SENSITIVITY OF PLATELET-LYMPHOCYTE RATIO, MONOCYTE-LYMPHOCYTE RATIO, NEUTROPHIL-LYMPHOCYTE RATIO, RED BLOOD CELL DISTRIBUTION WIDTH AND SYSTEMIC IMMUNE INFLAMMATORY INDEX IN MULTIPLE SCLEROSIS PATIENTS: RELATIONSHIP WITH DISEASE SUBTYPES AND DISABILITY

Year 2024, Volume: 25 Issue: 3, 315 - 321, 18.07.2024

Melike Doğan Ünlü , Serpil Demirci

https://doi.org/10.18229/kocatepetip.1268139

Abstract

OBJECTIVE: Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system (CNS). Although it is not clear how autoimmune responses occur, it is known that peripheral blood cells may promote the initiation and exacerbation of the inflammatory response in MS. The aim of this study was to evaluate the sensitivity and specificity of neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), erythrocyte distribution width (RDW) and systemic immune inflammation index (SIII) in MS and to determine their relationship with disability.
MATERIAL AND METHODS: In this single-center, retrospective case-control study, 104 patients with MS and 65 healthy individuals were included. Disability was assessed with the Expanded Disability Status Scale (EDSS) score, and patients were classified as mild (EDSS<3), moderate (3.5 ≤ EDSS ≥4.5), and severe (EDSS≥5) disabilities. NLR, MLR, PLR, RDW and SIII values were calculated according to the complete blood counts of the patients and the control group. Inflammation markers between the control group and MS patients, MS subtypes, and relapsing-remitting MS (RRMS) attack and remission periods were compared. the relationship between these markers and duration of illness, number of attacks and disability was examined.
RESULTS: MLR and RDW were higher in MS than the controls. There was no significant difference in these values between MS subtypes. It was observed that RDW increased as the disease duration, number of attacks and EDSS increased.
CONCLUSIONS: In our study, in evaluating inflammation it was seen that MLR and RDW were more determinative than PLR, NLR and SIII. The fact that RDW is higher in MS patients and is affected by disease disability indicates that RDW may have an important role in the follow-up of MS patients and in evaluating the degree of disability.

Keywords

Multiple sclerosis, Inflammatory response, Inflammation, Lymphocyte, Erythrocyte distribution volume

MULTİPL SKLEROZ HASTALARINDA PLATELET LENFOSİT ORANI, MONOSİT LENFOSİT ORANI, NÖTROFİL LENFOSİT ORANI, ERİTROSİT DAĞILIM GENİŞLİĞİ VE SİSTEMİK İMMÜN İNFLAMASYON İNDEKSİ DUYARLILIĞI: HASTALIK ALT TİPLERİ VE ENGELLİLİK İLE İLİŞKİSİ

Abstract

AMAÇ: Multipl skleroz (MS) merkezi sinir sisteminin (MSS) süreğen, inflamatuar otoimmün bir hastalığıdır. Otoimmün yanıtların nasıl oluştuğu netlik kazanmasa da periferik kan hücrelerinin MS'te inflamatuar yanıtın başlamasına ve şiddetlenmesine katkıda bulunabileceği bilinmektedir. Bu çalışmanın amacı MS’de nötrofil-lenfosit oranı (NLR), monosit-lenfosit oranı (MLR), platelet-lenfosit oranı (PLR), eritrosit dağılım genişliği (RDW) ve sistemik immün inflamasyon indeksi (SIII) duyarlılığını ve özgüllüğünü değerlendirmek ve engellilik ile arasındaki ilişkiyi belirlemektir.
GEREÇ VE YÖNTEM: Bu tek merkezli, retrospektif vaka kontrol çalışmasına toplam 104 MS hastası ile yaş ve cinsiyet uyumlu 65 sağlıklı birey alındı. Engellilik, Genişletilmiş Engellilik Durumu Ölçeği (EDSS) ile değerlendirildi ve buna göre hastalar, hafif (EDSS<3), orta (3,5 ≤ EDSS ≥4,5) ve şiddetli (EDSS≥5) engelliler olarak sınıflandırıldı. Hastaların ve kontrol grubunun tam kan sayımlarına göre NLR, MLR, PLR, RDW ve SIII değerleri hesaplandı. Kontrol grubu ile MS hastaları, MS alt tipleri ve relapsing-remitting MS (RRMS) atak ve remisyon dönemi arasındaki inflamasyon belirteçleri karşılaştırıldı. Bu belirteçler ile hastalık süresi, atak sayısı ve özürlülük arasındaki ilişkiye bakıldı.
BULGULAR: MLR ve RDW, MS’de kontrol grubuna göre daha yüksekti. MS alt tiplerin arasında bu değerlerde anlamlı farklılık yoktu. Hastalık süresi, atak sayısı ve EDSS arttıkça RDW’nin de arttığı görüldü.
SONUÇ: Çalışmamızda MLR ve RDW’nin PLR, NLR ve SIII’ye göre inflamasyonu değerlendirmede daha belirleyici olduğu görülmüştür. RDW'nin MS hastalarında daha yüksek olması ve hastalık disabilitesinden etkilenmesi, MS hastalarının takibinde ve özürlülük derecesinin değerlendirilmesinde RDW'nin önemli bir rolü olabileceğini göstermektedir.

