The Relationship Between Serum IL-6 Level and Mean Platelet Volume with the Disease Severity in Pediatric Patients with Henoch Schönlein Purpura

Abstract

Objectives: Henoch-Schönlein purpura (HSP) which is the most common childhood vasculitis, causes mortality that is generally related with severe renal and gastrointestinal symptoms. The present study aimed to investigate the relationship between serum interleukin (IL)-6 and mean platelet volume (MPV) levels and disease severity in pediatric patients. Materials and Methods: HSP was diagnosed based on the EULAR/PRINTO/PRES criteria. Age, gender, season of disease onset, and the presence and type of infection before the attack were recorded. Systemic involvement for each patient was evaluated from the medical history, physical examination, and laboratory tests. Results: A total of 85 patients between 2-17 years of age (median age: 8 years) were included in the study. All patients had the typical purpuric rash, with 71.8%, 74.1%, and 31.8% displaying joint, gastrointestinal system (GIS), and renal involvement, respectively. IL-6 levels were increased in 61.1%, 55.6%, and 63.3% of patients with renal, GIS, and joint involvement, respectively. MPV levels were decreased in 40.7%, 49.2%, and 49.2% of patients with renal, GIS, and joint involvement, respectively. IL-6 and MPV levels were not significantly different (p>0.05) between patients with and without renal, joint, or gastrointestinal involvement. Conclusion: There was no prognostic relationship between MPV or serum IL-6 levels at the initial diagnosis and GIS or renal involvement in HSP. Further studies are needed to determine the relationship between inflammatory cytokines and HSP

Keywords

• Henoch-Schönlein Purpura
• Interleukin-6
• Mean Platelet Volume

Henoch Schönlein Purpuralı Pediatrik Hastalarda Serum IL-6 Düzeyi ve Ortalama Trombosit Hacmi ile Hastalık Şiddeti Arasındaki İlişkisi

Abstract

Amaç: Çocukluk çağı vaskülitlerinin en sık görüleni olan Henoch-Schönlein purpurası (HSP), genellikle şiddetli böbrek ve gastrointestinal semptomlarla ilişkili mortaliteye neden olur. Bu çalışmada, pediatrik hastalarda serum interlökin (IL)-6 ve ortalama trombosit hacmi (MPV) düzeyleri ile hastalık şiddeti arasındaki ilişkinin araştırılmaktadır. Gereç ve Yöntem: EULAR/PRINTO/PRES kriterlerine göre HSP tanısı konuldu. Hastaların yaş, cinsiyet, hastalığın başladığı mevsim ve önceki enfeksiyon varlığı ve türü kaydedildi. Her hasta için sistemik tutulum tıbbi hikaye, fizik muayene ve laboratuvar testleri değerlendirildi. Bulgular: Çalışmaya 2-17 yaş arasında (ortanca yaş: 8 yıl) 85 hasta dahil edildi. Tüm hastalarda tipik purpurik döküntü vardı. Eklem tutulumu %71,8, gastrointestinal sistem (GİS) tutulumu %74,1 ve renal tutulum %31,8 oranında tespit edildi. Renal, GİS ve eklem tutulumu olan hastaların sırasıyla %61,1, %55,6 ve %63,3’ünde IL-6 seviyeleri yükselmiştir. Böbrek, GİS ve eklem tutulumu olan hastaların sırasıyla %40,7’sinde, %49,2’sinde ve %49,22sinde MPV seviyeleri düşmüştür. IL-6 ve MPV düzeyleri böbrek, eklem veya gastrointestinal tutulumu olan ve olmayan hastalar arasında anlamlı farklılık göstermedi (p>0,05). Sonuç: HSP’de başlangıç tanısında MPV veya serum IL-6 seviyeleri ile GİS veya böbrek tutulumu arasında prognostik ilişki yoktu. Enflamatuvar sitokinler ve HSP arasındaki ilişkiyi belirlemek için daha ileri çalışmalara ihtiyaç vardır.

Keywords

• Henoch-Schönlein Purpurası
• Interlökin-6
• Ortalama Trombosit Hacmi

References

1. 1. Kraft DM, Mckee D, Scott C. Henoch-Schönlein purpura: a review. Am Fam Physician. 1998;58:405-411.
2. 2. Dillon MJ. Henoch-Schönlein purpura (treatment and outcome). Cleve Clin J Med. 2002;69 Suppl 2:SII121-SII123.
3. 3. Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum. 2005;35:143-153.
4. 4. Yano S. Henoch-Schönlein purpura associated with pulmonary Mycobacterium avium-intracellulare complex. Intern Med. 2004;43:843-845.
5. 5. Pimentel MI, Vasconcellos Ede C, Cerbino-Neto J. Henoch-Schönlein purpura following influenza A H1N1 vaccination. Rev Soc Bras Med Trop. 2011;44:531.
6. 6. Inal A, Yılmaz M, Kendirli SG, et al. Henoch-Schönlein purpurası tanısı alan çocukların klinik özellikleri. Erciyes Tıp Dergisi. 2009;31:153-161.
7. 7. Arslan Ş, Saatçi Ü. Henoch-Schönlein Purpurası. Katkı Pediatri Dergisi. 1995;2:165-174.
8. 8. Ralli M, Campo F, Angeletti D, et al. Pathophysiology and therapy of systemic vasculitides. EXCLI J. 2020;19:817-854.

