The relationship between polycystic ovary syndrome phenotypes and systemic immune inflammation indices

Aims: Polycystic ovary syndrome (PCOS) displays chronic, low-grade inflammation characterized by an enhanced release of pro-inflammatory cytokines. However, the extent of systemic inflammation and its variations across different PCOS phenotypes has not been sufficiently characterized. The study aimed to investigate the relationship between the presence and phenotypes of PCOS and systemic immune inflammation (SII) and response (SIRI) indices. Methods: A total of 310 newly diagnosed PCOS patients and 105 healthy premenopausal women were included in this retrospective study. PCOS were categorized into four distinct phenotypes: phenotype A [hyperandrogenism (HA), oligomenorrhea (OA), and polycystic ovaries (PCO)], phenotype B (HA and OA), phenotype C (HA and PCO), and phenotype D (OA and PCO). Results: Median SII and SIRI were higher in patients with PCOS than control group. The androgenic phenotypes group, specifically Phenotype A, exhibited elevated levels of SII and SIRI compared to the non-androgenic phenotype group. There was a positive correlation between these indices and hormonal parameters and insulin resistance. These relationships were particularly pronounced in the phenotype A group. Increased SIRI was an independent predictor of PCOS fold (OR = 1.08, p < 0.001). In distinguishing the androgenic phenotypes from the non-androgenic phenotypes, the threshold value of the SIRI was found to be >1.1 with 67.1% sensitivity and 81.2% specificity. It was incapable of distinguishing phenotype B from Phenotype C, but it was found successful in predicting phenotype A among all phenotypes. Conclusion: Elevated SII and SIRI levels were associated with the presence of PCOS and its phenotypes, particularly phenotype A. SIRI demonstrated potential as a screening tool for phenotypic discrimination of PCOS, beyond predicting its presence.