Role of Hematological Parameters in Systemic Sclerosis Patients with Pulmonary System Involvement

Abstract

Aim: Systemic sclerosis (SSc) is an autoimmune disease characterized by generalized micro and macroangiopathy. Mortality in SSc is primarily due to pulmonary complications. This study was aimed to reveal the relationship between parenchymal and vascular involvements of the pulmonary system and hematological parameters in patients with SSc. Material and Method: Participants were divided into three groups: both interstitial lung disease (ILD) and pulmonary hypertension (PH), those with only ILD and those with neither ILD nor PH. Laboratory data were compared between these groups. Results: ILD was found to be associated with high red cell distribution width (RDW) and erythrocyte sedimentation rate, independent of PH. The platelet (PLT) count was significantly lower, and the RDW to PLT ratio (RPR) level was significantly higher in those with ILD and PH coexistence compared to those with only ILD. Conclusion: RPR can be used as screening parameters for PH in ILD associated with SSc.

Keywords

• Interstitial lung disease
• pulmonary hypertension
• systemic sclerosis

Project Number

yok

Pulmoner Tutulumu Olan Sistemik Skleroz Hastalarında Hematolojik Parametrelerin Rolü

Abstract

Amaç: Sistemik skleroz (SSc), mikro ve makroanjiyopati ile karakterize otoimmun bir hastalıktır. SSc'deki mortalite esas olarak pulmoner komplikasyonlara bağlıdır. Bu çalışma, SSc hastalarının vasküler ve parankimal pulmoner tutulumları ile hematolojik parametreler arasındaki ilişkiyi ortaya koymayı amaçladı. Gereç ve Yöntem: Katılımcılar, SSc tanılı interstisyel akciğer hastalığı (İAH) ile birlikte pulmoner hipertansiyonu (PH) olanlar, sadece İAH'si olanlar ve İAH ve PH'si olmayan hastalar olmak üzere üç gruba ayrıldı. Laboratuvar verileri bu gruplar arasında karşılaştırıldı Bulgular: İAH'nIn PH'dan bağımsız olarak yüksek kırmızı hücre dağılım genişliği (RDW) ve eritrosit sedimantasyon hızı ile ilişkili olduğu bulundu. Trombosit (PLT) sayısı anlamlı olarak daha düşüktü ve RDW / PLT oranı (RPO) seviyesi İAH ve PH birlikteliği olanlarda sadece İAH olanlara göre anlamlı olarak daha yüksekti. Sonuç: RPR, SSc ile ilişkili İAH'da PH için tarama parametreleri olarak kullanılabilir.

Keywords

• interstisyel akciğer hastalığı
• pulmoner hipertansiyon
• sistemik skleroz

Supporting Institution

yok

Project Number

yok

References

1. Asano Y. Systemic sclerosis. J Dermatol 2018;45:128-38.
2. Singh D, Parihar AK, Patel S, et al. Scleroderma: An insight into causes, pathogenesis and treatment strategies. Pathophysiology 2019;26:103-14.
3. Wielosz E, Majdan M. Clinical and serological diversity in systemic sclerosis. Wiad Lek 2018;71:78-83.
4. Amoda O, Ravat V, Datta S, et al. Trends in demographics, hospitalization outcomes, comorbidities, and mortality risk among systemic sclerosis patients. Cureus 2018;10:e2628.
5. Rubio-Rivas M, Homs NA, Cuartero D, et al. The prevalence and incidence rate of pulmonary arterial hypertension in systemic sclerosis:Systematic review and meta-analysis. Autoimmun Rev 2021;20:102713.
6. Distler O, Assassi S, Cottin V, et al. Predictors of progression in systemic sclerosis patients with interstitial lung disease. Eur Respir J 2020;55:1902026.
7. Harari S, Elia D, Humbert M. Pulmonary hypertension in parenchymal lung diseases:any future for new therapies? Chest 2018;153:217–23.
8. Chauvelot L, Gamondes D, Berthiller J,et al. Hemodynamic response to treatment and outcomes in pulmonary hypertension associated with interstitial lung disease versus pulmonary arterial hypertension in systemic sclerosis: data from a study identifying prognostic factors in pulmonary hypertension associated with interstitial lung disease. Arthritis Rheumatol 2021;73:295-304.

