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Is there any association between the monocyte / lymphocyte ratio and the presence and severity of the disease in patients with psoriasis? A cross-sectional study.

Year 2020, , 430 - 436, 15.09.2020
https://doi.org/10.31832/smj.719980

Abstract

Objective: Patients with psoriasis have increased systemic inflammation and monocytes levels compared with the general population. However, the role of monocytes in modulating inflammation in these patients is not clearly known. Psoriasis patients, where inflammation plays a role, are also at risk for cardiovascular diseases. The monocyte-to-lymphocyte ratio (MLR) may reflect a systemic inflammatory status. The aim of this study was to investigate the usefulness of MLR in patients with psoriasis.
Materials and Methods: A total of 180 consecutive patients who had been routinely referred to psoriasis outpatient clinic,and 40 healthy individuals were included in our case-control study between January 2015, and January 2017. Demographic features, Psoriasis Area and Severity Index (PASI) scores,and laboratory data were collected from electronic database system.
Results: Patients with psoriasis had higher leukocyte, neutrophil, monocyte counts and MLR compared with control group (p=0.003, p<0.001, p=0.032, p<0.001, respectively). The PASI scores positively correlated with MLR (r=.244, p=0.001). The monocyte counts(p=0.004) and MLR (p<0.001) were significantly higher in the moderate-severe psoriasis group than in the mild psoriasis group. After adjusted for confounding factors,only MLR and body weight were found independently associated with moderate-severe psoriasis in multivariate regression analysis (p=0.005; p=0.037,respectively). The ROC analysis showed that MLR predicted moderate-severe psoriasis with a sensitivity of 84% and with a specificity of 56%, using a cut-off value of 0,192. The AUC (area under curve) was found 0.71(p<0.001).
Conclusion: The MLR, an inexpensive and easily measurable variable,is significantly associated with the presence and severity of psorisis. More comprehensive studies are needed to validate and elaborate this relationship.