9. 9. Topaloglu R, Sungur A, Baskin E, et al. Vascular endothelial growth factor in Henoch-Schonlein purpura. J Rheumatol. 2001;28:2269-2273.
10. 10. Jaszczura M, Góra A, Grzywna-Rozenek E, et al. Analysis of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and mean platelet volume to platelet count ratio in children with acute stage of immunoglobulin A vasculitis and assessment of their suitability for predicting the course of the disease. Rheumatol Int. 2019;39:869-878.
11. 11. Ozen S, Pistorio A, Iusan SM, et al. EULAR/PRINTO/PRES criteria for HenochSchönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69:798-806.
12. 12. Meadow SR, Glasgow EF, White RH, et al. Schönlein-Henoch nephritis. Q J Med. 1972;41:241-258.
13. 13. Counahan R, Winterborn MH, White RH, et al. Prognosis of HenochSchönlein nephritis in children. Br Med J. 1977;2:11-14.
14. 14. Nishimoto N, Kishimoto T. Interleukin 6: from bench to bedside. Nat Clin Pract Rheumatol. 2006;2:619-626.
15. 15. Mahajan N, Kapoor D, Bisht D, et al. Levels of interleukin-18 and endothelin-1 in children with Henoch-Schönlein purpura: a study from northern India. Pediatr Dermatol. 2013;30:695-699.
16. 16. Sun DQ, Zhang QY, Dong ZY, et al. [Levels of IL-12 produced by dendritic cells and changes of TH1/TH2 balance in children with Henoch-Schonlein purpura]. Zhongguo Dang Dai Er Ke Za Zhi. 2006;8:307-310.
17. 17. Besbas N, Saatci U, Ruacan S, et al. The role of cytokines in Henoch Schonlein purpura. Scand J Rheumatol. 1997;26:456-460.
18. 18. Yuan L, Wang Q, Zhang S, et al. Correlation between serum inflammatory factors TNF-α, IL-8, IL-10 and Henoch-Schonlein purpura with renal function impairment. Exp Ther Med. 2018;15:3924-3928.
19. 19. Del Vecchio GC, Penza R, Altomare M, et al. Cytokine pattern and endothelium damage markers in Henoch-Schönlein purpura. Immunopharmacol Immunotoxicol. 2008;30:623-629.
20. 20. Rostoker G, Rymer JC, Bagnard G, et al. Imbalances in serum proinflammatory cytokines and their soluble receptors: a putative role in the progression of idiopathic IgA nephropathy (IgAN) and Henoch-Schönlein purpura nephritis, and a potential target of immunoglobulin therapy? Clin Exp Immunol. 1998;114:468-476.
21. 21. Amoli MM, Thomson W, Hajeer AH, et al. Interleukin 1 receptor antagonist gene polymorphism is associated with severe renal involvement and renal sequelae in Henoch-Schönlein purpura. J Rheumatol. 2002;29:1404-1407.
22. 22. Amoli MM, Thomson W, Hajeer AH, et al. Interleukin 8 gene polymorphism is associated with increased risk of nephritis in cutaneous vasculitis. J Rheumatol. 2002;29:2367-2370.
23. 23. Lin CY, Yang YH, Lee CC, et al. Thrombopoietin and interleukin-6 levels in Henoch-Schönlein purpura. J Microbiol Immunol Infect. 2006;39:476-482.
24. 24. Sayinalp N, Ozcebe OI, Ozdemir O, et al. Cytokines in Behçet’s disease. J Rheumatol. 1996;23:321-322.
25. 25. Gehr G, Braun T, Lesslauer W. Cytokines, receptors, and inhibitors. Clin Investig. 1992;70:64-69.
26. 26. Gasparyan AY, Ayvazyan L, Mikhailidis DP, et al. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17:47-58.
27. 27. Martin JF, Trowbridge EA, Salmon G, et al. The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration. Thromb Res. 1983;32:443-460.
28. 28. Thompson CB, Eaton KA, Princiotta SM, et al. Size dependent platelet subpopulations: relationship of platelet volume to ultrastructure, enzymatic activity, and function. Br J Haematol. 1982;50:509-519.
29. 29. Varol E. Mean platelet volume and neutrophil-to-lymphocyte ratio in patients with Henoch-Schonlein purpura. Rheumatol Int. 2014;34:1329- 1330.
30. 30. Makay B, Türkyilmaz Z, Duman M, et al. Mean platelet volume in Henoch-Schönlein purpura: relationship to gastrointestinal bleeding. Clin Rheumatol. 2009;28:1225-1228.
31. 31. Shi X, Li WC, Mo LJ, et al. Altered mean platelet volume in children with Henoch-Schonlein purpura and its association with disease activity. Ann Clin Biochem. 2018;55:368-372.
32. 32. Ekinci RMK, Balci S, Sari Gokay S, et al. Do practical laboratory indices predict the outcomes of children with Henoch-Schönlein purpura? Postgrad Med. 2019;131:295-298.