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Kürüm H, Key S, Tosun HB, Yılmaz E, Kürüm KO, İpekten F, Akcan A. Relationship between the clinical outcomes and the systemic inflammatory response index and systemic immune inflammation index after total knee arthroplasty. Musculoskelet Surg 2024:10.1007/s12306-024-00825-1. [PMID: 38898343 DOI: 10.1007/s12306-024-00825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is an extremely damaging complication that can occur after total knee arthroplasty (TKA). There is no study in the literature investigating the relationship between systemic inflammatory response index (SIRI) and systemic inflammation immune index (SII) values and prognosis and infection in patients who have undergone TKA. The aim of the study was to determine the relationship between the inflammatory index values and the rate of PJI in patients who had previously had TKA. METHODS A total of 187 patients who underwent TKA between 2015 and 2023 years were retrospectively analyzed. RESULTS The median value of the postoperative SII index was 1862.3 (1146.6-2630.4) in the infected group, while it was 1058.2 (605.0-1762.8) in the non-infected group (p < 0.001). In the infected group, the median value of preoperative SIRI was observed as 2.3 (1.7-3.5), while in the non-infected group it was 0.9 (0.7-1.5) (p < 0.001). The cutoff value for postoperative SIRI was observed to be 2.19, with a sensitivity value of 95%, a specificity value of 46%, the AUC value observed was 65%. The cutoff value for the postoperative SII index was observed to be 1058.96, with a sensitivity value of 100%, a specificity value of 50%. CONCLUSIONS Our study has associated the inflammatory markers SIRI, SII, neutrophil lymphocyte ratio, and platelet lymphocyte ratio with PJI, which are easy and inexpensive to obtain. There is no widely recognized serum biomarker that can be used alone with good sensitivity and specificity. This study contributes to finding the gold standard inflammatory marker for diagnosing PJI.
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Affiliation(s)
- H Kürüm
- Department of Orthopaedics and Traumatology, Ergani State Hospital, Diyarbakır, Turkey.
| | - S Key
- Department of Orthopedics and Traumatology, Firat University Hospital, Firat University Elazığ, Elazığ, Turkey
| | - H B Tosun
- Department of Orthopaedics and Traumatology, Elazığ Fethi Sekin Training and Research Hospital, Elazığ, Turkey
| | - E Yılmaz
- Department of Orthopedics and Traumatology, Firat University Hospital, Firat University Elazığ, Elazığ, Turkey
| | - K O Kürüm
- Department of Physiotherapy and Rehabilitation, İnönü University, Malatya, Turkey
| | - F İpekten
- Department of Biostatistics, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - A Akcan
- Department of Orthopaedics and Traumatology, Ergani State Hospital, Diyarbakır, Turkey
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Erre GL, Chessa I, Bassu S, Cavagna L, Carru C, Pintus G, Giordo R, Mangoni AA, Damiano Sanna G, Zinellu A. Association between ischemia-modified albumin (IMA) and peripheral endothelial dysfunction in rheumatoid arthritis patients. Sci Rep 2024; 14:3964. [PMID: 38368495 PMCID: PMC10874370 DOI: 10.1038/s41598-024-54641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/14/2024] [Indexed: 02/19/2024] Open
Abstract
The identification of circulating biomarkers of endothelial dysfunction (ED), a precursor to atherosclerosis, in rheumatoid arthritis (RA) would facilitate early risk stratification and prevention strategies. Ischemia-modified albumin (IMA) has emerged as a potential biomarker of oxidative stress, ischemia, and ED. However, studies examining the relationship between IMA and ED in RA patients are lacking. We measured serum IMA concentrations by using an albumin cobalt binding test and peripheral vasodilatory capacity by EndoPAT in 113 RA patients without previous cardiovascular events enrolled in the EDRA study (ClinicalTrials.gov: NCT02341066). The mean peripheral vasodilatory capacity, expressed by the log of reactive hyperemia index (logRHI), was 0.82, corresponding to 27% RA patients having ED. The mean plasma concentrations of IMA were 0.478 absorbance units. We observed a significant and inverse association between peripheral vasodilatory capacity and serum IMA concentrations (rho = - 0.22, p = 0.02). In univariate logistic regression, ED was significantly associated with serum IMA concentrations [OR 1173 (95% CI 1.3568 to 101,364), p = 0.040) and higher disease activity. In multivariate logistic regression, the independent association between ED and IMA remained significant after correction for disease activity and other RA-confounders [OR 2252 (95% CI 1.0596 to 4,787,505), p = 0.048 in Model 1; OR 7221 (95% CI 4.1539 to 12,552,859), p = 0.02 in Model 2]. Conclusions: This study suggests that IMA is a promising biomarker of ED in RA. Further research is needed to confirm our findings and determine the clinical utility of IMA in detecting and managing early atherosclerosis in RA patients.