References

  • 1. 1. Christophers E. Psoriasis–epidemiology and clinical spectrum. Clin Exp Dermatol 2001; 26: 314– 320.
  • 2. Paul C, Gourraud PA, Bronsard V, Prey S, Puzenat E, Aractingi S, et al. Evidencebased recommendations to assess psoriasis severity: systematic literatüre review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2010; 24:2–9.
  • 3. Schmitt J, Wozel G. The Psoriasis Area and Severity Index is the adequate criterion to define severity in chronic plaque-type psoriasis. Dermatology 2005; 210:194–9.
  • 4. Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009;23 Suppl 2:1–70.
  • 5. Uysal S, Yılmaz FM, Karatoprak K, Artüz F, Cumbul NU. The levels of serum pentraxin3, CRP, fetuin-A, and insulin in patients with psoriasis. Eur Rev for Med Pharmocol Sci 2014; 18:3453–8.
  • 6. Dowlatsahi EA, van der Voort EA, Arends LR, Nijsten T. Markers of systemic inflammation in psoriasis: a systematic review and meta-analysis. Br J Dermatol 2013; 169:266–82.
  • 7. Beygi S, Lajevardi V, Abedini R. C-reactive in psoriasis: a review of the literature. J Eur Acad Dermatol Venereol 2014; 28:700–11.
  • 8. Fujisawa T, Murase K, Kanoh H, Takemura M, Ohnishi H, Seishima M, et al. Adsorptive depletion of CD14(+), CD16(+) proinflammatory monocyte phenotype in patients with generalized pustular psoriasis: clinical efficacy and effects on cytokines. Ther Apher Dial 2012; 16: 436– 444.
  • 9. Han, LH, Jia, YB, Song, QX. Prognostic significance of preoperative lymphocyte-monocyte ratio in patients with resectable esophageal squamous cell carcinoma. Asian Pac J Cancer Prev 2015; 16: 2245–2250.
  • 10. Ferro, M, Musi, G, Serino. A. Neutrophil, platelets, and eosinophil to lymphocyte ratios predict gleason score upgrading in low-risk prostate cancer patients. Urol Int 2019; 102: 43–50.
  • 11. Murat, SN, Yarlioglues, M, Celik, IE. The relationship between lymphocyte-to-monocyte ratio and bare-metal stent in-stent restenosis in patients with stable coronary artery disease. Clin Appl Thromb Hemost 2017; 23: 235–240.
  • 12. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352:1685-95.
  • 13. Jindal S, Jindal N. Psoriasis and Cardiovascular Diseases: A Literature Review to Determine the Causal Relationship. Cureus 2018 Feb; 10(2): e2195.
  • 14. Daudén E, Puig L, Ferrándiz C, Sánchez-Carazo JL, Hernanz-Hermosa JM. Consensus document on the evaluation andtreatment of moderate-to-severe psoriasis: Psoriasis Group ofthe Spanish Academy of Dermatology and Venereology. J EurAcad Dermatol Venereol 2016; 30 Suppl 2:1-18.
  • 15. Boehncke, W.H.; Schon, M.P. Psoriasis. Lancet 2015, 386, 983–994.
  • 16. K.E. Nograles, B. Davidovici, J.G. Krueger. New insights in the immunologic basis of psoriasis. Semin Cutan Med Surg 2010; 29(1): 3-9.
  • 17. Wang Y, Edelmayer R, Wetter J, Salte K, Gauvin D, Leys L, et al. Monocytes/Macrophages play a pathogenic role in IL-23 mediated psoriasis-like skin inflammation. Sci Rep 2019 Mar 29;9(1):5310.
  • 18. A.M. Zawada, K.S. Rogacev, B. Rotter, P. Winter, R.R. Marell, D. Fliser, et al., SuperSAGE evidence for CD14++CD16+ monocytes as a third monocyte subset, Blood 118 (2011) e50–e61.
  • 19. J.B. Golden, S.G. Groft, M.V. Squeri, S.M. Debanne, N.L. Ward, T.S. McCormick, et al. Chronic psoriatic skin inflammation leads to increased monocyte adhesion and aggregation, J. Immunol 195 (2015) 2006–2018.
  • 20. M. Augustin, J. Vietri, H. Tian, I. Gilloteau. Incremental burden of cardiovascular comorbidity and psoriatic arthritis among adults with moderate-to-severe psoriasis in five European countries, J. Eur. Acad. Dermatol. Venereol 2017; 31 (8): 1316–1323.
  • 21. K.S. Rogacev, S. Seiler, A.M. Zawada, B. Reichart, E. Herath, D. Roth, et al. CD14+ +CD16+ monocytes and cardiovascular outcome in patients with chronic kidney disease, Eur. Heart J 2011; 32: 84–92.
  • 22. J. Xiang, Zhou L, Li X, Bao W, Chen T, Xi X, et al. Preoperative monocyte-to-lymphocyte ratio in peripheral blood predicts stages, metastasis, and histological grades in patients with ovarian cancer, Transl Oncol 10 (1) (2017) 33–39.
  • 23. S. Song, C. Li, S. Li, H. Gao, X. Lan, Y. Xue, et al. Derived neutrophils to lymphocyte ratio and monocyte to lymphocyte ratio may be better biomarkers for predicting overall survival of patients with advanced gastric cancer, Onco Targets Ther 10 (2017) 3145–3154.
  • 24. Y. Jiang, Zang M, Li S. Serum PLR and LMR in Behçet's disease: can they show the disease activity? Medicine (Baltimore) 2017 May; 96(21): e6981.
  • 25. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45: 1638–43.
  • 26. Fan Z, Ji H, Li Y, Jian X, Li L, Liu T. Relationship between monocyte-to-lymphocyte ratio and coronary plaque vulnerability in patients with stable angina. Biomark Med 2017; 11: 979-990.
  • 27. Kiris T, Çelik A, Variş E, Akan E, Akyildiz ZI, Karaca M, et al. Association of lymphocyte-to-monocyte ratio with the mortality in patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Angiology 2017; 68: 707-715.

Psöriazis hastalarında monosit / lenfosit oranı ile hastalığın varlığı ve şiddeti arasında bir ilişki var mıdır? Kesitsel bir çalışma.

