Blood-based immune biomarkers and functional outcomes in acute schizophrenia: A retrospective cohort study

BACKGROUND: Schizophrenia is a chronic psychiatric disorder characterized by acute relapses and significant functional impairment. While antipsychotic medications are effective in managing acute episodes, many patients fail to achieve functional remission. Recent research suggests that immune mechanisms may influence treatment outcomes, yet studies focusing on the relationship between immune biomarkers and functional recovery are limited. OBJECTIVE: This study aims to evaluate whether blood-based immune biomarkers can predict functional response and remission in patients with acute schizophrenia. METHODS: A retrospective cohort study was conducted with 354 inpatients diagnosed with schizophrenia, admitted to an acute psychiatric unit between January 2010 and December 2020. Sociodemographic, clinical, and immune biomarker data were extracted from electronic records. Functional outcomes were measured using Global Assessment of Functioning (GAF) scores at admission and discharge. Immune biomarkers assessed included white blood cell counts, ratios and C-reactive protein. Functional response was defined as a GAF score improvement >40 points, while functional remission was defined as a GAF score ≥70 at discharge. RESULTS: Higher leukocyte counts increased the risk of non-functional response, while a higher platelet-lymphocyte ratio (PLR) was a protective factor. Additionally, Higher lymphocyte and platelet counts were protective against non-functional remission. However, the predictive performance for both functional response and remission was limited, with an AUC ranging from 0.53 to 0.61. CONCLUSION: Immune biomarkers, particularly leukocyte counts, PLR, and lymphocyte counts, show significant associations with functional outcomes in acute schizophrenia. However, their predictive value for clinical practice remains limited.