Immune inflammation markers and physical fitness during a congested match play period in elite male soccer players
Authors: Saidi Karim , Abderrahman Abderraouf Ben , Laher Ismail , Hackney Anthony C. , Hage Rawad El , Saeidi Ayoub , Bideau Benoit , Granacher Urs , Zouhal Hassane 
Published: December 2024

Abstract
Background/Objective
Cellular immune markers of inflammation such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) are frequently used in patient care. The adoption of these markers to elite sports, e.g. soccer could be beneficial when monitoring training and aiming to maximize physical fitness. This study investigated cellular immune inflammation markers and physical fitness in elite male soccer players in relation to changes in training and match exposure during a congested match play period.

Methods
Fifteen elite male soccer players were evaluated three times (T1, T2, and T3) over 12 weeks (T1–T2: six weeks uncongested period of match play and T2–T3: six weeks congested period of match play). Players performed vertical jump tests (squat jumps [SJ], countermovement jumps [CMJ]), the 20-meter sprint test, and the Yo-Yo intermittent recovery test (YYIRL1) at T1, T2 and T3. Measurements included counts of leucocytes and its subtypes, as well as platelets. Cellular immune inflammation markers (NLR, PLR and SII) were calculatedat T1, T2, and T3. Training session rating of perceived exertion was also recorded on a daily basis.

Results
Significant increases in leucocyte, neutrophil, eosinophil, basophil and monocyte counts occurred at T3 compared with T2 (0.002 < p < 0.04, -0.56 < ES < -0.40) and T1 (-0.78 < ES < -0.49). Lymphocyte counts were lower at T3 as compared to T2 and T1 (p = 0.038, -0.48 < ES <-0.25), while NLR, PLR and SII were greater at T3 compared to T2 (0.001 < p < 0.015, -1.01 < ES < -0.44) and T1 (-0.99 < ES < -0.21). There was a negative correlation between YYIRL1 performance with NLR (r= -0.56; p = 0.02), PLR (r=-0,44, p = 0.015), and SII (r= -0.63; p = 0.01) after the congested period of match play (i.e., T3). Values for maximal oxygen uptake (VO2max), estimated from the YYIRL1 test, negatively correlated with NLR (r= -0.56; p = 0.02), PLR (r=-0,44, p = 0.015), and SII (p = 0.01; r= -0.63). There was a positive correlation between NLR, and SII with workload parameters. In addition, a clear positive correlation was observed between NLR and SII with competitive loadinstead (r= [0.59–0.64; p˂ 0.001), training load (TL) (r= [0.65–0.68]; p˂ 0.001), session rating of perceived exertion (S-RPE) (r= [0.65–0.68]; p = 0.001), and training volume (r= [0.60–0.61; p = 0.001).

Conclusion
An intensive period of congested match play significantly alterated immune cell counts and cellular markers of inflammation (NLR, PLR and SII). Changes in NLR and SII were related to workload parameters, suggesting the usefulness of these markers in regulating training intensity and competitive load. An association between physical fitness (YYIRL1, VO2max) and NLR, PLR and SII suggests that these biomarkers are promising tools to monitor aerobic physical fitness of elite soccer players during congested periods of match play.