Year 2020, , 430 - 436, 15.09.2020
https://doi.org/10.31832/smj.719980

Abstract

Amaç: Psöriyazis’li hastalar, genel popülasyona kıyasla artmış sistemik inflamasyon ve monosit seviyelerine sahiptir. Bununla birlikte, bu hastalarda monositlerin enflamasyonu modüle etmedeki rolü açıkça bilinmemektedir. Enflamasyonun rol oynadığı psöriyazis hastaları kardiyovasküler hastalıklar içinde risk altındadır. Monosit-lenfosit oranı (MLO) sistemik bir enflamatuar durumu yansıtabilir. Bu çalışmanın amacı psöriyazis hastalarında MLO'nın yararlılığını araştırmaktır.
Gereç ve Yöntemler: Vaka-kontrol çalışmamıza Ocak 2015 ile Ocak 2017 arasında psöriyazis polikliniğine rutin olarak yönlendirilen toplam 180 ardışık hasta ve 40 sağlıklı birey dahil edildi. Demografik özellikler, Psöriyazis Alan ve Şiddet İndeksi (PASI) skorları ve laboratuvar verileri elektronik veri tabanı sisteminden toplandı.
Bulgular: Psöriyazis hastalarında kontrol grubuna kıyasla daha yüksek lökosit, nötrofil, monosit sayısı ve MLO vardı (sırasıyla p = 0.003, p <0.001, p = 0.032, p<0.001). PASI skorları MLO ile pozitif korelasyon gösterdi (r = .244, p = 0.001). Monosit sayıları (p = 0.004) ve MLO (p <0.001) orta-şiddetli psöriyazis grubunda hafif psöriyazis grubuna göre anlamlı derecede yüksekti. Karıştırıcı faktörler ayarlandıktan sonra, çok değişkenli regresyon analizinde sadece MLO ve vücut ağırlığının orta-şiddetli psöriyazis hastalığı ile bağımsız ilişkili olduğu bulunmuştur (sırasıyla p = 0.005; p = 0.037). ROC analizi, MLO'nın 0,192'lik bir cut-off değeri kullanılarak %84 sensitivite ve %56 spesifite ile orta-şiddetli psöriyazisi öngördüğünü gösterdi. EAA (eğrinin altındaki alan) 0.71 (p<0.001) bulundu.
Sonuç: Ucuz ve kolayca ölçülebilen bir değişken olan MLO, psöriyazis varlığı ve ciddiyeti ile önemli ölçüde ilişkilidir. Bu ilişkiyi doğrulamak ve detaylandırmak için daha kapsamlı çalışmalara ihtiyaç vardır.

