Blood Index Tracks Glaucoma Severity

Blood Index Tracks Glaucoma Severity

September 24, 2025 Author Summary 0

Glaucoma: what it is and why new tools are needed

Glaucoma is a group of diseases that cause visual dysfunction and optic nerve damage. It is projected to affect 100 million people by 2040, making earlier detection and better monitoring urgent priorities. Current approaches struggle to definitively track progression, especially with non‑invasive tests. As the authors note, “The pursuit of non‑invasive methods for monitoring visual deterioration in glaucoma remains a significant clinical challenge.” Growing evidence suggests systemic inflammation plays a role in glaucoma, and routine blood tests have emerged as practical, accessible ways to capture inflammatory signals in people at risk. Prior studies, including the authors’ own, reported lower serum albumin and bilirubin in glaucoma and links between blood cell indices and disease features.

What the study set out to test

The team developed a simple composite measure from routine labs: LAP = lymphocyte percentage (LYMPH%) × serum albumin (Alb). They hypothesized that combining an immune cell percentage with a blood protein that has antioxidant and anti‑inflammatory roles would better reflect disease status than either measure alone. “We developed a novel composite index: the product of lymphocyte percentage (LYMPH%) and serum Alb concentration, which we termed the lymphocyte–Alb product (LAP).”

How the study was done

This single‑center, retrospective case–control study included 161 glaucoma patients (99 primary angle‑closure glaucoma; 62 primary open‑angle glaucoma) and 181 healthy controls (all ≥18 years). Each participant had standard eye exams, and glaucoma severity was graded using visual field mean deviation as Early, Moderate, or Severe. Non‑fasting venous blood was drawn, LYMPH% and Alb were measured using routine analyzers, and LAP was calculated. The authors compared Alb, LYMPH%, and LAP across groups and assessed how well these markers distinguished cases from controls and separated severity levels.

Key messages

  • Glaucoma shows lower Alb, LYMPH%, and LAP: Compared with controls, glaucoma patients had lower Alb (43.48 vs. 44.63 g/L; P < 0.001), lower LYMPH% (24.25% vs. 29.12%; P < 0.001), and lower LAP (1053 vs. 1298; P < 0.001). In a multivariable model with age and sex, LAP remained associated with case status (OR 0.997 per unit; P < 0.001).
  • Severity signal: LAP decreased stepwise from Early to Severe disease; differences were significant when comparing the Severe group with Early and Moderate groups.
  • Discrimination: For glaucoma vs. controls, LAP AUC = 0.7080 with cutoff 1141 (sensitivity 69.06%, specificity 67.7%), outperforming Alb (AUC 0.6151) and LYMPH% (AUC 0.6894). For Early vs. Severe, LAP AUC = 0.8061 with cutoff 1130 (sensitivity 89.06%, specificity 64.71%). In the authors’ comparative analyses, LAP also exceeded several previously reported indices in this dataset.
  • Subtype comparison: LAP did not differ between primary angle‑closure and primary open‑angle glaucoma (1067 vs. 1032; P = 0.491).

What is novel here?

LAP uses two routine, low‑cost measurements to create a single, non‑invasive index that tracks with glaucoma severity and outperforms Alb or LYMPH% alone in discrimination tasks within this cohort. The authors summarize: “Our study yielded two key findings: first, glaucoma patients exhibit significantly lower LAP levels compared to healthy controls; second, LAP correlates strongly with disease severity, supporting its potential as a clinical evaluation tool.”

Practical implications

Because LAP comes from standard blood work, it could be added to existing assessments without extra procedures. The authors state, “Incorporating LAP into routine clinical practice could provide clinicians with valuable insights into disease progression, supporting more informed treatment decisions.” They note its non‑invasive nature supports long‑term monitoring. In their words: “LAP may serve as a supportive biomarker of systemic inflammation in glaucoma. It demonstrates good accuracy in reflecting glaucoma severity and shows potential for monitoring disease progression.”

