Sistemik Lupus Eritematozus Hastalarında İnflamasyon Belirteci ve Yüksek Hastalık Aktivite Göstergesi Olarak Yeni Hematolojik İndeksler

Yıl 2022, Cilt: 48 Sayı: 2, 189 - 196, 15.09.2022

Selime Ermurat , Dilek Tezcan

https://doi.org/10.32708/uutfd.1110778

Cited By: 4

Öz

Bu çalışmada, sistemik lupus eritematozus (SLE) hastalarında nötrofil/lenfosit (NLO), trombosit/lenfosit (PLO), monosit/lenfosit (MLO) oranı gibi hematolojik belirteçlere ek olarak sistemik inflamatuar indeks (Sİİ), sistemik inflamasyon yanıt indeksi (SİYİ) ve sistemik inflamasyon agregat indeksi (SİAİ) gibi yeni hematolojik belirteçlerin SLE’de inflamasyon belirteci olarak öneminin belirlenmesi, bu paramatrelerin SLE hastalık aktivitesi ile ilişkisinin değerlendirilmesi ve çok yüksek hastalığı göstermedeki duyarlılıklarının araştırılması amaçlandı. Çalışmaya 91 SLE hastası ve 100 sağlıklı kontrol dahil edildi. SLE hastalarının hastalık aktivitesini değerlendirmede Sistemik Lupus Eritematozus Hastalık Aktivite İndeksi 2000 (SLEDAI-2K) kullanıldı. SLE hastaları hastalık aktivitesine göre SLEDAI-2K <20 ve ≥20 olan hastalar olarak ikiye ayrıldı. SLE hastalarında hematolojik parametrelerin hepsi (NLO, PLO, MLO, Sİİ, SİYİ, SİAİ) sağlıklı kontrol grubu ile karşılaştırıldığında anlamlı olarak daha yüksek saptandı; sırasıyla (p<0.001, p<0.001, p=0.022, p=0.016, p<0.001, p=0.007). SLEDAI-2K≥20 olan hastalarda NLO (p=0.040), Sİİ (p=0.012), SİYİ (p=0.002) ve SİAİ (p=0.003) SLEDAI-2K<20 olan hastalara göre anlamlı olarak daha yüksekti. Hastalık aktivitesi ile NLO, Sİİ, SİYİ ve SİAİ arasında pozitif korelasyon izlendi; sırasıyla (r=0.216) (p=0.039), (r=0.265) (p=0.011), (r=0.3258) (p=0.002), (r=0.309) (p=0.003). Hematolojik parametrelerin çok yüksek hastalık aktivitesini tahmin etmede duyarlılıkları ROC eğrisi ile değerlendirildi. Duyarlılığı en yüksek olan parametreler SİYİ, SİAİ, Sİİ ve NLO idi. Bu çalışmada yeni hematolojik belirteçler olan Sİİ, SİYİ ve SİAİ’nin SLE hastalarında inflamasyonu göstermede etkili olduğu, çok yüksek hastalık aktivitesi ile ilişkili olduğu ve çok yüksek hastalık aktivitesini saptamada duyarlılığının yüksek olduğu gösterilmiştir.

Anahtar Kelimeler

Sistemik lupus eritematozus, Hastalık aktivitesi, Sistemik inflamatuar indeks (SII), Sistemik inflamasyon yanıt indeksi (SIRI), Sistemik inflamasyon agregat indeksi (AISI)

New Hematological Indices as Markers of Inflammation and High Disease Activity in Patients With Systemic Lupus Erythematosus

Öz

(MLR) ratio, systemic inflammatory index (SII), systemic inflammation response index (SIRI), and systemic inflammation aggregate index (AISI) were evaluated in systemic lupus erythematosus (SLE) patients. It was aimed to determine the importance of new hematological markers as an inflammation marker in SLE, evaluate the relationship of these parameters with SLE disease activity (DA), and investigate their sensitivity in showing very high DA. 91 SLE patients and 100 healthy controls were included in the study. The Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was used to evaluate the DA. SLE patients were divided into patients with SLEDAI-2K <20 and ≥20. NLR, PLR, MLR, SII, SIRI, AISI were all found to be significantly higher in SLE patients compared to the healthy controls; respectively (p<0.001, p<0.001, p=0.022, p=0.016, p<0.001, p=0.007). NLR (p=0.040), SII (p=0.012), SIRI (p=0.002) and AISI (p=0.003) were significantly higher in patients with SLEDAI-2K≥20 than patients with SLEDAI-2K<20. A positive correlation was observed between SLEDAI-2K and NLR, SII, SIRI and AISI; respectively (r=0.216) (p=0.039), (r=0.265) (p=0.011), (r=0.3258) (p=0.002), (r=0.309) (p=0.003). The sensitivity of hematological parameters to predict very high DA was evaluated with the ROC curve. SIRI, AISI, SII, and NLR had the highest sensitivity. In this study, it has been shown that the new hematological markers are effective in demonstrating inflammation in SLE, are associated with very high DA, and have a high sensitivity in detecting very high DA.