References

  • 1. 1. Christophers E. Psoriasis–epidemiology and clinical spectrum. Clin Exp Dermatol 2001; 26: 314– 320.
  • 2. Paul C, Gourraud PA, Bronsard V, Prey S, Puzenat E, Aractingi S, et al. Evidencebased recommendations to assess psoriasis severity: systematic literatüre review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2010; 24:2–9.
  • 3. Schmitt J, Wozel G. The Psoriasis Area and Severity Index is the adequate criterion to define severity in chronic plaque-type psoriasis. Dermatology 2005; 210:194–9.
  • 4. Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009;23 Suppl 2:1–70.
  • 5. Uysal S, Yılmaz FM, Karatoprak K, Artüz F, Cumbul NU. The levels of serum pentraxin3, CRP, fetuin-A, and insulin in patients with psoriasis. Eur Rev for Med Pharmocol Sci 2014; 18:3453–8.
  • 6. Dowlatsahi EA, van der Voort EA, Arends LR, Nijsten T. Markers of systemic inflammation in psoriasis: a systematic review and meta-analysis. Br J Dermatol 2013; 169:266–82.
  • 7. Beygi S, Lajevardi V, Abedini R. C-reactive in psoriasis: a review of the literature. J Eur Acad Dermatol Venereol 2014; 28:700–11.
  • 8. Fujisawa T, Murase K, Kanoh H, Takemura M, Ohnishi H, Seishima M, et al. Adsorptive depletion of CD14(+), CD16(+) proinflammatory monocyte phenotype in patients with generalized pustular psoriasis: clinical efficacy and effects on cytokines. Ther Apher Dial 2012; 16: 436– 444.
  • 9. Han, LH, Jia, YB, Song, QX. Prognostic significance of preoperative lymphocyte-monocyte ratio in patients with resectable esophageal squamous cell carcinoma. Asian Pac J Cancer Prev 2015; 16: 2245–2250.
  • 10. Ferro, M, Musi, G, Serino. A. Neutrophil, platelets, and eosinophil to lymphocyte ratios predict gleason score upgrading in low-risk prostate cancer patients. Urol Int 2019; 102: 43–50.
  • 11. Murat, SN, Yarlioglues, M, Celik, IE. The relationship between lymphocyte-to-monocyte ratio and bare-metal stent in-stent restenosis in patients with stable coronary artery disease. Clin Appl Thromb Hemost 2017; 23: 235–240.
  • 12. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352:1685-95.
  • 13. Jindal S, Jindal N. Psoriasis and Cardiovascular Diseases: A Literature Review to Determine the Causal Relationship. Cureus 2018 Feb; 10(2): e2195.
  • 14. Daudén E, Puig L, Ferrándiz C, Sánchez-Carazo JL, Hernanz-Hermosa JM. Consensus document on the evaluation andtreatment of moderate-to-severe psoriasis: Psoriasis Group ofthe Spanish Academy of Dermatology and Venereology. J EurAcad Dermatol Venereol 2016; 30 Suppl 2:1-18.
  • 15. Boehncke, W.H.; Schon, M.P. Psoriasis. Lancet 2015, 386, 983–994.
  • 16. K.E. Nograles, B. Davidovici, J.G. Krueger. New insights in the immunologic basis of psoriasis. Semin Cutan Med Surg 2010; 29(1): 3-9.
  • 17. Wang Y, Edelmayer R, Wetter J, Salte K, Gauvin D, Leys L, et al. Monocytes/Macrophages play a pathogenic role in IL-23 mediated psoriasis-like skin inflammation. Sci Rep 2019 Mar 29;9(1):5310.
  • 18. A.M. Zawada, K.S. Rogacev, B. Rotter, P. Winter, R.R. Marell, D. Fliser, et al., SuperSAGE evidence for CD14++CD16+ monocytes as a third monocyte subset, Blood 118 (2011) e50–e61.
  • 19. J.B. Golden, S.G. Groft, M.V. Squeri, S.M. Debanne, N.L. Ward, T.S. McCormick, et al. Chronic psoriatic skin inflammation leads to increased monocyte adhesion and aggregation, J. Immunol 195 (2015) 2006–2018.
  • 20. M. Augustin, J. Vietri, H. Tian, I. Gilloteau. Incremental burden of cardiovascular comorbidity and psoriatic arthritis among adults with moderate-to-severe psoriasis in five European countries, J. Eur. Acad. Dermatol. Venereol 2017; 31 (8): 1316–1323.
  • 21. K.S. Rogacev, S. Seiler, A.M. Zawada, B. Reichart, E. Herath, D. Roth, et al. CD14+ +CD16+ monocytes and cardiovascular outcome in patients with chronic kidney disease, Eur. Heart J 2011; 32: 84–92.
  • 22. J. Xiang, Zhou L, Li X, Bao W, Chen T, Xi X, et al. Preoperative monocyte-to-lymphocyte ratio in peripheral blood predicts stages, metastasis, and histological grades in patients with ovarian cancer, Transl Oncol 10 (1) (2017) 33–39.
  • 23. S. Song, C. Li, S. Li, H. Gao, X. Lan, Y. Xue, et al. Derived neutrophils to lymphocyte ratio and monocyte to lymphocyte ratio may be better biomarkers for predicting overall survival of patients with advanced gastric cancer, Onco Targets Ther 10 (2017) 3145–3154.
  • 24. Y. Jiang, Zang M, Li S. Serum PLR and LMR in Behçet's disease: can they show the disease activity? Medicine (Baltimore) 2017 May; 96(21): e6981.
  • 25. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45: 1638–43.
  • 26. Fan Z, Ji H, Li Y, Jian X, Li L, Liu T. Relationship between monocyte-to-lymphocyte ratio and coronary plaque vulnerability in patients with stable angina. Biomark Med 2017; 11: 979-990.
  • 27. Kiris T, Çelik A, Variş E, Akan E, Akyildiz ZI, Karaca M, et al. Association of lymphocyte-to-monocyte ratio with the mortality in patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Angiology 2017; 68: 707-715.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Nur Cihan Coşansu 0000-0001-6156-6380

Bahar Sevimli Dikicier 0000-0002-1912-3946

Mahizar Yaldiz This is me 0000-0001-6981-457X

Berna Solak This is me

Publication Date September 15, 2020
Submission Date May 15, 2020
Published in Issue Year 2020

Cite

AMA Coşansu NC, Sevimli Dikicier B, Yaldiz M, Solak B. Is there any association between the monocyte / lymphocyte ratio and the presence and severity of the disease in patients with psoriasis? A cross-sectional study. Sakarya Tıp Dergisi. September 2020;10(3):430-436. doi:10.31832/smj.719980

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