) had comorbidities (manifested as DM in 37.4%, hypertension in 36.5%, CVD in 8.7% and hypothyroidism in 1.7% of patients), there was no statistically significant difference between the studied groups regarding anthropometric measurements, NAFLD cases (group 1) had significantly lower Hb, HDL level and PLT p value &amp;lt;0.001 and higher NLR, ALT, AST, GGT, cholesterol, triglycerides and LDL levels p &amp;lt; 0.001,there was a significant positive correlation between NLR and each of steatosis and fibrosis p &amp;lt; 0.001,NLR was significantly positively correlated with FIB-4 (r = 0.667, P &amp;lt; 0.001) and FIB-5 (r = 0.361, P &amp;lt; 0.001), NLR was a significant predictor of hepatic steatosis (AUC= 0.816, P = 0.011) and fibrosis (AUC=0.739, P &amp;lt; 0.001) in NAFLD cases. Conclusion The study conducted on NAFLD patients at Ain Shams University Hospital found significant associations between NLR and liver steatosis/fibrosis. NLR proved to be a valuable predictor, with optimal cutoff values for steatosis and fibrosis, aiding in noninvasive assessment and management of NAFLD patients.

Objective To investigate the differential effect of neutrophil to lymphocyte ratio (NLR) at admission on large artery atherosclerosis (LAA) and small vessel occlusion (SVO) in patients with minor stroke. Methods Patients with first-ever acute ischemic stroke registered in Nanjing Stroke Registration System were enrolled retrospectively. Minor stroke was defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤3. Binary logistic regression was used to evaluate the independent relationship between NLR and LAA. Results A total of 417 patients with minor stroke were included, of which 242 were in a LAA group and 175 were in a SVO group. Univariate analysis showed that there were significant differences in leukocyte count, neutrophil count, lymphocyte count, NLR, glycosylated hemoglobin, high-density lipoprotein cholesterol, onset to treatment time, and onset to NLR detection time between the patients of the LAA group and the SVO group (all P<0.05). Binary logistic regression analysis suggested that after adjusting for sex and high-density lipoprotein cholesterol, NLR (with the highest quartile as a reference, the first quartile: odds ratio [OR] 0.207, 95% confidence interval [CI] 0.089-0.482; P<0.001; the second quartile: OR 0.277, 95% CI 0.122-0.625, P=0.002; the third quartile: OR 0.456, 95% CI 0.197-1.057; P=0.067), onset to NLR detection time (OR 1.216, 95% CI 1.038-1.424; P=0.015), and glycosylated hemoglobin (OR 1.414, 95% CI 1.142-0.751; P=0.002) were independently associated with LAA. The area under the ROC curve of NLR predicting the LAA was 0.611 in patients admitted within 7 d after onset, and was 0.673 in patients admitted within 24 h after onset. Conclusions The increased NLR was independently associated with the LAA in patients with minor stroke. Early NLR value may have higher predictive value for LAA. Key words: Stroke; Brain Ischemia; Severity of Illness Index; Neutrophils; Lymphocytes; Atherosclerosis; Cerebral Small Vessel Diseases; Risk Factors

Patients with psoriasis have increased systemic inflammation and serum uric acid (SUA) levels compared with the general population. However, the role of SUA in modulating inflammation in these patients is not known. We evaluated the associations of SUA with inflammation and psoriasis severity; 199 patients with psoriasis and 54 healthy volunteers were included in the study. Demographic features, Psoriasis Area and Severity Index (PASI) scores, and laboratory data including SUA, C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) were collected. Patients with psoriasis had higher fasting blood glucose, body mass index (BMI), CRP, SUA, white blood cell (WBC) count, neutrophil count, and NLR compared with controls. The PASI score positively correlated only with CRP ( r = .185, P = .012) and NLR ( r = .313, P < .001). The BMI, WBC count, PASI score, and CRP, but not SUA, appeared as independent associates of NLR in patients with psoriasis in linear regression analysis. Neutrophil to lymphocyte ratio and SUA were significantly increased in patients with psoriasis compared with controls. Neutrophil to lymphocyte ratio and CRP were independent predictors of PASI score, whereas SUA was not. Serum uric acid seemed not to modulate the inflammation seen in patients with psoriasis in our cohort.