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Affiliation(s)
- Gian Luca Erre
- Dipartimento di Medicina, Chirurgia e Farmacia, University of Sassari, Sassari, Italy.
- UO Reumatologia, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy.
| | - Ilaria Chessa
- Dipartimento di Scienze Biomediche, University of Sassari, Sassari, Italy
| | - Stefania Bassu
- Dipartimento di Scienze Biomediche, University of Sassari, Sassari, Italy
| | - Lorenzo Cavagna
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Ciriaco Carru
- Dipartimento di Scienze Biomediche, University of Sassari, Sassari, Italy
| | - Gianfranco Pintus
- Dipartimento di Scienze Biomediche, University of Sassari, Sassari, Italy
| | - Roberta Giordo
- Dipartimento di Scienze Biomediche, University of Sassari, Sassari, Italy
| | - Arduino Aleksander Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia
| | | | - Angelo Zinellu
- UO Reumatologia, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
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Mangoni AA, Zinellu A. The diagnostic role of the systemic inflammation index in patients with immunological diseases: a systematic review and meta-analysis. Clin Exp Med 2024; 24:27. [PMID: 38285324 PMCID: PMC10824868 DOI: 10.1007/s10238-024-01294-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
The identification of novel, easily measurable biomarkers of inflammation might enhance the diagnosis and management of immunological diseases (IDs). We conducted a systematic review and meta-analysis to investigate an emerging biomarker derived from the full blood count, the systemic inflammation index (SII), in patients with IDs and healthy controls. We searched Scopus, PubMed, and Web of Science from inception to 12 December 2023 for relevant articles and evaluated the risk of bias and the certainty of evidence using the Joanna Briggs Checklist and the Grades of Recommendation, Assessment, Development, and Evaluation Working Group system, respectively. In 16 eligible studies, patients with IDs had a significantly higher SII when compared to controls (standard mean difference, SMD = 1.08, 95% CI 0.75 to 1.41, p < 0.001; I2 = 96.2%, p < 0.001; moderate certainty of evidence). The pooled area under the curve (AUC) for diagnostic accuracy was 0.85 (95% CI 0.82-0.88). In subgroup analysis, the effect size was significant across different types of ID, barring systemic lupus erythematosus (p = 0.20). In further analyses, the SII was significantly higher in ID patients with active disease vs. those in remission (SMD = 0.81, 95% CI 0.34-1.27, p < 0.001; I2 = 93.6%, p < 0.001; moderate certainty of evidence). The pooled AUC was 0.74 (95% CI 0.70-0.78). Our study suggests that the SII can effectively discriminate between subjects with and without IDs and between ID patients with and without active disease. Prospective studies are warranted to determine whether the SII can enhance the diagnosis of IDs in routine practice. (PROSPERO registration number: CRD42023493142).
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Affiliation(s)
- Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford ParkAdelaide, SA, 5042, Australia.
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia.
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Xu Y, Liu W, Ren L. Emerging roles and mechanism of m6A methylation in rheumatoid arthritis. Biomed Pharmacother 2024; 170:116066. [PMID: 38157641 DOI: 10.1016/j.biopha.2023.116066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/16/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
Rheumatoid arthritis (RA) is a multifaceted autoimmune disease characterized by systemic inflammation, affecting both articular and extra-articular structures. This condition results in inflammation of joints and synovial membranes, accompanied by the development of systemic comorbidities. Despite extensive research, the precise pathogenic mechanisms responsible for RA have yet to be completely understood. RNA methylation, a burgeoning epigenetic alteration, assumes a pivotal function in the regulation of a myriad of biological phenomena, encompassing immunity, DNA damage response, tumorigenesis, metastasis, stem cell renewal, adipocyte differentiation, circadian rhythms, cellular development and differentiation, and cell division. The N6-methyladenosine (m6A) modification is the most prevalent among the various RNA modifications found in mammalian mRNA. Recent studies have provided evidence of the significant role played by m6A modification in the pathophysiological progression of RA. This review aims to provide a comprehensive analysis of the progress made in research focused on m6A modification in the context of RA, consolidate the underlying mechanisms involved in m6A modification during the initiation of RA and discuss the potential of targeting m6A modification as a viable therapeutic approach for RA.
