Comparison of Monocyte/High-Density Lipoprotein Cholesterol Ratio (MHR) Between Patients with First-Episode and Chronic Schizophrenia

Yusuf Çokünlü, Ali Mete CALISKAN , Kamile YÜCEL

  • Yusuf Çokünlü: Konya Numune Hastanesi
  • Ali Mete CALISKAN: University of Health Sciences, Konya Education and Research Hospital
  • Kamile YÜCEL: Samsun Üniversitesi, Tıp Fakültesi,
  • Year : 2026
  • Vol : 42
  • Issue : 3
  •  Page : 261-268
Objective: To investigate the monocyte/high-density lipoprotein ratio (MHR), which has been shown in the literature to be a novel inflammatory marker in patients
with first-episode (FES) and chronic (CS) schizophrenia.
Materials and Methods: The study involved 38 patients with FES, 65 patients with CS and 40 healthy controls (HC). Retrospective investigations of blood parameters
were carried out using the database and associated records. The monocyte count was divided by the HDL-C level to determine the MHR.
Results: Monocyte levels were significantly higher and platelet and HDL-C levels were significantly lower in both the FES and CS groups compared with the HC group.
MHR levels were significantly higher in both the FES and CS groups compared with healthy controls, although no statistically significant difference was detected
between the two groups. Correlation analyses revealed several modest associations between MHR and certain clinical variables, though no consistent relationship
with illness duration or hospitalisation-related variables was observed.
Conclusion: The findings of this study demonstrate that MHR is significantly increased in patients with schizophrenia, supporting the notion that schizophrenia is
associated with inflammatory activation. These results suggest that MHR may be associated with the inflammatory alterations observed in schizophrenia.
Cite this Article As : Cokunlu Y, Caliskan AM, Yucel K. Comparison of Monocyte/High-Density Lipoprotein Cholesterol Ratio (MHR) Between Patients with First-Episode and Chronic Schizophrenia. Selcuk Med J 2026;42(3): 261-268

Download Citation: Endnote/Zotero/Mendeley (RIS) RIS File

Download Citation: BibTeX BibTeX File

Conflict of interest : The authors declare that they have no conflict of interest.
This article is published under the CC BY-NC 4.0 license.
Selcuk Medical Journal
2026, Vol. 42 (3)
ISSN: 1017-6616
E-ISSN: 2149-8059
Received : , Accepted : , Published Online :

