A NEW BIOMARKER IN SJOGREN’S SYNDROME? PAN-IMMUNE-INFLAMMATION VALUE AND ITS CLINICAL APPLICABILITY

Öz

Objective: Primary Sjogren’s syndrome (pSS) is a systemic autoimmune disease that primarily affects exocrine glands. The conventional inflammatory markers commonly used to assess disease activity, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), have limited sensitivity. This study aimed to investigate the relationship between the Pan-Immune-Inflammation Value (PIV), disease activity (ESSDAI), and inflammatory markers (CRP, ESR) in patients with pSS. Material and Methods: This retrospective study included 63 patients diagnosed with pSS according to the 2016 ACR/EULAR criteria and 52 healthy controls.PIV was calculated using neutrophil, monocyte, platelet, and lymphocyte counts at diagnosis. Disease activity was assessed using the EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI), and CRP and ESR levels were recorded. Statistical analysis included the Mann-Whitney U test for group comparisons, Spearman correlation for associations,ROC analysis to evaluate discriminative performance, and univariate logistic regression for effect assessment. Results: The mean PIV was 329.52±264.32 in the patient group and 291.67±201.54 in the control group (p=0.552). ESR levels were significantly higher in patients compared to controls(p=0.000), while CRP levels did not differ significantly (p=0.093). A weak, non-significant positive correlation was observed between PIV and ESSDAI (rho=0.107, p=0.414), whereas a significant moderate correlation was found between PIV and ESR (rho=0.311, p=0.018). Although the mean PIV was higher in the moderate-high disease activity group, the difference did not reach statistical significance (p=0.071). ROC analysis yielded an AUC of 0.675 for PIV in predicting higher disease activity. Conclusion: PIV may serve as an indirect indicator of inflammatory activity in pSS. While not sufficient as a standalone marker, it has potential as a complementary biomarker to identify patients with higher systemic disease activity. Further prospective studies with larger sample sizes are warranted.

Anahtar Kelimeler

• Primary Sjogren’s syndrome
• PIV
• ESSDAI
• CRP
• ESR
• disease activity

Sjögren Sendromunda Yeni Bir Biyobelirteç mi? Pan İmmün İnflamasyon Değeri ve Klinik Kullanılabilirliği

Öz

Amaç: Primer Sjögren sendromu (pSS), öncelikle ekzokrin bezleri etkileyen sistemik bir otoimmün hastalıktır. Hastalık aktivitesini değerlendirmede yaygın olarak kullanılan C-reaktif protein (CRP) ve eritrosit sedimantasyon hızı (ESR) gibi konvansiyonel inflamatuar belirteçlerin duyarlılığı sınırlıdır. Bu çalışmada, Pan İmmün İnflamasyon Değeri (PIV) ile hastalık aktivitesi (ESSDAI) ve inflamatuar belirteçler (CRP, ESR) arasındaki ilişki araştırılmıştır. Gereç ve Yöntemler: Retrospektif tasarıma sahip bu çalışmaya, 2016 ACR/EULAR kriterlerine göre tanı almış 63 pSS hastası ve 52 sağlıklı kontrol dahil edilmiştir. PIV, tanı anındaki nötrofil, monosit, trombosit ve lenfosit sayılarından hesaplanmıştır. Hastalık aktivitesi, EULAR Sjögren Sendromu Hastalık Aktivite İndeksi (ESSDAI) kullanılarak değerlendirilmiş, CRP ve ESR düzeyleri kaydedilmiştir. İstatistiksel analizlerde grup karşılaştırmaları için Mann- Whitney U testi, ilişkilerin değerlendirilmesinde Spearman korelasyonu, ayırt edici gücün analizinde ROC analizi ve etki değerlendirmesi için univaryant lojistik regresyon analizi kullanılmıştır. Bulgular: Hasta grubunda ortalama PIV değeri 329,52±264,32, kontrol grubunda ise 291,67±201,54 olarak hesaplanmıştır (p=0,552). ESR düzeyleri hasta grubunda kontrol grubuna göre anlamlı derecede yüksek bulunmuştur (p=0,000), ancak CRP düzeylerinde anlamlı bir fark izlenmemiştir (p=0,093). PIV ile DAI arasında zayıf ve istatistiksel olarak anlamlı olmayan pozitif bir korelasyon (rho=0,107, p=0,414), PIV ile ESR arasında ise anlamlı düzeyde orta şiddette pozitif bir korelasyon saptanmıştır (rho=0,311, p=0,018). Orta-yüksek hastalık aktivitesi grubunda PIV ortalaması daha yüksek bulunmasına rağmen bu fark istatistiksel anlamlılığa ulaşmamıştır (p=0,071). ROC analizinde PIV'nin yüksek hastalık aktivitesini öngörmedeki eğri altı alan (AUC) değeri 0,675 olarak hesaplanmıştır. Sonuç: PIV, primer Sjögren sendromunda inflamatuar aktivitenin dolaylı bir göstergesi olabilir. Tek başına yeterli bir belirteç olmasa da, sistemik hastalık aktivitesi yüksek hastaların belirlenmesinde tamamlayıcı bir biyobelirteç olarak potansiyele sahiptir. Daha geniş örneklemli, ileriye dönük çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• Primer Sjögren sendromu
• PIV
• ESSDAI
• CRP
• ESR
• hastalık aktivitesi

Kaynakça

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