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Affiliation(s)
- Yayun Xu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China
| | - Wenqiang Liu
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Institute of Innovative Drugs, Anhui Medical University, Hefei 230000, China; The Key Laboratory of Anti-inflammatory and Immune Medicines, Ministry of Education, Hefei 230000, China
| | - Lijie Ren
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen 518035, China.
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TANG J, CHEN J, LIN G, ZHANG H, GUI M, LI N, GU Y, LUO L, SUN J. [Neutrophil-lymphocyte and platelet-lymphocyte ratios for assessing disease activity in patients with rheumatoid arthritis receiving tofacitinib treatment]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2023; 43:1651-1656. [PMID: 37933639 PMCID: PMC10630215 DOI: 10.12122/j.issn.1673-4254.2023.10.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/15/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To evaluate the value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for assessing disease activity in patients with rheumatoid arthritis (RA) treated with tofacitinib. METHODS This retrospective study was conducted among 98 RA patients in active stage treated with tofacitinib in Third Xiangya Hospital and 100 healthy control subjects from the Health Management Center of the hospital from 2019 to 2021. We collected blood samples from all the participants for measurement of erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and other blood parameters 1 month before and 6 months after tofacitinib treatment. We further evaluated PLR and NLR before and after tofacitinib treatment in the RA patients, and analyzed their correlations with RA disease activity. RESULTS PLR and NLR increased significantly in RA patients as compared with the healthy controls. In the RA patients, PLR and NLR were positively correlated with the levels of hs- CRP, ESR, IL- 6, Disease Activity Score of 28 joints-ESR (DAS28-ESR), anti-cyclic citrullinated peptide (CCP), and rheumatoid factor (RF) before and after tofacitinib treatment. Tofacitinib treatment for 6 months significantly decreased hs-CRP, ESR, IL-6, CCP, RF and DAS28-ESR levels in the RA patients. CONCLUSION NLR and PLR can be useful biomarkers for assessing disease activity in RA patients treated with tofacitinib.
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Affiliation(s)
- Juan TANG
- Department of Nephrology and Rheumatology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院肾病风湿免疫科,湖南长沙 410013
| | - Juan CHEN
- Department of Nephrology and Rheumatology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院肾病风湿免疫科,湖南长沙 410013
- Department of Nephrology, Yuyao People's Hospital, Yuyao 315499, China余姚市人民医院肾内科,浙江余姚 315499
| | - Guoxin LIN
- Department of Anesthesiology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院麻醉科,湖南长沙 410013
| | - Hao ZHANG
- Department of Nephrology and Rheumatology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院肾病风湿免疫科,湖南长沙 410013
| | - Ming GUI
- Department of Nephrology and Rheumatology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院肾病风湿免疫科,湖南长沙 410013
| | - Nannan LI
- Department of Nephrology and Rheumatology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院肾病风湿免疫科,湖南长沙 410013
| | - Yihong GU
- Department of Nephrology and Rheumatology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院肾病风湿免疫科,湖南长沙 410013
| | - Linjuan LUO
- Department of Nephrology and Rheumatology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院肾病风湿免疫科,湖南长沙 410013
| | - Jian SUN
- Department of Nephrology and Rheumatology, Third Xiangya Hospital, Central South University, Changsha 410013, China中南大学湘雅三医院肾病风湿免疫科,湖南长沙 410013
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Sariyildiz A, Benlidayi IC, Turk I, Acemoglu SSZ, Unal I. Evaluation of the relationship between blood cell markers and inflammation, disease activity, and general health status in ankylosing spondylitis. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230722. [PMID: 37729230 PMCID: PMC10511277 DOI: 10.1590/1806-9282.20230722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/09/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of this study was to assess the relation of systemic immune inflammation index, systemic inflammation response index, and systemic inflammation aggregate index with disease activity, functional status, and general health status in ankylosing spondylitis. METHODS Patients with ankylosing spondylitis and healthy volunteers were included in this cross-sectional study. Demographic data; disease activity measurements such as the Bath Ankylosing Spondylitis Disease Activity Index, the Ankylosing Spondylitis Disease Activity Score with C-reactive protein, and the Ankylosing Spondylitis Disease Activity