References

  1. 1. Owen MJ, Sawa A, Mortensen PB. Schizophrenia. Lancet. 2016:2;388(10039):86-97. doi: 10.1016/S0140-6736(15)01121.
  2. 2. Tandon R, Keshavan MS, Nasrallah HA. Schizophrenia, “Just the Facts” What we know in 2008. 2. Epidemiology and etiology. Schizophr Res. 2008;102(1–3):1-18. https://doi.org/10.1016/j.schres.2008.04.011
  3. 3. Rothermundt M, Arolt V, Bayer TA. Review of immunological and immunopathological findings in schizophrenia. Brain Behav Immun. 2001;15(4):319-39. https://doi.org/10.1006/brbi.2001.0648
  4. 4. Kartalcı Ş, Erbay LG, Zayman EP, et al. IL-4, TGF-β, NF-κB and MPO levels in patients with treatment resistant schizophrenia. Turk Psikiyatr Derg. 2016;27(3):1-6. https://doi: 10.5080/u13642
  5. 5. Nikkilä H V, Müller K, Ahokas A, et al. Increased frequency of activated lymphocytes in the cerebrospinal fluid of patients with acute schizophrenia. Schizophr Res. 2001;49(1–2):99-105. https://doi.org/10.1016/S0920-9964(99)00218-2
  6. 6. Samaroo D, Dickerson F, Kasarda DD, et al. Novel immune response to gluten in individuals with schizophrenia. Schizophr Res. 2010;118(1–3):248-55. https://doi.org/10.1016/j.schres.2009.08.009
  7. 7. Al-Hakeim HK, Al-Rammahi DA, Al-Dujaili AH. IL-6, IL-18, sIL-2R, and TNFα proinflammatory markers in depression and schizophrenia patients who are free of overt inflammation. J Affect Disord. 2015;182:106-14. https://doi.org/10.1016/j.jad.2015.04.044
  8. 8. Cristiano VB, Vieira Szortyka MF, Lobato MI, et al. Postural changes in different stages of schizophrenia is associated with inflammation and pain: a cross-sectional observational study. Int J Psychiatry Clin Pract. 2017;21(2):104-11. https://doi.org/10.1080/13651501.2016.1249892
  9. 9. Muller N, J. Schwarz M. The role of immune system in schizophrenia. Curr Immunol Rev. 2010;6(3):213-20. https://doi.org/10.2174/157339510791823673
  10. 10. Yüksel RN, Ertek IE, Dikmen AU, et al. High neutrophil-lymphocyte ratio in schizophrenia independent of infectious and metabolic parameters. Nord J Psychiatry. 2018;72(5):336-40. https://doi.org/10.1080/08039488.2018.1458899
  11. 11. Semiz M, Yildirim O, Canan F, et al. Elevated Neutrophil / Lymphocyte Ratio. Psychiatr Danub. 2014;26(3):220-5.
  12. 12. Özdin S, Böke Ö. Neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte ratios in different stages of schizophrenia. Psychiatry Res. 2019;271:131-5. https://doi.org/10.1016/j.psychres.2018.11.043
  13. 13. Ucar FM. A potential marker of bare metal stent restenosis: Monocyte count - to- HDL cholesterol ratio. BMC Cardiovasc Disord. 2016;16(1):1-7. Doi 10.1186/s12872-016-0367-3
  14. 14. Barter PJ, Nicholls S, Rye KA, et al. Antiinflammatory properties of HDL. Circ Res. 2004;95(8):764-72. https://doi.org/10.1161/01.RES.0000146094.59640.13
  15. 15. Ossoli A, Remaley AT, Vaisman B, et al. Plasma-derived and synthetic high-density lipoprotein inhibit tissue factor in endothelial cells and monocytes. Biochem J. 2016;473(2):211-9. https://doi.org/10.1042/BJ20151000
  16. 16. Korkmaz A, Demir M, Unal S, et al. Monocyte-to-high density lipoprotein ratio (MHR) can predict the significance of angiographically intermediate coronary lesions. Int J Cardiovasc Acad. 2017;3(1–2):16-20. https://doi.org/10.1016/j.ijcac.2017.05.008
  17. 17. Bolayir A, Gokce SF, Cigdem B, et al. Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol. 2018;52(2):150-5. DOI: 10.1016/j.pjnns.2017.08.011
  18. 18. Katipoğlu Z, Mirza E, Oltulu R, et al. May monocyte/HDL cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) be an indicator of inflammation and oxidative stress in patients with keratoconus? Ocul Immunol Inflamm. 2020;28(4):632-6. https://doi.org/10.1080/09273948.2019.1611876
  19. 19. Mirza E, Oltulu R, Katipoğlu Z, et al. Monocyte/HDL ratio and lymphocyte/monocyte ratio in patients with pseudoexfoliation syndrome. Ocul Immunol Inflamm. 2020;28(1):142-6. https://doi.org/10.1080/09273948.2018.1545913
  20. 20. Şatırtav G, Mirza E, Oltulu R, et al. Assessment of monocyte/HDL ratio in branch retinal vein occlusion. Ocul Immunol Inflamm. 2020;28(3):463-7. https://doi.org/10.1080/09273948.2019.1569244