Keywords

Multipl skleroz, İnflamatuar yanıt, İnflamasyon, Lenfosit, Eritrosit dağılım hacmi

Supporting Institution

yoktur

References

• 1. Hemmer B, Kerschensteiner M, Korn T. Role of the innate and adaptive immune responses in the course of multiple sclerosis. Lancet Neurol. 2015;14:406–19.
• 2. Dendrou C, Fugger L, Friese M. Immunopathology of multiple sclerosis. Nat Rev Immunol. 2015;15(9):545-58.
• 3. Dargahi N, Katsara M, Tselios T, et al. Multiple sclerosis: immunopathology and treatment update. Brain Sci. 2017;7(7):78.
• 4. Demirci S, Demirci S, Kutluhan S, Koyuncuoglu HR, Yurekli VA. The clinical significance of the neutrophil-to- lymphocyte ratio in multiple sclerosis. Int J Neurosci. 2016;126(8):700-6.
• 5. Peng YF, Cao WY, Zhang Q, Chen D, Zhang ZX. Assessment of the relationship between red cell distribution width and multiple sclerosis. Medicine (Baltimore). 2015;94(29):1182.
• 6. Hemond C, Glaz B, Bakshi R, Chitnis T, Healy B. The neutrophil-to-lymphocyte and monocyte-to- lymphocyte ratios are independently associated with neurological disability and brain atrophy in multiple sclerosis. BMC Neurology. 2019;19:23.
• 7. Hao X, Li D, Wu D, Zhang N. The relationship between hematological indices and autoimmune rheumatic diseases (ARDs), a meta-analysis. Sci Rep. 2017;7:10833.
• 8. Saçmacı H, Aktürk T, Tanık N. The Predictive Value of the Systemic Immune-inflammation Index as a New Prognostic Marker for Disability in Patients with Multiple Sclerosis. Turk J Neurol. 2021;27:133-9.
• 9. Contentti E, López PA, Criniti J, et al. Platelet-to-lymphocyte ratio differs between MS and NMOSD at disease onset and predict disability. Mult Scler Relat Disord. 2022;58:103507.
• 10. Arhan M, Onal I, Tas A, et al. The role of red cell distribution width as a marker in inflammatory bowel disease. Turk J Med Sci. 2011;41(2):227-34.
• 11. Dziedzic A, Bijak M. Interactions between platelets and leukocytes in pathogenesis of multiple sclerosis. Adv Clin Exp Med. 2019;28(2):277-85.
• 12. Liu X, Shao S, Wang L, et al. Predictive value of the systemic immune-inflammation index for intravenous immunoglobulin resistance and cardiovascular complications in Kawasaki disease. Front Cardiovasc Med. 2021;24;8:711007.
• 13. Thompson AJ, Barwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162-73.
• 14. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS). Neurology 1983;33:1444-52.
• 15. Çinar BP, Yorgun YG. What we learned from the history of multiple sclerosis measurement: expanded disability status scale. Noro Psikiyatr Ars. 2018;55:69-75.
• 16. Pierson ER, Wagner CA, Goverman JM. The contribution of neutrophils to CNS autoimmunity. Clin Immunol. 2018;189:23–8.
• 17. Soulika AM, Lee E, McCauley E, et al. Initiation and progression of axonopathy in experimental autoimmune encephalomyelitis. J Neurosci. 2009;29:14965–79.
• 18. Horstman LL, Jy W, Ahn YS, et al. Role of platelets in neuroinflammation: a wide-angle perspective. J Neuroinflam. 2010;7:10.
• 19. Semple JW, Italiano JE, Freedman J. Platelets and the immune continuum. Nat Rev Immunol. 2011;11:264–74.
• 20. Hershko KA, Hadi E, Asali A, et al. Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: a population study. PLoS One. 2018;13(5):e0196706.
