An Overview of Systemic Immune-Inflammatıon Index and Hematological Laboratory Findings in Fibromyalgia Syndrome

Abstract

This study aimed to determine disease activity by evaluating the relationship between the Systemic Immune-Inflammation Index (SII) and blood parameters in fibromyalgia syndrome (FMS). 109 FMS patients and 82 healthy controls were included in this retrospective study. Age, gender, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), hemoglobin (HGB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution (RDW), platelet distribution width (PDW), mean platelet volume (MPV), platelet (PLT), platelet crit (PCT), lymphocyte (LYM), monocyte (MONO), neutrophil (NEU) levels were scanned retrospectively from the hospital information system. Platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and SII were calculated. CRP and ESR levels were elevated in fibromyalgia (FMS) patients compared to healthy controls, although they remained within the standard value range (p<0.001). PDW (p<0.001), HGB (p<0.001), MCV (p<0.001), MCH (p<0.001), and MCHC (p=0.02) levels were lower in patients than in the healthy group. There was no discernable age difference between the patient and control groups, WBC, NEU, LYM, MONO, RDW, MPV, PLT, PCT, SII, PLR, NLR, and MLR values. A significant positive correlation was detected between WBC levels and SSS values (r=0.2; p=0.005) and lymphocyte levels and WPI values (r=0.2; p=0.01) in FMS patients. According to the results of this study, SII has no decisive role in FMS, but the disease exhibits distinct inflammatory factors that could be valuable for diagnostic purposes, so more detailed studies are needed.

Keywords

• Fibromyalgia syndrome
• inflammatory marker
• systemic immune inflammation index

Fibromiyalji Sendromunda Sistemik İmmün-İnflamasyon İndeksi ve Hematolojik Laboratuvar Bulgularına Genel Bakış

Abstract

Bu çalışmada fibromiyalji sendromunda (FMS) Sistemik İmmün-İnflamasyon İndeksi (SII) ile kan parametreleri arasındaki ilişki değerlendirilerek hastalık aktivitesinin belirlenmesi amaçlanmıştır. Çalışmaya Ocak 2021 ve Ocak 2022 tarihleri arasında Fizik Tedavi ve Rehabilitasyon Kliniğine başvuran 109 FMS hastası ve 82 sağlıklı kontrol dahil edilmiştir. Yaş, cinsiyet, C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESR), beyaz kan hücresi (WBC), hemoglobin (HGB), ortalama korpusküler hacim (MCV), ortalama korpusküler hemoglobin (MCH), ortalama korpusküler hemoglobin konsantrasyonu (MCHC), kırmızı hücre dağılımı (RDW), trombosit dağılım genişliği (PDW), ortalama trombosit hacmi (MPV), trombosit (PLT), trombosit kriteri (PCT), lenfosit (LYM), monosit (MONO), nötrofil (NEU) düzeyleri hastane bilgi sisteminden retrospektif olarak taranmıştır. Trombosit-lenfosit oranı (PLR), nötrofil-lenfosit oranı (NLR), monosit-lenfosit oranı (MLR) ve sistemik immün-inflamasyon indeksi (SII) hesaplanmıştır. CRP ve ESR düzeyleri FMS hastalarında sağlıklı kontrollere göre daha yüksekti ancak değer aralığının dışında değildi (p<0,001). PDW (p<0,001), HGB (p<0,001), MCV (p<0,001), MCH (p<0,001) ve MCHC (p=0,02) düzeyleri hastalarda sağlıklı gruba göre daha düşüktü. Hasta ve kontrol grupları arasında yaş, WBC, NEU, LYM, MONO, RDW, MPV, PLT, PCT, SII, PLR, NLR ve MLR değerleri açısından istatistiksel olarak anlamlı fark yoktu. FMS hastalarında WBC düzeyleri ile SSS değerleri arasında (r=0,2; p=0,005) ve lenfosit düzeyleri ile WPI değerleri arasında (r=0,2; p=0,01) anlamlı pozitif korelasyon bulunmuştur. Çalışma sonuçlarına göre, SII'nin FMS'de belirleyici bir rolü yoktur, ancak hastalığın tanıda yararlı olabilecek bazı inflamatuvar bileşenleri vardır ve daha ayrıntılı çalışmalara ihtiyaç vardır.