IntroductionAssociation of vitamin D, inflammation and endothelial dysfunction, beside the classic bone metabolism disorders, may explain the pathogenesis of numerous diseases associated with vitamin D deficiency. While large numbers of reports support the relationship of vitamin D with inflammation, several reports fail to confirm this relationship. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel and inexpensive markers of inflammation that can be studied in all centers. The goal of this study was to investigate the association between 25-hydroxy vitamin D (25(OH)D) and inflammation with the novel inflammatory markers NLR and PLR.Material and methodsThis study was performed retrospectively. Results of the simultaneously performed 25(OH)D, parathyroid hormone, albumin, calcium, phosphorus, alkaline phosphatase and creatinine level measurements and complete blood count were recorded. The data of 4120 patients were included in the study.ResultsBetween vitamin D deficient and non-deficient groups there were significant differences in PLR (p < 0.001) and NLR (p = 0.001). Vitamin D had a significant negative correlation with PLR (p < 0.001) and NLR (p < 0.001). Multiple regression analysis indicated that 25(OH)D was independently and negatively correlated with PLR (OR = 0.994, 95% CI 0.991–0.998, p = 0.02).ConclusionsPlatelet-to-lymphocyte ratio and NLR were significantly associated with 25(OH)D levels, and PLR was found to be an independent predictor of 25(OH)D levels. Our study revealed an inverse association of vitamin D levels and inflammation with these inexpensive and universally available markers.

To explore the correlation between left atrial thrombosis and peripheral blood neutrophil-to-lymphocyte ratio (NLR) in patients with non-valvular atrial fibrillation (NVAF). A total of 207 NVAF patients treated from March 2016 to August 2020 were divided into low and high NLR groups. Their clinical data were compared, and the correlations of NLR with clinical indicators and left atrial thrombosis were analyzed. The influencing factors for left atrial thrombosis and their predictive values were investigated. CHADS2 score, CHA2DS2-VASc score, NLR, D-dimer (D-D), serum uric acid (SUA), brain natriuretic peptide (BNP), C-reactive protein (CRP), left atrial dimension (LAD) and ratio of early mitral diastolic flow peak value to early diastolic mitral annular velocity (E/Em) increased, while left atrial ejection fraction (LAEF) decreased in high NLR group compared with those in low NLR group (p < 0.05). NLR was significantly positively correlated with the CHADS2 score, CHA2DS2-VASc score, D-D, SUA, BNP, CRP, LAD and E/Em, and significantly negatively correlated with LAEF (p < 0.0001). Left atrial thrombosis had positive correlations with CHADS2 score, CHA2DS2-VASc score, NLR, D-D, SUA, BNP, CRP, LAD and E/Em, and negative correlation with LAEF (p = 0.000). CHA2DS2-VASc score, NLR, D-D and LAD were risk factors for left atrial thrombosis (p < 0.05). The optimal cut-off value was 1.85 when the area under the curve of NLR for predicting left atrial thrombosis in the case of NVAF was 0.806 [95% confidence interval (CI): 0.746 - 0.865], the sensitivity was 74.82% (95% CI: 0.668 -0.818) and the specificity was 67.65% (95% CI: 0.552 - 0.785). The increase of NLR prominently elevates the risk of left atrial thrombosis in NVAF patients, and NLR was an independent risk factor, with certain predictive value.

To evaluate the correlation of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) with parameters related to gout activity. The general data of the patients and healthy controls (HCs), including complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum uric acid (SUA), and the presence of tophi were retrospectively analyzed. NLR, MPV, and PLR were calculated in patients with intercritical gout and gout flares. Correlation of the 3 markers with clinical features, like ESR, CRP, SUA, and the presence of tophi, were analyzed. The results revealed that NLR and PLR were elevated and MPV was markedly decreased in patients with gout compared with HCs (all P < .05). In patients with gout flares, NLR, and PLR were higher and MPV was lower than in intercritical gout patients (all P < .05). NLR and PLR were positively correlated with ESR and CRP, whereas MPV was negatively correlated with ESR. NLR, PLR, and MPV showed no obvious correlation with SUA and the presence of tophi. The receiver operating characteristic curve showed that NLR was more valuable in assessing gout disease activity. NLR, PLR, and MPV were correlated with inflammatory parameters in gout; they may be used as complementary tools to evaluate gout activity.