• 21. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
• 22. Yang DH, Qian MZ, Wei MM, et al. The correlation of neutrophil-tolymphocyte ratio with the presence and activity of myasthenia gravis. Oncotarget. 2017;8:76099-107.
• 23. Saliba W, Barnett-Griness O, Elias M, Rennert G. Neutrophil to lymphocyte ratio and risk of a first episode of stroke in patients with atrial fibrillation: a cohort study. J Thromb Haemost. 2015;13:1971-9.
• 24. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-tolymphocyte ratio and neurological deterioration following acute cerebral hemorrhage. Oncotarget. 2017;8:57489-94.
• 25. Bisgaard AK, Pihl-Jensen G, Frederiksen JL. The neutrophil-to-lymphocyte ratio as disease actvity marker in multiple sclerosis and optic neuritis. Mult Scler Relat Disord. 2017;18:213-7.
• 26. Al-Hussain F, Alfallaj MM, Alahmari AN, et al. Relationship between neutrophil-to-lymphocyte ratio and stress in multiple sclerosis patients. J Clin Diag Res. 2017;11:1–4.
• 27. Guzel I, Mungan S, Oztekin ZN, Ak F. Is there an association between the expanded disability status scale and inflammatory markers in multiple sclerosis. J Chinese Med Assoc. 2016;79:54–7.
• 28. Smith RA, Bosonnet L, Ghaneh P, et al. The plateletlymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer. Surgery. 2008;143:658-66.
• 29. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17:47-58.
• 30. Uzar E, Arıkanoğlu A, Yücel Y, et al. Investigation of Mean Platelet Volume in Patients with Multiple Sclerosis. Turk Norol Derg. 2011;17:185-8.
• 31. Marinkovic D, Zhang X, Yalcin S, et al. Foxo3 is required for the regulation of oxidative stress in erythropoiesis. J Clin Invest. 2007;117:2133-44.
• 32. Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic Peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J. 2009;50:301-12.
• 33. Patel KV, Mohanty JG, Kanapuru B, et al. Association of the red cell distribution width with red blood cell deformability. Adv Exp Med Biol. 2013;765:211–6.
• 34. Piagnerelli M, Boudjeltia KZ, Brohee D, et al. Alterations of red blood cell shape and sialic acid membrane content in septic patients. Crit Care Med. 2003;31:2156-62.
• 35. Tecer D, Sezgin M, Kanık A, et al. Can mean platelet volume and red blood cell distribution width show disease activity in rheumatoid arthritis? Biomark Med. 2016;10:967-74.
• 36. Song CS, Park DI, Yoon MY, et al. Association Between Red Cell Distribution Width and Disease Activity in Patients with Inflammatory Bowel Disease. Digest Dis Sci. 2012; 57:1033-8.
• 37. Yuksel O, Helvaci K, Basar O, et al. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets. 2009;20:277-81.
• 38. Ani C, Ovbiagele B. Relation of baseline presence and severity of renal disease to long-term mortality in persons with known stroke. J Neurol Sci. 2010;288:123-8.
• 39. Hou D, Wang C, Luo Y, et al. Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci. 2020;26:1–6.
• 40. Mei Y, Yang J, Yuan Y, et al. Systemic Inflammation Index Values Are Associated With Worsened Disease Severity and Poor Response to Autoimmune Encephalitis Treatment. Front. Neurol. 2021;12:709553.