Keywords

• Fibromiyalji sendromu
• inflamatuvar belirteç
• sistemik immün inflamasyon indeksi

References

1. 1. Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311(15):1547-55.
2. 2. Marques AP, Santo ASDE, Berssaneti AA, Matsutani LA, Yuan SLK. Prevalence of fibromyalgia: literature review update. Rev Bras Reumatol Engl Ed 2017; 57(4):356-363.
3. 3. Russell IJ, Larson AA. Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin N Am 2009; 35:421-435.
4. 4. Al-Nimer MSM, Mohammad TAM. Correlation of hematological indices and ratios derived from them with FIQR scores in fibromyalgia. Pak J Med Sci 2018; 34(5):1219–24.
5. 5. Benlidayi C. Role of inflammation in the pathogenesis and treatment of fibromyalgia. Rheumatol Int 2019; 39(5):781-91.
6. 6. Çetin MS, Özcan Çetin EH, Akdı A, et al. Platelet distribution width and plateletcrit: novel biomarkers of ST elevation myocardial infarction in young patients. Kardiol Pol 2017; 75(10):1005-12.
7. 7. Çintesun E, Akar S, Gul A, et al. Subclinical inflammation markers in hyperemesis gravidarum and ketonuria: A case-control study. J Lab Physicians 2019; 11(2):149-53.
8. 8. Tanacan E, Dincer D, Erdogan FG, Gurler A. A cutoff value for the Systemic Immune-Inflammation Index in determining the activity of Behçet disease. Clin Exp Dermatol 2021;46(2):286-91.

