Prognostic Value of Hematological Parameters in Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis

Abstract

Objective: Hematological parameters including neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), and monocyte–lymphocyte ratio (MLR) have been demonstrated as new predictors of prognosis and activity in various diseases. In this study, we aimed to investigate the associations of NLR, PLR and MLR with disease severity and prognosis in patients with anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). Materials and Methods: Medical records of 92 AAV patients were investigated retrospectively. The clinical and laboratory data, and disease outcomes were recorded. The patients having five factor score (FFS) ≥ 2 were categorized as severe disease. Results: 92 patients with a median age of 60 years were included. Patients with NLR≥4.8 (RR 1.83), PLR≥151.8 (RR 2.02) and MLR≥0.38 (RR 1.85) had higher risk of severe disease. In correlation analysis, NLR, PLR and MLR were positively correlated with C reactive protein and erythrocyte sedimentation rate (ESR). NLR, PLR and MLR were associated with remission. Conclusion: Only the patients with high PLR had higher relapse rate. MLR was also correlated with development of end-stage renal disease (ESRD). Renal involvement was more frequent in patients with high levels of NLR, PLR and MLR. Conclusions: We showed that NLR, PLR and MLR at diagnosis were associated with the severity and prognosis of AAV. This is the first study, showing the correlation of MLR with disease severity and ESRD in patients with AAV.

Keywords

• Antineutrophil cytoplasmic antibody-associated vasculitis
• eutrophil / lymphocyte ratio
• platelet / lymphocyte ratio
• monocyte / lymphocyte ratio

Project Number

01.07.2020/20.478.486/429

Anti-Nötrofil Sitoplazmik Antikor İlişkili Vaskülitlerde Hematolojik Parametrelerin Prognostik Değeri

Abstract

Giriş ve Amaç: Nötrofil-Lenfosit oranı (NLO), Platelet-Lenfosit oranı (PLO) ve Monosit-Lenfosit oranı (MLO) dahil olmak üzere hematolojik parametreler, çeşitli hastalıklarda prognoz ve aktivitenin yeni belirleyicileri olarak gösterilmiştir. Bu çalışmada, anti-nötrofil sitoplazmik antikor (ANCA) ilişkili vaskülit (AİV) tanısı olan hastalarda NLO, PLO ve MLO' nun hastalık şiddeti ve prognozu ile ilişkisini araştırmayı amaçladık. Gereç ve Yöntemler: 92 AİV hastasının tıbbi kayıtları geriye dönük olarak incelendi. Klinik ve laboratuvar verileri ve hastalık sonuçları kaydedildi. Beş faktör skoru (FFS) ≥ 2 olan hastalar ağır hastalık olarak sınıflandırıldı. Bulgular: Ortanca yaşı 60 olan 92 hasta dahil edildi. NLO≥4.8 (RR 1.83), PLO≥151.8 (RR 2.02) ve MLO≥0.38 (RR 1.85) olan hastalarda ciddi hastalık riski daha yüksekti. Korelasyon analizinde, NLO, PLO ve MLO, C reaktif protein düzeyi ve eritrosit sedimantasyon hızı (ESH) ile pozitif korelasyon gösterdi. NLO, PLO ve MLO remisyon ile ilişkilendirildi. Sadece PLO'su yüksek olan hastalarda nüks oranı daha yüksekti. MLO ayrıca son dönem böbrek hastalığının (SDBY) gelişimi ile de korele idi. NLO, PLO ve MLO düzeyleri yüksek olan hastalarda böbrek tutulumu daha sıktı. Sonuç: Tanı anında NLO, PLO ve MLO'nun AİV şiddeti ve prognozu ile ilişkili olduğunu gösterdik. Bu çalışma AİV'li hastalarda MLO'nun hastalık şiddeti ve SDBY ile ilişkisini gösteren ilk çalışmadır.

Keywords

• Antinötrofil sitoplazmik antikor ilişkili vaskülit
• nötrofil/lenfosit oranı
• trombosit/lenfosit oranı
• monosit/lenfosit oranı

Supporting Institution

yok

Project Number

01.07.2020/20.478.486/429

References

1. Jennette, J.C, Falk, R, Bacon, P, et al., 2012 revised international chapel hill consensus conference nomenclature of vasculitides, 2013.
2. Moiseev, S, Novikov P, Jayne, D, et al., End-stage renal disease in ANCA-associated vasculitis. Nephrology Dialysis Transplantation, 2017, 32(2), 248-253.
3. Mukhtyar, C, Flossmann, O, Hellmich, B, et al., Outcomes from studies of antineutrophil cytoplasm antibody associated vasculitis: a systematic review by the European League Against Rheumatism systemic vasculitis task force, Annals of the rheumatic diseases, 2008, 67(7), 1004-1010.
4. Bhat, T, Teli, S, Rijal, J, et al., Neutrophil to lymphocyte ratio and cardiovascular diseases: a review, Expert review of cardiovascular therapy, 2013, 11(1), 55-59.
5. Proctor, M, McMillan, D, Morrison, D, et al., A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer, British journal of cancer, 2012, 107(4):695-699.
6. Wang, D, Yang, J.X, Cao, D.Y, et al., Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma, Onco Targets Therapy, 2013, 6, 211-216.
7. Azab, B, Shah, N, Akerman, M, et al., Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction, Journal of thrombosis and thrombolysis, 2012, 34(3), 326-334.
8. Turkmen, K, Platelet-to-Lymphocyte Ratio: One of the novel and valuable platelet indices in hemodialysis patients, Hemodialysis international International Symposium on Home Hemodialysis, 2013, 2013, 670.