Score with erythrocyte sedimentation rate; functional status such as the Bath Ankylosing Spondylitis Functional Index; and general health status such as the Assessment of Spondyloarthritis International Society Health Index of the patients were recorded. C-reactive protein, erythrocyte sedimentation rate, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, systemic immune inflammation index, systemic inflammation response index, and systemic inflammation aggregate index values were recorded. Patients were grouped as active and remission according to the Bath Ankylosing Spondylitis Disease Activity Index score and as inactive-low and high-very high disease activity according to the Ankylosing Spondylitis Disease Activity Score. The correlation of laboratory parameters with disease-related parameters was tested. RESULTS The indexes were significantly higher in patients compared to controls (p<0.001, for platelet to lymphocyte ratio p=0.03). No significant differences existed in any blood cell-derived indexes among patient groups categorized by disease activity (p<0.05 for all). Systemic immune inflammation index was weakly correlated with Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ρ=0.197 and p=0.049) and Ankylosing Spondylitis Disease Activity Score-erythrocyte sedimentation rate (ρ=0.201 and p=0.045). Systemic immune inflammation index was not correlated with Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, and Assessment of Spondyloarthritis International Society Health Index. No correlation was found between other indexes and disease-related variables. Platelet to lymphocyte ratio, systemic immune inflammation index, systemic inflammation response index, and systemic inflammation aggregate index showed a weak positive correlation with C-reactive protein and erythrocyte sedimentation rate (ρ=0.200-0.381). CONCLUSION Systemic immune inflammation index, systemic inflammation response index, and systemic inflammation aggregate index can be used to indicate systemic inflammatory burden in ankylosing spondylitis patients. However, these indexes are not effective in indicating patients' disease activity, general health status, and functional status.
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Affiliation(s)
- Aylin Sariyildiz
- Cukurova University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation – Adana, Turkey
| | - Ilke Coskun Benlidayi
- Cukurova University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation – Adana, Turkey
| | - Ipek Turk
- Cukurova University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology – Adana, Turkey
| | - Serife Seyda Zengin Acemoglu
- Cukurova University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology – Adana, Turkey
| | - Ilker Unal
- Cukurova University, Faculty of Medicine, Department of Biostatistics – Adana, Turkey
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Zinellu A, Carru C, Pirina P, Fois AG, Mangoni AA. A Systematic Review of the Prognostic Significance of the Body Mass Index in Idiopathic Pulmonary Fibrosis. J Clin Med 2023; 12:jcm12020498. [PMID: 36675428 PMCID: PMC9866551 DOI: 10.3390/jcm12020498] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The identification of novel prognostic biomarkers might enhance individualized management strategies in patients with idiopathic pulmonary fibrosis (IPF). Although several patient characteristics are currently used to predict outcomes, the prognostic significance of the body mass index (BMI), a surrogate measure of excess fat mass, has not been specifically investigated until recently. We systematically searched PubMed, Web of Science, and Scopus, from inception to July 2022, for studies investigating associations between the BMI and clinical endpoints in IPF. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the risk of bias. The PRISMA 2020 statement on the reporting of systematic reviews was followed. Thirty-six studies were identified (9958 IPF patients, low risk of bias in 20), of which 26 were published over the last five years. Significant associations between lower BMI values and adverse outcomes were reported in 10 out of 21 studies on mortality, four out of six studies on disease progression or hospitalization, and two out of three studies on nintedanib tolerability. In contrast, 10 out of 11 studies did not report any significant association between the BMI and disease exacerbation. Our systematic review suggests that the BMI might be useful to predict mortality, disease progression, hospitalization, and treatment-related toxicity in IPF (PROSPERO registration number: CRD42022353363).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
- Quality Control Unit, University Hospital of Sassari (AOU), 07100 Sassari, Italy
| | - Pietro Pirina
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
