Background:As the standard markers of systemic inflammation in autoimmune diseases erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are usually used, but in recent years there have been conflicting results about the potential significance of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR).Objectives:Our aim was to investigate the correlation of NLR and PLR with disease activity in patients with systemic lupus erythematosus (SLE).Methods:The study involved 160 patients with SLE (145 women and 15 men), hospitalized in the Clinic of Rheumatology, Institute „Niška Banja“, aged on the average 46.34 ± 10.82 years and with average disease duration of 9.76 ± 8.27 years, in whom the diagnosis was established based on the revised ACR criteria from 1997. In addition to clinical examination and supplementary tests, their disease activity was assessed using theSystemic Lupus Erythematosus Disease Activity Index(SLEDAI), together with determination of NLR and PLR.Results:In SLE patients, there was a positive correlation of NLR with ESR (r=0.212; p=0.010), anti-dsDNA antibodies (r=0.185; p=0.025), and PLR (r=0.601; p<0.001), as well as a negative correlation with complement component 3 (C3) (r=-0.264; p=0.003). Further, there was a positive correlation of PLR with ESR (r=0.329; p<0.001), CRP (r=0.249; p=0.003), anti-dsDNA antibodies (r=0.280; p=0.001), anti-nucleosome antibodies (r=0.263; p=0.026), and values of urinary chemoattractant protein-1 (MCP1) (r=0.263; p=0.043), as well as a negative correlation with C3 (r=-0.276; p=0.002). Our univariate analysis demonstrated that not only the values of ESR, CRP, C3, anti-dsDNA, anti-nucleosome, anti-C1q antibodies, serum and urinary MCP1 (p<0.001) were statistically significantly associated with SLEDAI, but also the NLR (p<0.001) and PLR (p<0.001). Using the method of standard multiple regression analysis, we examined the impact of the above parameters on SLEDAI. The examined model accounted for 21.7% of variance in activity index (corrected r2=0.217, F=2.525, p=0.017). As the statistically significant risk factors, ESR (Beta=0.394, p=0.020) and serum MCP1 (Beta=0.325, p=0.043) stood out.Conclusion:NLR and PLR, as hematological parameters available in everyday clinical work, can be significant for disease activity assessment in SLE patients.References:[1]Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD. The Platelet-to-Lymphocyte Ratio as an Inflammatory Marker in Rheumatic Diseases. Ann Lab Med. 2019;39(4):345-57.[2]Yu H, Jiang L, Yao L, Gan C, Han X, Liu R, Su N. Predictive value of the neutrophil-to-lymphocyte ratio and hemoglobin in systemic lupus erythematosus. Exp Ther Med. 2018;16(2):1547-53.[3]Wu Y, Chen Y, Yang X, Chen L, Yang Y. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol. 2016;36:94-9.[4]Yolbas S, Yildirim A, Gozel N, Uz B, Koca SS. Hematological Indices May Be Useful in the Diagnosis of Systemic Lupus Erythematosus and in Determining Disease Activity in Behcet’s Disease. Med Princ Pract. 2016;25(6):510–6.[5]Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, Hu Z, Liang Y, Yang Z, Zhong R. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26(3):372–6.Disclosure of Interests:None declared
Clinical significance of red blood cell distribution width in systemic lupus erythematosus patients