How to read the numbers

  • Between-group differences: Alb, LYMPH%, and LAP were each significantly lower in glaucoma than in controls.
  • Severity gradient: LAP declined from Early → Moderate → Severe disease.
  • Screening/identification: For case vs. control, AUC 0.7080 (cutoff 1141, sensitivity 69.06%, specificity 67.7%).
  • Risk stratification: For Early vs. Severe, AUC 0.8061 (cutoff 1130, sensitivity 89.06%, specificity 64.71%).

Limitations and next steps

The authors emphasize that LYMPH% and Alb are general indicators of inflammation and nutrition and are not specific to glaucoma. The study is single‑center, retrospective, and cross‑sectional, with a relatively small sample, which limits generalization and prevents conclusions about causality. They call for larger, multicenter, cross‑regional cohorts and long‑term follow‑up to test whether LAP can monitor progression reliably. They also highlight interest in integrated, multi‑level composite biomarkers (e.g., combining several blood indicators) to strengthen auxiliary diagnosis and decision‑making.

Conclusion

This study introduces LAP (LYMPH% × Alb) as a simple blood index that correlates with glaucoma severity and shows better discrimination than Alb or LYMPH% alone in this dataset. Its accessibility and non‑invasiveness make it a promising supportive tool alongside standard clinical measures, pending validation in larger, longitudinal studies.

“LAP may serve as a supportive biomarker of systemic inflammation in glaucoma… It demonstrates good accuracy in reflecting glaucoma severity and shows potential for monitoring disease progression.”

 

The translation of the preceding English text in Chinese:

 

青光眼：它是什么，以及为什么需要新的工具

青光眼是一组导致视觉功能障碍和视神经损伤的疾病。预计到 2040 年将影响 1 亿人，因此更早期的检测和更好的监测已成为紧迫的优先事项。目前的方法难以明确追踪疾病进展，尤其是采用无创检查时。正如作者所指出的那样：“寻找无创方法来监测青光眼的视觉损害仍然是一个重大的临床挑战。” 越来越多的证据表明，全身性炎症在青光眼中发挥作用，而常规血液检测作为捕捉高危人群炎症信号的实用且易得的方式已逐渐受到关注。既往研究（包括作者团队的研究）报道，青光眼患者血清白蛋白和胆红素水平较低，并且血细胞指标与疾病特征存在关联。

研究要验证的假设

研究团队基于常规实验室检查开发了一个简单的综合指标：LAP = 淋巴细胞百分比 (LYMPH%) × 血清白蛋白 (Alb)。他们假设，将免疫细胞百分比与具有抗氧化和抗炎作用的血液蛋白相结合，能比单一指标更好地反映疾病状态。正如作者所说：“我们开发了一种新型综合指数——淋巴细胞百分比 (LYMPH%) 与血清 Alb 浓度的乘积，我们称之为淋巴细胞-白蛋白乘积 (LAP)。”

研究方法

这是一项单中心回顾性病例对照研究，共纳入 161 例青光眼患者（99 例原发性闭角型青光眼；62 例原发性开角型青光眼）和 181 名健康对照（均 ≥18 岁）。所有参与者均接受了标准眼科检查，青光眼严重程度根据视野平均缺损 (mean deviation) 分为早期、中期和重度。采集非空腹静脉血，使用常规分析仪测量 LYMPH% 和 Alb，并计算 LAP。作者比较了各组间 Alb、LYMPH% 和 LAP 的差异，并评估这些指标在区分病例与对照以及分级严重程度方面的表现。

主要发现

  • 青光眼患者 Alb、LYMPH% 和 LAP 较低：与对照相比，青光眼患者 Alb 更低（43.48 vs. 44.63 g/L；P < 0.001）、LYMPH% 更低（24.25% vs. 29.12%；P < 0.001）、LAP 更低（1053 vs. 1298；P < 0.001）。在校正年龄和性别的多变量模型中，LAP 仍与病例状态相关（OR 0.997/单位；P < 0.001）。