Objective To investigate the relationship between neutrophil to lymphocyte ratio (NLR) and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus. Methods The clinical data of 117 patients with type 2 diabetes mellitus from January 2016 to June 2017 in Anhui No.2 Provincial People′s Hospital were analyzed retrospectively. According to the eGFR level, the patients were divided into 3 groups: eGFR ≥ 90 ml/(min·1.73 m2) in 68 cases (DM0 group), eGFR 60 to 89 ml/(min·1.73 m2) in 33 cases (DM1 group), and eGFR<60 ml/(min·1.73 m2) in 16 cases (DM2 group). In addition, 30 healthy people in the same period were selected as control group (NC group), eGFR ≥ 90 ml/(min·1.73 m2). The systolic blood pressure, diastolic blood pressure, blood routine, glycosylated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), urea nitrogen, creatinine and uric acid were recorded; and the NLR was calculated. The influencing factors of eGFR in patients with type 2 diabetic mellitus were analyzed, and the relationship between NLR and eGFR was evaluated. Results Compared with that in NC group and DM0 group, the eGFR in DM1 group and DM2 group was significantly lower: (75.12 ± 8.14) and (46.31 ± 13.25) ml/(min·1.73 m2) vs. (114.17 ± 12.21) and (113.21 ± 12.04) ml/(min·1.73 m2), the NLR was significantly higher: 2.50 ± 1.16 and 2.75 ± 1.39 vs. 1.53 ± 0.22 and 1.83 ± 0.65, and there were statistical differences (P 0.05). Correlation analysis result showed that NLR, age, course of disease, systolic blood pressure, TC, HDL-C, urea nitrogen, creatinine and uric acid were negatively correlated with eGFR (r=-0.415, -0.555, -0.491, -0.432, -0.259, -0.237, -0.584, -0.840 and -0.261; P 0.05). Multiple linear regression analysis result showed that NLR, age, TC, creatinine and systolic blood pressure were independent risk factors of eGFR in patients with type 2 diabetes mellitus (P<0.01 or < 0.05). Conclusions There is a close relationship between the increase of NLR and the decrease of eGFR in patients with type 2 diabetes mellitus. Monitoring NLR is helpful to understand the changes of eGFR in patients with type 2 diabetes mellitus. Key words: Diabetes mellitus, type 2; Glomerular filtration rate; Retrospective studies; Neutrophil to lymphocyte ratio

High levels of serum inflammatory markers are related to extended hospitalisation and more severe disease in the case of tubo-ovarian abscess (TOA). There is scarce information on the serial measurement of inflammatory markers during the postoperative follow-up period of surgically treated TOA. The present study aimed to assess the postoperative longitudinal changes in serum inflammatory markers following surgery for TOA. In this retrospective cohort study, patients who underwent surgery for TOA between January 2010 and March 2020 were reviewed. All inflammatory markers peaked within 48 hours after surgical intervention and then declined with time. The predicted mean of white blood cell count (WBC) to return to normal was 2.5 days (95% CI: 1.0–4.3), which was followed by neutrophil to lymphocyte ratio (NLR) (7.1 days, 95% CI: 4.7–10.8) and C-reactive protein (CRP) (+14 days). In conclusion, serum inflammatory markers increase in the very early post-operative period. While the normalisation period is very slow, it may not be appropriate to use CRP for evaluating the treatment success of TOA surgery. However, WBC and NLR measurements might be useful for follow-up and predicting the need for medical or surgical intervention. Impact statement What is already known on this subject? Serum inflammatory markers such as C-reactive protein, white blood cell count, and neutrophil to lymphocyte ratio are usually elevated in women with tubo-ovairan abscess, and high levels of these markers are associated with extended hospitalisation and more severe disease. What do the results of this study add? Our results indicate that the serum inflammatory markers increase and peak within the first 48 hours after surgery for tubo-ovarian abscess. Normalisation of white blood cell count is the fastest in successfully treated patients. However, normalisation of C-reactive protein is slowest, reaching 14 days and might not be as feasible as white blood cell count and neutrophil to lymphocyte ratio in postoperative patient follow-up. What are the implications of these findings for clinical practice and further research? The serum inflammatory markers should be interpreted with caution within 48 hours after surgical treatment for tubo-ovarian abscess. Instead of C-reactive protein white blood cell count, and neutrophil to lymphocyte ratio measurements can be preferred in post-operative follow-up to predict the need for further medical or surgical intervention.