Anahtar Kelimeler

Systemic lupus erythematosus, Disease activity, Systemic inflammatory index, Systemic inflammatory response index, Systemic inflammation aggregate index

Kaynakça

• 1. Kiriakidou M, Ching CL. Systemic Lupus Erythematosus. Ann Intern Med 2020;172(11).
• 2. Fortuna G, Brennan MT. Systemic lupus erythematosus: epidemiology, pathophysiology, manifestations, and management. Dent Clin North Am 2013;57(4):631-655.
• 3. Tunnicliffe DJ, Singh-Grewal D, Kim S, Craig JC, Tong A. Diagnosis, Monitoring, and Treatment of Systemic Lupus Erythematosus: A Systematic Review of Clinical Practice Guidelines. Arthritis Care Res (Hoboken) 2015;67(10):1440-1452.
• 4. Khan A, Haider I, Ayub M, Khan S. Mean Platelet Volume (MPV) as an indicator of disease activity and severity in lupus. F1000Res 2017;6:126.
• 5. Mikdashi J, Nived O. Measuring disease activity in adults with systemic lupus erythematosus: the challenges of administrative burden and responsiveness to patient concerns in clinical research. Arthritis Res Ther 2015;17(1):183.
• 6. Peirovy A, Malek Mahdavi A, Khabbazi A, Hajialilo M, Sakhinia E, Rashtchizadeh N. Clinical Usefulness of Hematologic Indices as Predictive Parameters for Systemic Lupus Erythematosus. Lab Med 2020;51(5):519-528.
• 7. Hao X, Li D, Wu D, Zhang N. The Relationship between Hematological Indices and Autoimmune Rheumatic Diseases (ARDs), a Meta-Analysis. Sci Rep 2017;7(1):10833.
• 8. Yang Z, Zhang Z, Lin F, ve ark. Comparisons of neutrophil-, monocyte-, eosinophil-, and basophil- lymphocyte ratios among various systemic autoimmune rheumatic diseases. APMIS 2017;125:863-71.
• 9. Ayna AB, Ermurat S, Coşkun BN, et al. Neutrophil to Lymphocyte Ratio and Mean Platelet Volume as Inflammatory Indicators in Systemic Lupus Erythematosus Nephritis. Arch Rheumatol 2017;32:21-5.
• 10. Carli L, Tani C, Vagnani S, Signorini V, Mosca M. Leukopenia, lymphopenia, and neutropenia in systemic lupus erythematosus: Prevalence and clinical impact--A systematic literature review. Semin Arthritis Rheum 2015;45(2):190-194.
• 11. Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLO) and platelet-to-lymphocyte ratio (PLO) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol 2016;36:94–99.
• 12. Yavuz S, Ece A. Mean platelet volume as an indicator of disease activity in juvenile SLE. Clin Rheumatol 2014;33(5):637–641.
• 13. Chen SY, Du J, Lu XN, Xu JH. Platelet distribution width as a novel indicator of disease activity in systemic lupus erythematosus. J Res Med Sci 2018;23:48.
• 14. Haitao Y, Lili J, Liqiong Y, Chao G. ve ark. (2018) Predictive value of the neutrophil-to-lymphocyte ratio and hemoglobin in systemic lupus erythematosus. Exp Ther Med 16(2):1547–1553.
• 15. Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M et al. (2019) The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 39(4):345–357.
• 16. Qin B, Ma N, Tang Q, et al. Neutrophil to lymphocyte ratio (NLO) and platelet to lymphocyte ratio (PLO) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 2016;26(3):372-376.
• 17. Soliman WM, Sherif NM, Ghanima IM, El-Badawy MA. Neutrophil to lymphocyte and platelet to lymphocyte ratios in systemic lupus erythematosus: relation with disease activity and lupus nephritis. Reumatol Clin 2020;16(4):255-261.
• 18. Bai M, Xing L, Feng J, Cui C, Huang L, Liang G. Mean Platelet Volume Could Reflect Disease Activity of Adult Patients With Systemic Lupus Erythematosus. Clin Lab 2016;62(7):1317-1322.
• 19. Boilard E, Nigrovic PA, Larabee K, ve ark. Platelets amplify inflammation in arthritis via collagen-dependent microparticle production. Science 2010;327(5965):580-583.
• 20. 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.
• 21. Erre GL, Buscetta G, Mangoni AA, ve ark. Diagnostic accuracy of different blood cells-derived indexes in rheumatoid arthritis: A cross-sectional study. Medicine (Baltimore) 2020;99(44):e22557.
• 22. Zhang Y, Xing Z, Zhou K, Jiang S. The Predictive Role of Systemic Inflammation Response Index (SİYİ) in the Prognosis of Stroke Patients. Clin Interv Aging 2021;16:1997-2007.
• 23. Eissa M, Shaarawy S, Abdellateif MS. The Role of Different Inflammatory Indices in the Diagnosis of COVID-19. Int J Gen Med 2021;14:7843-7853.