- Clinical and Interventional Pneumology, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Alessandro G. Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
- Clinical and Interventional Pneumology, University Hospital Sassari (AOU), 07100 Sassari, Italy
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA 5042, Australia
- Correspondence:
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Aboud FM, Galal S, Elwafa MAZA, Farouk ALM. Impact of biological and non-biological treatment on hematological indices in patients with ankylosing spondylitis and psoriatic arthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023; 50:14. [PMCID: PMC9974394 DOI: 10.1186/s43166-023-00174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background Blood dyscrasias are common in patients with rheumatic diseases, as bone marrow and blood cells can be targets for autoimmune processes. This in addition to the potentially adverse effect of the disease-modifying anti-rheumatic drugs used for the treatment of inflammatory arthritis as in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) on blood counts. Aim of this study The aim of this study is to analyze the effect of biologic therapy on complete blood cell parameters, derived ratios, and cell volume indices in Egyptian patients with ankylosing spondylitis and psoriatic arthritis. Results One hundred and twenty Egyptian patients had been included, 60 have ankylosing spondylitis (AS) and 60 have psoriatic arthritis (PSA). On comparing the blood indices between the biologics and non-biologics groups of PSA patients, there was a statistically highly significant reduction in red cell distribution width (RDW%) at the biologics group than non-biologics (p < 0.006), where there was a statistically highly significant increase in Hb (hemoglobin)/RDW ratio and Hb/platelets ratio at the biologics group than non-biologics (p < 0.005). Conclusion As a result, biologic drugs used in rheumatology practice may have some effects on hematological parameters. In our study, no major negative effects on hematological parameters were observed in patients with AS and PsA who received Secukinumab, Adalimumab-atto, or Golimumab biologic therapy. However, the changes in the hematological indices correlates with their potent anti-inflammatory action in rheumatic patients.
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Affiliation(s)
- Fatma Mohammed Aboud
- grid.7269.a0000 0004 0621 1570l Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt ,grid.511523.10000 0004 7532 2290Armed Forces College of Medicine, Cairo, Egypt
| | - Salwa Galal
- grid.511523.10000 0004 7532 2290Armed Forces College of Medicine, Cairo, Egypt ,grid.7269.a0000 0004 0621 1570 Medicine, Rheumatology and Rehabilitation Department, Faculty of Medicine Ain Shams University, Cairo, Egypt
| | | | - ALshymaa Mohammed Farouk
- grid.7269.a0000 0004 0621 1570l Medicine and Rheumatology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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9
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Sarhan SA, El-Meligui YM. Significance of platelets to lymphocytes and platelets to haemoglobin ratios in patients with systemic sclerosis. REUMATOLOGIA CLINICA 2023; 19:12-17. [PMID: 36603962 DOI: 10.1016/j.reumae.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/17/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a progressive autoimmune connective tissue disease. Platelets to lymphocytes (PLR) and platelets to haemoglobin ratios (PHR) are emerging biomarkers used in the assessment of activity and severity of various autoimmune diseases. This study was designed to clarify the association of PLR and PHR with SSc disease activity and its different manifestations. METHOD A cross-sectional study involved sixty SSc patients. Demographic, clinical data and investigations were done. RESULTS PLR and PHR were correlated positively with ESR (r=0.351, p=0.003*), (r=0.620, p=0.000**), CRP (r=0.417, p=0.001*), (r=0.305, p=0.018**) and SSc activity index (r=0.292, p=0.024*), (r=0.359, p=0.005*). PLR and PHR were highly significantly related to digital ulcerations, musckeloskeletal, and pulmonary manifestations. Also, they had a significant relation to ground glass abnormalities on HRCT, mild restriction in pulmonary function tests and anti-scleroderma-70 antibodies. The cutoff value for PLR was 107.8 with high sensitivity 97.9% and specifity 92.3%, area under the curve (AUC=0.723, P 0.015) on receiver operating characteristic curve (ROC). PHR AUC (0.799, P .001), cut value was 23.5 at 95.7% sensitivity and 84.6% specifity. CONCLUSION PLR and PHR were significantly related to digital ulcerations, musculoskeletal, and pulmonary manifestations and can be considered as predictive biomarkers for the assessment of SSc disease activity and severity.