9. Nishijima, T.F, Muss, H.B, Shachar, S.S, et al., Prognostic value of lymphocyte-to-monocyte ratio in patients with solid tumors: a systematic review and meta-analysis. Cancer treatment reviews. 2015, 41(10):971-978.
10. Naranbhai V, Kim S, Fletcher H, et al. The association between the ratio of monocytes: lymphocytes at age 3 months and risk of tuberculosis (TB) in the first two years of life, BMC medicine, 2014, 12(1), 120.
11. Ji, H, Li, Y, Fan, Z, et al., Monocyte/lymphocyte ratio predicts the severity of coronary artery disease: a syntax score assessment, BMC cardiovascular disorders, 2017, 17(1), 90.
12. Abaza, N.M, Abd El-Latif, E.M, Gheita, T.A, Clinical significance of neutrophil/lymphocyte ratio in patients with granulomatosis with polyangiitis, Reumatología Clínica (English Edition), 2019, 15(6), 363-367.
13. Ahn, S.S, Jung, S.M, Song, J.J, et al., Neutrophil to lymphocyte ratio at diagnosis can estimate vasculitis activity and poor prognosis in patients with ANCA-associated vasculitis: a retrospective study, BMC nephrology, 2018, 19(1), 187.
14. Küçük, H, Göker, B, Varan, Ö, et al., Predictive value of neutrophil/lymphocyte ratio in renal prognosis of patients with granulomatosis with polyangiitis, Renal failure, 2017, 39(1), 273-276.
15. Park, H.J, Jung, S.M, Song, J.J, et al., Platelet to lymphocyte ratio is associated with the current activity of ANCA-associated vasculitis at diagnosis: a retrospective monocentric study, Rheumatology international, 2018, 38(10), 1865-1871.
16. Levey, A.S, Stevens, L.A, Schmid, C.H, et al., A new equation to estimate glomerular filtration rate, Annals of internal medicine, 2009, 150(9), 604-612.
17. Guillevin, L, Pagnoux, C, Seror, R, et al., The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort, Medicine, 2011, 90(1),19-27.
18. Berden, A.E, Kallenberg, C.G, Savage, C.O, et al., Cellular immunity in Wegener's granulomatosis: characterizing T lymphocytes, Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 2009, 60(6), 1578-1587.
19. Rondina, M.T, Weyrich, A.S, Zimmerman, G.A. Platelets as cellular effectors of inflammation in vascular diseases, Circulation research, 2013, 112(11), 1506-1519.
20. Brunini, F, Page, T.H, Gallieni, M, et al., The role of monocytes in ANCA-associated vasculitides, Autoimmunity reviews, 2016, 15(11), 1046-1053.
21. Pan, L, Du, J, Li, T, Liao, H, Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio associated with disease activity in patients with Takayasu’s arteritis: a case-control study, BMJ open, 2017, 7(4), e014451.
22. Yuksel, M, Yildiz, A, Oylumlu, M, et al., Novel markers of endothelial dysfunction and inflammation in Behçet’s disease patients with ocular involvement: epicardial fat thickness, carotid intima media thickness, serum ADMA level, and neutrophil-to-lymphocyte ratio, Clinical Rheumatology, 2016, 35(3), 701-708.
23. Chantasiriwan, N, Silvilairat, S, Makonkawkeyoon, K, et al., Predictors of intravenous immunoglobulin resistance and coronary artery aneurysm in patients with Kawasaki disease, Paediatrics and international child health, 2018, 38(3), 209-212.
24. Park, C.H, Han, D.S, Jeong, J.Y, et al., The Optimal Cut-Off Value of Neutrophil-to-Lymphocyte Ratio for Predicting Prognosis in Adult Patients with Henoch–Schönlein Purpura, PloS one, 2016, 11(4), e0153238.
25. Kim, H.A, Jung, J.Y, Suh, C.H, Usefulness of neutrophil-to-lymphocyte ratio as a biomarker for diagnosing infections in patients with systemic lupus erythematosus, Clinical rheumatology, 2017, 36(11), 2479-2485.
26. Kilic, E, Rezvani, A, Toprak, A, et al., Evaluation of neutrophil to lymphocyte and platelet to lymphocyte ratios in rheumatoid arthritis, Dicle Medical Journal, 2016, 43(2), 241-247.
27. Toraman, A, Neşe, N, Özyurt, B.C, et al., Association between neutrophil-lymphocyte & platelet lymphocyte ratios with prognosis & mortality in rapidly progressive glomerulonephritis, The Indian Journal of Medical Research, 2019, 150(4), 399.
28. Huang, L, Shen, C, Zhong, Y, et al., The association of neutrophil-to-lymphocyte ratio with all-cause mortality in Chinese patients with MPO-ANCA associated vasculitis, Clinical and Experimental Medicine, 2020,1-8.
29. Gasparyan, A.Y, Ayvazyan, L, Mukanova, U, et al., The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases, Annals of laboratory medicine, 2019, 39(4), 345-357.
30. Kucuk, H, Tecer, D, Goker, B, et al., Platelet/lymphocyte ratio and mean platelet volume in patients with granulomatosis with polyangiitis, Advances in Rheumatology, 2020, 60.
31. Huang, Y, Deng, W, Zheng, S, et al., Relationship between monocytes to lymphocytes ratio and axial spondyloarthritis, International Immunopharmacology, 2018, 57, 43-46.
32. Kadiyoran, C, Zengin, O, Cizmecioglu, H.A, et al., Monocyte to lymphocyte ratio, neutrophil to lymphocyte ratio, and red cell distribution width are the associates with gouty arthritis, Acta Medica (Hradec Králové), 2019, 62(3), 99-104.