• 24. Aringer M, Costenbader KH, Daikh DI, ve ark. 2019 EULAR/ACR Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol 2019 Sep; 71(9): 1400–1412.
• 25. Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002;29(2):288-291.
• 26. Zivković V, Stanković A, Cvetković T, ve ark. Anti-dsDNA, anti-nucleosome and anti-C1q antibodies as disease activity markers in patients with systemic lupus erythematosus. Srp Arh Celok Lek 2014;142(7-8):431-436.
• 27. Koelmeyer R, Nim HT, Nikpour M, ve ark. High disease activity status suggests more severe disease and damage accrual in systemic lupus erythematosus. Lupus Sci Med 2020;7(1).
• 28. Yu H, Jiang L, Yao L, ve ark. Predictive value of the neutrophil-to-lymphocyte ratio and hemoglobin in systemic lupus erythematosus. Exp Ther Med 2018;16(2):1547-1553.
• 29. Liu P, Li P, Peng Z, ve ark. Predictive value of the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-neutrophil ratio, and neutrophil-to-monocyte ratio in lupus nephritis. Lupus 2020;29:1031-9.
• 30. Li L, Xia Y, Chen C, Cheng P, Peng C. Neutrophil-lymphocyte ratio in systemic lupus erythematosus disease: a retrospective study. Int J Clin Exp Med 2015;8(7):11026-11031.
• 31. Wang L, Wang C, Jia X, Yang M, Yu J. Relationship between Neutrophil-to-Lymphocyte Ratio and Systemic Lupus Erythematosus: A Meta-analysis. Clinics (Sao Paulo). 2020;75:e1450.
• 32. Ma L, Zeng A, Chen B, Chen Y, Zhou R. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in patients with systemic lupus erythematosus and their correlation with activity: A meta-analysis. Int Immunopharmacol 2019;76:105949.
• 33. Suszek D, Górak A, Majdan M. Differential approach to peripheral blood cell ratios in patients with systemic lupus erythematosus and various manifestations. Rheumatol Int 2020;40(10):1625-1629.
• 34. Huang H, Liu Q, Zhu L, ve ark. Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Patients with Cervical Cancer. Sci Rep 2019;9(1):3284.
• 35. Ohno Y. Role of systemic inflammatory response markers in urological malignancy. Int J Urol 2019;26(1):31-47.
• 36. Çakır N, Koc AN. Gamma-glutamyl transpeptidase-platelet ratio, systemic immune inflammation index, and system inflammation response index in invasive Aspergillosis. Rev Assoc Med Bras (1992) 2021;67(7):1021-1025.
• 37. Cremer J, Martin M, Redl H, ve ark. Systemic inflammatory response syndrome after cardiac operations. Ann Thorac Surg 1996;61(6):1714-1720.
• 38. Zinellu A, Collu C, Nasser M, ve ark. The Aggregate Index of Systemic Inflammation (SİAİ): A Novel Prognostic Biomarker in Idiopathic Pulmonary Fibrosis. J Clin Med 2021;10(18):4134.
• 39. Hamad DA, Aly MM, Abdelhameid MA, ve ark. Combined Blood Indexes of Systemic Inflammation as a Mirror to Admission to Intensive Care Unit in COVID-19 Patients: A Multicentric Study. J Epidemiol Glob Health 2022;12(1):64-73.
• 40. Muhammad S, Fischer I, Naderi S, ve ark. Systemic Inflammatory Index Is a Novel Predictor of Intubation Requirement and Mortality after SARS-CoV-2 Infection. Pathogens 2021;10(1):58–58.
• 41. Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic immune-inflammation index in cancer: A meta-analysis. J Cancer 2018;9(18):3295–3302.
• 42. Çirakoğlu ÖF, Yılmaz AS. Systemic immune-inflammation index is associated with increased carotid intima-media thickness in hypertensive patients. Clin Exp Hypertens 2021;15(1):1–7.
• 43. Kim JW, Jung JY, Suh CH, Kim HA. Systemic immune-inflammation index combined with ferritin can serve as a reliable assessment score for adult-onset Still's disease. Clin Rheumatol 2021;40(2):661–668.
• 44. Fang H, Zhang H, Wang Z, Zhou Z, Li Y, Lu L. 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).
• 45. Wang ZC, Jiang W, Chen X, Yang L, Wang H, Liu YH. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr 2021;21(1):155–155.
• 46. Kim Y, Choi H, Jung SM, Song JJ, Park YB, Lee SW. Systemic immune-inflammation index could estimate the cross-sectional high activity and the poor outcomes in immunosuppressive drug-naïve patients with antineutrophil cytoplasmic antibody-associated vasculitis. Nephrology (Carlton) 2019;24(7):711–717.
• 47. Tanacan E, Dincer D, Erdogan FG, Gurler A. A cutoff value for the Systemic Immune-Inflammation Index in determining activity of Behçet disease. Clin Exp Dermatol 2021;46(2):286–291.