ORIGINAL RESEARCH article
Front. Immunol.
Sec. Systems Immunology
Is it possible to use complete blood collection based systemic inflammatory indices as potential biomarkers for chronic spontaneous urticaria
Bingyu Li 1,2
Lu Peng 1,2
Runqing Li 1
Mai Shi 1,2
Yingyi Li 1,2
Chinghsuan Sun 1,2
Zhuying Zhang 1,2
Jingwen Xue 1,2
Yi Zhao 1,2
1. Beijing Tsinghua Changgeng Hospital, Tsinghua University, Beijing, China
2. Tsinghua University, Beijing, China
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Abstract
Chronic spontaneous urticaria (CSU) is mediated not only by mast cells but also by eosinophils and basophils. We evaluated whether complete blood collection based systemic inflammatory indices-including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate Index of Systemic Inflammation (AISI), systemic inflammation modulation index (SIMI), neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), platelet-to-lymphocyte ratio (PLR), basophil-to-lymphocyte ratio (BLR)-and platelet parameters (mean platelet volume [MPV], platelet distribution width [PDW], platelet large cell ratio [PLCR]) reflect CSU severity or treatment response. A retrospective study of 190 CSU patients and 570 matched controls was performed, with sensitivity analyses using propensity-score matching (PSM) and inverse-probability-of-treatment weighting (IPTW). Subgroup analyses examined UAS7, antihistamine response and allergy history. As a result, CSU patients exhibited lower SII/SIRI, white blood cells (WBC), neutrophils, lymphocytes, and NLR, alongside higher MPV/PLCR and reduced PDW. NLR showed a weak correlation with UAS7, and systemic indices did not reliably differentiate standard-dosed and updosed antihistamine response. Patients with allergy history demonstrated lower eosinophils and ELR. CSU is characterized by reduced systemic inflammatory indices and enhanced platelet activation. Among these, NLR may serve as a cost-effective supplementary tool for assessing systemic inflammation trends of CSU.
Summary
Keywords
biomarkers, chronic spontaneous urticaria, Inflammation, MPV, NLR, PDW, Platelet, PLR
Received
04 December 2025
Accepted
19 February 2026
Copyright
© 2026 Li, Peng, Li, Shi, Li, Sun, Zhang, Xue and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jingwen Xue; Yi Zhao
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