  • 严重程度信号：LAP 随着疾病由早期 → 中期 → 重度逐级下降；在重度组与早期、中期组比较时差异显著。

  • 区分能力：在区分青光眼与对照时，LAP 的 AUC = 0.7080，截断值 1141（敏感度 69.06%，特异度 67.7%），优于 Alb (AUC 0.6151) 和 LYMPH% (AUC 0.6894)。在区分早期与重度时，LAP 的 AUC = 0.8061，截断值 1130（敏感度 89.06%，特异度 64.71%）。与既往部分报道的指标相比，LAP 的表现也更佳。

  • 亚型比较：LAP 在原发性闭角型和开角型青光眼之间无显著差异（1067 vs. 1032；P = 0.491）。

创新之处

LAP 利用两个常规、低成本的检测结果，构建了一个单一、无创的指标，能够随青光眼严重程度变化，并在本研究队列中优于 Alb 或 LYMPH% 的单独使用。作者总结道：“我们的研究得出了两个关键发现：第一，青光眼患者的 LAP 水平显著低于健康对照；第二，LAP 与疾病严重程度密切相关，支持其作为临床评估工具的潜力。”

临床意义

由于 LAP 来源于常规血液检查，可以无额外操作地纳入现有评估体系。作者指出：“将 LAP 纳入常规临床实践，能够为医生提供有关疾病进展的有价值见解，从而支持更合理的治疗决策。” 他们强调其无创特性适合长期随访监测。正如文中所述：“LAP 可作为青光眼全身炎症的辅助性生物标志物。它在反映青光眼严重程度方面具有良好准确性，并显示出监测疾病进展的潜力。”

如何解读这些数据

  • 组间差异：青光眼患者的 Alb、LYMPH%、LAP 均显著低于对照。

  • 严重程度梯度：LAP 随疾病从早期 → 中期 → 重度逐渐下降。

  • 筛查/识别：病例 vs. 对照，AUC 0.7080（截断值 1141，敏感度 69.06%，特异度 67.7%）。

  • 风险分层：早期 vs. 重度，AUC 0.8061（截断值 1130，敏感度 89.06%，特异度 64.71%）。

局限性与下一步

作者强调，LYMPH% 和 Alb 是炎症和营养的一般性指标，并非青光眼特异性。本研究为单中心、回顾性、横断面设计，样本量相对较小，限制了结果的普遍性，也无法得出因果关系。作者呼吁开展更大规模、多中心、跨区域的队列研究和长期随访，以验证 LAP 在监测病程方面的可靠性。同时，他们还提出，可以探索整合多水平的复合生物标志物（如结合多种血液指标），以加强辅助诊断和临床决策。

结论

本研究提出了 LAP（LYMPH% × Alb）这一简单的血液学指标，它与青光眼严重程度显著相关，并在本队列中优于 Alb 或 LYMPH% 的单独使用。其普遍可得性和无创性，使其在常规临床指标之外成为一个有前景的辅助工具，仍需在更大规模、纵向研究中加以验证。

“LAP 可作为青光眼全身炎症的辅助性生物标志物……它在反映青光眼严重程度方面具有良好准确性，并显示出监测疾病进展的潜力。”

Reference:

Xiao Xiao, Yanping Gao, Gao Zhang, Zuo Wang, An Li, Donghua Liu, Jing Fu, Wenbo Xiu, Chang Lu, Jinxia Wang, Xiong Zhu, Yang Chen, Lingling Chen, Bolin Deng, Ping Shuai, Chong He, Fang Lu

Clinical significance of a novel inflammatory-nutritional index in glaucoma severity evaluation.

Biomol Biomed [Internet]. 2025 May 27 [cited 2025 Sep. 23];25(11):2505–2512.

Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/12374

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Editor: Merima Hadžić

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