Neutrophil to lymphocyte ratio may be used as a predictor in tendinopathy

Abstract

Objectives: Tendinopathy is a very common clinical disorder and a complex inflammation and degeneration process. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have been studied and accepted as biomarkers of inflammation, predictors of progression and prognosis in several studies. We aimed to show that NLR and PLR levels can help predict prognosis for tendinopathy by comparing NLR and PLR levels of patients with tendinopathy with healthy control groups.

Methods: Tendinopathy and healthy cases whose complete blood test was requested, were included in the study. Age, gender, white blood cell (WBC), neutrophil, lymphocyte, platelet counts, NLR and PLR of these cases were examined.

Results: There is a statistically significant difference between the tendinopathy (n = 140) and control (n = 51) groups in WBC and NLR values (p < 0.001). One unit increase in WBC and NLR levels increases the risk of tendinopathy 1.74 and 10.616 times respectively. According to the results of the ROC analysis, the threshold value of the WBC and NLR values to increase the risk of tendinopathy is 6.47, and 1.64 respectively.

Conclusions: Our study suggested NLR and WBC values are significant indicators of tendinopathy. We consider these results to be a guide for all physicians, especially sports medicine physicians.

Keywords

• Tendinopathy
• neutrophil to lymphocyte ratio
• inflammation
• neutrophil

References

1. 1. Dean BJF, Dakin SG, Millar NL, Carr AJ. Review: emerging concepts in the pathogenesis of tendinopathy. Surgeon 2017;15:349-54.
2. 2. Federer AE, Steele JR, Dekker TJ, Liles JL, Adams SB. Tendonitis and tendinopathy: what are they and how do they evolve? Foot Ankle Clin 2017;22:665-76.
3. 3. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am 2005;87:187-202.
4. 4. Scott A, Squier K, Alfredson H, Bahr R, Cook JL, Coombes B, et al. ICON 2019: International Scientific Tendinopathy Symposium Consensus: clinical terminology. Br J Sports Med 2020;54:260-2.
5. 5. Bisciotti GN, Volpi P. Tendonitis, tendinosis, or tendinopathy? In: Bisciotti G. VP ed. Low. Limb Tendinopathies. Sport. Traumatol. Cham: Springer. 2016: pp. 1-19.
6. 6. Loiacono C, Palermi S, Massa B, Belviso I, Romano V, Gregorio A Di, et al. Tendinopathy: pathophysiology, therapeutic options, and role of nutraceutics. A narrative literature review. Medicina (Kaunas) 2019;55:447.
7. 7. Andarawis-puri N, Flatow EL, Soslowsky LJ, Gustave O, Place LL, Sun HB, et al. Tendon basic science. J Orthop Res 2015;33:780-4.
8. 8. Ozgonul C, Sertoglu E, Mumcuoglu T, Kucukevcilioglu M. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as novel biomarkers of primary open-angle glaucoma. J Glaucoma 2016;25:e815-20.

9. 9. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10:1-4.
10. 10. Maffulli N, Aicale R, Tarantino D. Tendinopathy of the achilles tendon. In: Allegra F, Cortese F, Lijoi F. (eds.), Ankle Joint Arthroscopy. Cham: Springer International Publishing. 2020: pp. 227-37.
11. 11. Abate M, Gravare Silbernagel K, Siljeholm C, Di Iorio A, De Amicis D, Salini V, et al. Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther 2009;11:235.
12. 12. Kucuk A, Uslu AU, Ugan Y, Bagcaci S, Karahan AY, Akarmut A, et al. Neutrophil-to-lymphocyte ratio is involved in the severity of ankylosing spondylitis. Bratisl Lek Listy 2015;116:722-5.
13. 13. Okyay GU, Inal S, Öneç K, Er RE, Paşaoǧlu Ö, Paşaoǧlu H, et al. Neutrophil to lymphocyte ratio in evaluation of inflammation in patients with chronic kidney disease. Ren Fail 2013;35:29-36.
14. 14. Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail 2012;34:155-9.
15. 15. Fawzy RM, Said EA, Mansour AI. Association of neutrophil to lymphocyte ratio with disease activity indices and musculoskeletal ultrasound findings in recent onset rheumatoid arthritis patients. Egypt. Rheumatol 2017;39:203-6.
16. 16. Carp SJ, Barbe MF, Winter KA, Amin M, Barr AE. Inflammatory biomarkers increase with severity of upper-extremity overuse disorders. Clin Sci 2007;112:305-14.
17. 17. Barbe MF, Gallagher S, Popoff SN. On the horizon from the ORS serum biomarkers as predictors of work-related musculoskeletal disorders. J Am Acad Orthop Surg 2013;21:644-6.
18. 18. Karakoyun A, Calik Y. May neutrophil lymphocyte ratio and platelet lymphocyte ratio be used as inflammatory markers in patients with epicondylitis? Inflammatory markers in patients with epicondylitis. Ann Med Res 2021;27:2604-9.
19. 19. Woods JA, Wilund KR, Martin SA, Kistler BM. Exercise, inflammation and aging. Aging Dis 2012;3:130-40.