Prognostic Factors Associating with Pro-oxidant-antioxidant Balance; Neutrophils to Lymphocytes Ratio, Vitamin D, Heat Shock Protein 27, and Red Cell Distribution Width

Hamideh Ghazizadeh, Mohammad Reza Mirinezhad, Seyed Mohammad Reza Seyedi, Fatemeh Sadabadi, Mahsa Ahmadnezhad, Naghme Jaberi, Alireza Pasdar, Gordon A. Ferns, Habibollah Esmaily, Majid Ghayour-Mobarhan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


Background. Several chronic diseases are mediated by oxidative stress. Oxidative stress affects cell morphology and function and is associated with alterations in the serum protein component. In the current study, we analyzed four individual prognostic factors associating with serum Pro-Oxidant-Antioxidant Balance (PAB): neutrophil to lymphocyte ratio (NLR), Vitamin D, anti-heat shock protein 27 (anti-hsp27) antibody titer, and red blood cell distribution width (RDW) to evaluate them as the potential prognostic markers. In the current study, we attempted to investigate the relationship between serum PAB, RDW, NLR, serum vitamin D and anti-hsp27 concentration.

Methods. A total of 852 participants (438 males and 414 females) aged 47.64 +/- 7.77 years were recruited in a cross-sectional study based on the Mashhad stroke and heart atherosclerotic disorders (MASHAD) cohort study data. Hematological parameters, and vitamin D, PAB and anti-hsp27 antibody titers were measured using the Sysmex auto analyzer system and enzyme-linked immune sorbent assay (ELISA), respectively.

Results. The results showed a significant correlation between Vitamin D and anti-hsp27 antibody titers (r = -0.13 and p 0.05) we found a significant association between serum PAB and serum anti hsp-27 antibody titers. Subjects with PAB levels 36.31-82.63 had a higher risk (1.83 fold) of having an increased anti-hsp27 antibody titers in comparison to the reference group (PAB level

Conclusion. The present study shows that serum vitamin D can be associated with reduction in inflammatory status probably by decreasing levels of serum anti-hsp27 antibody titers, reduction in oxidative stress and therefore may reduce the risk of cardiovascular diseases. Anti-hsp27 antibody titers are associated with oxidative stress through the serum PAB, therefore these factors may be of prognostic values in detecting oxidative stress and risk of atherosclerosis. The evaluation of these factors in a larger population may help further confirm these findings. (C) 2020 IMSS. Published by Elsevier Inc.

Original languageEnglish
Pages (from-to)261-267
Number of pages7
JournalArchives of medical research
Issue number3
Early online date26 Feb 2020
Publication statusPublished - 3 Apr 2020

Bibliographical note

We would like to thank Mashhad University of Medical Sciences Research council for their financial support. The study was approved by the Ethics Committee of Mashhad University of Medical Sciences (Ethics number: IR.MUMS.REC.1386.250).
Funding: Research reported in this publication was supported by the Mashhad University of Medical Sciences, Mashhad, Iran.


  • Red blood cell distribution width (RDW)
  • Pro-oxidant-antioxidant balance (PAB)
  • Neutrophil to lymphocyte ratio (NLR)
  • Vitamin D
  • anti-hsp27
  • Oxidative Stress/physiology
  • Prognosis
  • Neutrophils/cytology
  • Humans
  • Middle Aged
  • Erythrocyte Indices
  • Lymphocytes/cytology
  • Male
  • Adult
  • Biomarkers/blood
  • Female
  • Molecular Chaperones/immunology
  • Vitamin D/metabolism
  • Reactive Oxygen Species/metabolism
  • Antibodies/blood
  • Cross-Sectional Studies
  • Atherosclerosis/epidemiology
  • HSP27 Heat-Shock Proteins/immunology
  • Antioxidants/metabolism
  • Lymphocyte Count
  • Cohort Studies
  • Heat-Shock Proteins/immunology


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