Absolute blood lymphocytes/monocytes and lymphocytes/neutrophils in patients with neurosyphilis may affect the response to therapy and diagnostic efficacy

Abstract

Background:To investigate the effects of absolute blood lymphocytes/absolute monocyte (LMR), absolute lymphocytes/absolute neutrophils (LNR) and sero-TRUST titers on treatment response after initial treatment in HIV-negative neurosyphilis (NS) patients, whether they can be used as auxiliary indicators for response after treatment. Methods: NS patients who were hospitalized in Nanjing Second Hospital from January 1, 2018 to December 31, 2022 for initial treatment ,complete treatment response will be taken as the study endpoint. COX regression was used to analyze the influencing factors of treatment response in NS patients. Evaluate the ability to respond by assessing baseline LMR and LNR, changes in LMR and LNR at different time points compared to baseline, and the multiple decrease in the toluidine red unheated serum test titer from baseline(sero-TRUST) using time-dependent ROC curves.The forest plot analyzed the influencing factors of the LNR difference between baseline and 3 months after treatment (LNR3), baseline sero-TRUST titer (sero-TRUST0), sero-TRUST decrease from baseline at 3 months or 6 months after treatment (sero-TRUST3 or sero-TRUST6). Results: A total of 249 patients were included in this study, including 200 in the response group and 49 in the non-response group.Univariate and multivariate COX regression analysis showed that baseline blood LMR> 1.93 (HR : 2.907, P=0.013), LNR > 0.3 (HR: 0.559, P= 0.013), and sero-TRUST titer >1:16 (HR: 1.760, P=0.002) affects the outcome of response after treatment. The AUC of LNR3 > 0.12 at 3M was 81.52 , the AUC of the baseline sero-TRUST titer was > 1:16 was 71.64, and the AUC of sero-TRUST3 titer decreased by more than 2 times at 3M was 72.85.The forest plot showed that if the blood was positive for syphilis ≥for 240 days before screening, the more likely the baseline sero-TRUST titer was less than 1:16. Conclusion: The complete response rate of patients with NS to initial treatment was low, and peripheral blood LMR ,LNR ,and sero-TRUST may affect treatment response.The increase in LNR3 > 0.12 ,the baseline sero-TRUST titer > 1:16 , and the sero-TRUST 3 >2 titer could be used as auxiliary indicators to evaluate the treatment response of patients.