  21. 21. Kılıç N, Tasci G, Yılmaz S, et al. Monocyte/HDL Cholesterol Ratios as a New Inflammatory Marker in Patients with Schizophrenia. J Pers Med. 2023;13(2):276:1-13. https://doi.org/10.3390/jpm13020276
  22. 22. Cheng N, Ma H, Zhang K, et al. The Predictive Value of Monocyte/High-Density Lipoprotein Ratio (MHR) and Positive Symptom Scores for Aggression in Patients with Schizophrenia. Medicina (Kaunas). 2023;59(3):503.1-14. https://doi.org/10.3390/medicina59030503
  23. 23. Sahpolat M, Ayar D, Ari M, et al. Elevated monocyte to high-density lipoprotein ratios as an inflammation markers for schizophrenia patients. Clin Psychopharmacol Neurosci. 2021;19(1):112-6. doi: 10.9758/cpn.2021.19.1.112
  24. 24. Wei Y, Wang T, Li G, et al. Investigation of systemic immune-inflammation index, neutrophil/high-density lipoprotein ratio, lymphocyte/high-density lipoprotein ratio, and monocyte/high-density lipoprotein ratio as indicators of inflammation in patients with schizophrenia and bipolar. Front Psychiatry. 2022;13(July):1-14. DOI: 10.3389/fpsyt.2022.941728
  25. 25. Dickerson F, Stallings C, Origoni A, et al. Markers of gluten sensitivity and celiac disease in recent-onset psychosis and multi-episode schizophrenia. Biol Psychiatry. 2010;68(1):100-4. DOI: 10.1016/j.biopsych.2010.03.021
  26. 26. Rowland LM, Demyanovich HK, Wijtenburg SA, et al. Antigliadin antibodies (AGA IgG) are related to neurochemistry in schizophrenia. Front Psychiatry. 2017;8:1-7. DOI: 10.3389/fpsyt.2017.00104
  27. 27. Dzikowski M, Juchnowicz D, Dzikowska I, et al. The differences between gluten sensitivity, intestinal biomarkers and immune biomarkers in patients with first-episode and chronic schizophrenia. J Clin Med. 2020;9(11):1-13. DOI: 10.3390/jcm9113707
  28. 28. Kinney DK, Hintz K, Shearer EM, et al. A unifying hypothesis of schizophrenia: Abnormal immune system development may help explain roles of prenatal hazards, post-pubertal onset, stress, genes, climate, infections, and brain dysfunction. Med Hypotheses. 2010;74(3):555-63. https://doi.org/10.1016/j.mehy.2009.09.040
  29. 29. A Kato, T Yamauchi, Y Horikawa, et al. Neurotransmitters, psychotropic drugs and microglia: clinical implications for psychiatry. Current medicinal chemistr.2013; 20(3), 331-44. https://doi.org/10.2174/0929867311320030003
  30. 30. Yang X, Feng D, Yan P, et al. Serum levels in neuroleptic-free schizophrenia : association with psychopathology. Schizophr Res. 2002;57:247-58.
  31. 31. Kim YK, Myint AM, Lee BH, et al. Th1, Th2 and Th3 cytokine alteration in schizophrenia. Prog Neuro-Psychopharmacology Biol Psychiatry. 2004;28(7):1129-34. https://doi.org/10.1016/j.pnpbp.2004.05.047
  32. 32. Potvin S, Stip E, Sepehry AA, et al.. Inflammatory cytokine alterations in schizophrenia: A systematic quantitative review. Biol Psychiatry. 2008;63(8):801-8. https://doi.org/10.1016/j.biopsych.2007.09.024
  33. 33. Meyer U, Schwarz MJ, Müller N. Inflammatory processes in schizophrenia: A promising neuroimmunological target for the treatment of negative/cognitive symptoms and beyond. Pharmacol Ther. 2011;132(1):96-110. https://doi.org/10.1016/j.pharmthera.2011.06.003
  34. 34. Ancuta P, Wang J, Gabuzda D. CD16+ monocytes produce IL-6, CCL2, and matrix metalloproteinase-9 upon interaction with CX3CL1-expressing endothelial cells. J Leukoc Biol. 2006;80(5):1156-64. https://doi.org/10.1189/jlb.0206125
  35. 35. Murphy AJ, Woollard KJ. High-density lipoprotein: A potent inhibitor of inflammation: Frontiers in research review: Physiological and pathological functions of high-density lipoprotein. Clin Exp Pharmacol Physiol. 2010;37(7):710-8. https://doi.org/10.1111/j.1440-1681.2009.05338.x
  36. 36. Ganjali, S., Gotto Jr, A. M., Ruscica, M., Atkin, S. L., Butler, A. E., Banach, M., & Sahebkar, A. (2018). Monocyte‐to‐HDL‐cholesterol ratio as a prognostic marker in cardiovascular diseases. Journal of cellular physiology.2018;233(12):9237-46.
  37. 37. Canpolat U, Aytemir K, Yorgun H, et al. The role of preprocedural monocyte-to-high-density lipoprotein ratio in prediction of atrial fibrillation recurrence after cryoballoon-based catheter ablation. Europace. 2015;17(12):1807-15.