9. Volkmann ER, Saggar R, Khanna D, et al. Improved transplant-free survival in patients with systemic sclerosis-associated pulmonary hypertension and interstitial lung disease. Arthritis Rheumatol 2014;66:1900-8.
10. Le Pavec J, Girgis RE, Lechtzin N, et al. Systemic sclerosis-related pulmonary hypertension associated with interstitial lung disease:impact of pulmonary arterial hypertension therapies. Arthritis Rheum 2011;63:2456-64.
11. Young A, Vummidi D, Visovatti S, et al. Prevalence, treatment, and outcomes of coexistent pulmonary hypertension and interstitial lung disease in systemic sclerosis. Arthritis Rheumatol 2019;71:1339-49.
12. Weatherald J, Montani D, Jevnikar M, et al. Screening for pulmonary arterial hypertension in systemic sclerosis. Eur Respir Rev 2019;28:190023.
13. Yayla ME, İlgen U, Okatan İE, et al. Association of simple hematological parameters with disease manifestations, activity, and severity in patients with systemic sclerosis. Clin Rheumatol 2020;39:77-83.
14. Farkas N, Szabó A, Lóránd V, et al. Clinical usefulness of measuring red blood cell distribution width in patients with systemic sclerosis. Rheumatology (Oxford) 2014;53:1439-45.
15. Ge S, Lin S, Zhang L, et al. The association of red blood cell distribution width to platelet count ratio and 28-day mortality of patients with sepsis:a retrospective cohort study. Ther Clin Risk Manag 2020;16:999-1006.
16. Li LH, Chen CT, Chang YC, et al. Prognostic role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammation index in acute ischemic stroke: A STROBE-compliant retrospective study. Medicine (Baltimore) 2021;100:e26354.
17. Tanacan E, Dincer D, Erdogan FG, et al. A cut-off value for the systemic immune-inflammation index in determining activity of Behçet disease. Clin Exp Dermatol 2021;46:286-91.
18. van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis:an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 2013;65:2737-47.
19. LeRoy EC, Black C, Fleischmajer R. Scleroderma (systemic sclerosis):classification, subsets and pathogenesis. J Rheumatol 1988;15:202–5.
20. Petrauskas LA, Saketkoo LA, Kazecki T, et al. Use of red cell distribution width in a population at high risk for pulmonary hypertension. Respir Med 2019;150:131-5.
21. Karampitsakos T, Torrisi S, Antoniou K, et al. Increased monocyte count and red cell distribution width as prognostic biomarkers in patients with Idiopathic Pulmonary Fibrosis. Respir Res 2021;22:140.
22. Hu L, Li M, Ding Y, et al. Prognostic value of RDW in cancers:a systematic review and meta-analysis. Oncotarget 2017;8:16027-35.
23. Liu C, Yang J, Lu Z. Study on the red blood cell distribution width in connective tissue disease associated with interstitial lung disease. Biomed Res Int 2020;2020:8130213.
24. Wang W, Liu J, Yang YH, et al. Red cell distribution width is increased in chronic thromboembolic pulmonary hypertension. Clin Respir J 2016;10:54–60.
25. Zhao J, Mo H, Guo X, et al. Red blood cell distribution width as a related factor of pulmonary arterial hypertension in patients with systemic sclerosis. Clin Rheumatol 2018;37:979-85.
26. Bellan M, Giubertoni A, Piccinino C, et al. Red Cell Distribution Width and Platelet Count as Biomarkers of Pulmonary Arterial Hypertension in Patients with Connective Tissue Disorders. Dis Markers 2019;2019:4981982.
27. Liu J, Yang J, Xu S, et al. Prognostic impact of red blood cell distribution width in pulmonary hypertension patients: A systematic review and meta-analysis. Medicine (Baltimore) 2020;99:e19089.
28. Zhang X, Wang D, Chen Z, et al. Red cell distribution width-to-lymphocyte ratio:A novel predictor for HBV-related liver cirrhosis. Medicine (Baltimore) 2020;99:e20638.
29. Li X, Xu H, Gao P. Red blood cell distribution width-to-platelet ratio and other laboratory indices associated with severity of histological hepatic fibrosis in patients with autoimmune hepatitis: a retrospective study at a single center. Med Sci Monit 2020;26:e927946.
30. Zhu X, Li G, Li S, et al. Neutrophil-to-lymphocyte ratio and red blood cell distribution width-to-platelet ratio predict cardiovascular events in hemodialysis patients. Exp Ther Med 2020;20:1105-14.
31. Celık T, Balta S, Demır M, et al. Predictive value of admission red cell distribution width-platelet ratio for no-reflow phenomenon in acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiol J 2016;23:84-92.
32. Takeuchi H, Abe M, Takumi Y, et al. The prognostic impact of the platelet distribution width-to-platelet count ratio in patients with breast cancer. PLoS One 2017;12:e0189166.
33. Liu L, Cao J, Zhong Z, et al. Noninvasive indicators predict advanced liver fibrosis in autoimmune hepatitis patients. J Clin Lab Anal 2019;33:e22922.
34. Wang H, Wang J, Huang R, et al. Red blood cell distribution width for predicting significant liver inflammation in patients with autoimmune hepatitis. Eur J Gastroenterol Hepatol 2019;31:1527-32.
35. Xie S, Chen X. Red blood cell distribution width-to-platelet ratio as a disease activity-associated factor in systemic lupus erythematosus. Medicine 2018;97:e12342.
36. Qiu L, Chen C, Li SJ, et al. Prognostic values of red blood cell distribution width, platelet count, and red cell distribution width-to-platelet ratio for severe burn injury. Sci Rep 2017;7:13720.
37. Cetinkaya E, Senol K, Saylam B, et al. Red cell distribution width to platelet ratio:new and promising prognostic marker in acute pancreatitis. World J Gastroenterol 2014;20:14450-4.
38. Tsirigotis P, Chondropoulos S, Frantzeskaki F, et al. Thrombocytopenia in critically ill patients with severe sepsis/septic shock: Prognostic value and association with a distinct serum cytokine profile. J Crit Care 2016;32:9-15.
39. Guo F, Liang X, Huan J. Clinical significance of continuous thrombocytopenia in predicting sepsis after severe burn. Zhonghua Shao Shang Za Zhi 2014;30:295-8.