9. 9. Erdogan T. Role of systemic immune-inflammation index in asthma and NSAID-exacerbated respiratory disease. Clin Respir J 2021;15(4):400-5.
10. 10. Sun, Y., et al., Increased systemic immune-inflammation index independently predicts poor survival for hormone receptor-negative, HER2-positive breast cancer patients. Cancer Man Res 2019; 11:3153.
11. 11. Ustundag, Y., et al., Relationship between C-reactive protein, systemic immune-inflammation index, and routine hemogram-related inflammatory markers in low-grade inflammation. Int J Med Biochem 2018; 1(1):24-8.
12. 12. Metyas SK, Solyman JS, Arkfeld DG. Inflammatory fibromyalgia: is it real? Curr Rheumatol Rev 2015;11(1):15-17.
13. 13. Balın ŞÖ, Sağmak Tartar A, Akbulut A. The predictive role of hematological parameters in the diagnosis of osteoarticular brucellosis. Afr Health Sci 2018; 18(4): 988–994.
14. 14. Targońska-Stępniak B, Zwolak R, Piotrowski M, Grzechnik K, Majdan M. The Relationship between Hematological Markers of Systemic Inflammation (Neutrophil-To-Lymphocyte, Platelet-To-Lymphocyte, Lymphocyte-To-Monocyte Ratios) and Ultrasound Disease Activity Parameters in Patients with Rheumatoid Arthritis. J Clin Med 2020; 9(9):2760.
15. 15. Groven N, Fors EA, Reitan SK. Patients with Fibromyalgia and Chronic Fatigue Syndrome show increased hsCRP compared to healthy controls. Brain Behav Immun 2019; 81:172-177.
16. 16. Beiner E, Miguel SB, Friederich HC, Tesarz J, PerPAIN Consortium. She elevated highly sensitive C-reactive protein in fibromyalgia. Front Psychiatry 2023; 14: 1237518.
17. 17. Feinberg T, Sambamoorthi U, Lilly C, Innes KK. Potential Mediators between Fibromyalgia and C-Reactive protein: Results from a Large U.S. Community Survey. BMC Musculoskelet Disord 2017; 18: 294.
18. 18. Korkmaz MD, Medin Ceylan C. Evaluation of Inflammatory Markers in Fibromyalgia Syndrome. İKSSTD 2022;14(3):251-254.
19. 19. Xiao Y, Haynes WL, Michalek JE, Russell IJ. Elevated serum high-sensitivity C-reactive protein levels in fibromyalgia syndrome patients correlate with body mass index, interleukin-6, interleukin-8, and erythrocyte sedimentation rate. Rheumatol Int 2013; 33:1259–1264.
20. 20. Haliloğlu S, Carlioglu A, Sahiner E, Karaaslan Y, Kosar A. Mean platelet volume in patients with fibromyalgia. Z Rheumatol 2014;73(8):742-5.
21. 21. Turgay T, Günel Karadeniz P. Fibromiyaljili Hastalarda D Vitamini Düzeyi Hastalık Şiddeti ve Enflamatuar Göstergeler ile İlişkili midir? Uludağ Üni Tıp Fak Der 2019; 45(3):317-321.
22. 22. Tezel N, Gultuna S. Comparisons of neutrophil, monocyte, eosinophil, basophil, and lymphocyte ratios among the fibromyalgia syndrome and healthy individuals. Med Sci Disc 2020; 7(4):455-458.
23. 23. Khamisy-Farah R, Fund E, Raibman-Spector S, Adawi M. Inflammatory Markers in the Diagnosis of Fibromyalgia. Isr Med Assoc J 2021; 23(12):801-804.
24. 24. Jayakrishnan AKR, Easwar SV, Thattil J et al. Studying the Relation Between Fibromyalgia Severity and Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Mean Platelet Volume. Cureus 2022; 14(5): e24847.
25. 25. Ata E, Düzenli T. Fibromiyalji Tanısında İnflamatuar Birbelirteç: Platelet Dağılım Genişliği. Bozok Tıp Derg 2019; 9(4):73-7.
26. 26. Aykurt Karlıbel İ, Demirci H, Kasapoğlu Aksoy M, Azkan Türe D, Altan L. The relationship between vitamin 25(OH)D level and hematological parameters in newly diagnosed women with fibromyalgia syndrome. J Surg Med 2021; 5(1):61-65.
27. 27. Zetterman T, Markkula R, Kalso E. Elevated, highly sensitive C-reactive protein in fibromyalgia is associated with symptom severity. Rheumatol Adv Pract 2022; 6(2):53.
28. 28. Satis S. New Inflammatory Marker Associated with Disease Activity in Rheumatoid Arthritis: The Systemic Immune-Inflammation Index. Curr Health Sci J 2021; 47(4): 553–557.
29. 29. Yorulmaz A, Hayran Y, Akpinar U, Yalcin B. Systemic Immune-Inflammation Index (SII) Predicts Increased Severity in Psoriasis and Psoriatic Arthritis. Curr Health Sci J 2020; 46(4):352-357.
30. 30. Fang H, Zhang H, Wang Z, Zhou Z, Li Y, Lu L. The systemic immune‐inflammation index acts as a novel diagnostic biomarker for postmenopausal osteoporosis and could predict the risk of osteoporotic fracture. J Clin Lab Anal 2020; 34(1): e23016.
31. 31. Yang Z, Zhang Z, Lin F, et al. Comparisons of neutrophil-, monocyte-, eosinophil-, and basophil- lymphocyte ratios among various systemic autoimmune rheumatic diseases. APMIS 2017;125(10):863-871.
32. 32. Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in the assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 2016; 26:372–376.
33. 33. Tak AZA, Şengül Y. Evaluation of Inflammation with Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio in Restless Legs Syndrome. Turk J Neurol 2018; 24(3): 259-263.
34. 34. Karataş G, Gündüz R. Significance of inflammation markers in complete blood count in patients with fibromyalgia. Med Sci Disc 2020;7(1):364-7.