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Affiliation(s)
- Shymaa A Sarhan
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Egypt.
| | - Yomna M El-Meligui
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Egypt
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Fan W, Wei C, Liu Y, Sun Q, Tian Y, Wang X, Liu J, Zhang Y, Sun L. The Prognostic Value of Hematologic Inflammatory Markers in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2022; 28:10760296221146183. [PMID: 36567485 PMCID: PMC9806387 DOI: 10.1177/10760296221146183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aggregate index of systemic inflammation (AISI), systemic inflammation response index (SIRI), and neutrophil-to-lymphocyte*platelet ratio (NLRP) are novel indices that simultaneously reflect the inflammatory and immune status. However, the role of these indices in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) remains unclear. We aimed to elucidate the predictive value of AISI, SIRI, and NLRP in patients with ACS undergoing PCI. A total of 1558 patients with ACS undergoing PCI were consecutively enrolled from January 2016 to December 2018. The AISI, SIRI, NLRP, systemic immune-inflammatory index, derived neutrophil-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio cutoff values for predicting major adverse cardiovascular events (MACE) were calculated using receiver-operating characteristic curves, and Spearman's test was used to analyze correlations between these indices. Kaplan-Meier curves and Cox regression models were used for survival analyses, and the endpoint was a MACE, which included all-cause mortality and rehospitalization for severe heart failure during the follow-up period. The Kaplan-Meier curves showed that higher AISI, SIRI, and NLRP values were associated with a higher risk of MACE (all P < .001). The association between AISI, SIRI, and NLRP and ACS prognosis was stable in various subgroups according to sex, age, smoking, dyslipidemia, hypertension, diabetes mellitus, history of stroke, and heart failure (P for interaction > .05). Increasing tertiles of AISI, SIRI, and NLRP significantly increased the MACE risk (P for trend < .05). AISI, SIRI, and NLRP may be suitable laboratory markers for identifying high-risk patients with ACS after PCI.
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Affiliation(s)
- Wenjun Fan
- Department of Cardiology, The Affiliated Hospital of Chengde Medical
University, Chengde, China
| | - Chen Wei
- Department of Cardiology, The Affiliated Hospital of Chengde Medical
University, Chengde, China
| | - Yixiang Liu
- Department of Cardiology, The Affiliated Hospital of Chengde Medical
University, Chengde, China
| | - Qiyu Sun
- Department of Clinical Laboratory, The Affiliated Hospital of
Chengde Medical University, Chengde, China
| | - Yanan Tian
- Department of Cardiology, The Affiliated Hospital of Chengde Medical
University, Chengde, China
| | - Xinchen Wang
- Department of Cardiology, The Affiliated Hospital of Chengde Medical
University, Chengde, China
| | - Jingyi Liu
- Department of Cardiology, The Affiliated Hospital of Chengde Medical
University, Chengde, China
| | - Ying Zhang
- Department of Cardiology, The Affiliated Hospital of Chengde Medical
University, Chengde, China
| | - Lixian Sun
- Department of Cardiology, The Affiliated Hospital of Chengde Medical
University, Chengde, China,Lixian Sun, Department of Cardiology, The
Affiliated Hospital of Chengde Medical University, Chengde, HeBei, 067000,
China.
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11
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The role of combined hematological inflammatory indices in predicting poor outcomes in patients with acute pancreatitis. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1137585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim
The aim of the instant study is to evaluate the predictability of AISI, NLPR, and SIRI in patients with acute pancreatitis, which predicts more than 7 days of hospitalization, the need for intensive care, and 30-day mortality.
Material and Method
This retrospective observational study was conducted in patients diagnosed with acute pancreatitis who applied to the emergency medicine clinic of XXX Hospital between July 15, 2017 and February 15, 2021.Statistical analysis was performed using SPSS v. 26.0.
Results
The study included 592 patients, 58.3% of which were women. A statistically significant difference was found between high NLPR, and hospital stay longer than 7 days (p = 0.01). No statistically significant correlation was found between AISI and SIRI and the length of hospital stay (p = 0.16, p = 0.19, respectively). There was a statistically significant correlation between high NLPR, and mortality (p = 0.03). No statistically significant correlation was found between AISI, SIRI, and mortality (p = 0.866, p = 0.311, respectively). There was a statistically significant correlation between high NLPR, and hospitalization in the intensive care unit (p = 0.018) No statistically significant relationship was found between AISI, SIRI, and admission to the intensive care unit (p = 0.89, p = 0.6, respectively).
Conclusion
Acute pancreatitis is an inflammatory process that requires serious approach. Hematological parameters are helpful in predicting the prognosis, but there is a need for differently developed hematological indices in managing acute pancreatitis.
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Diagnostic Value of Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte, and Monocyte-to-Lymphocyte Ratios for the Assessment of Rheumatoid Arthritis in Patients with Undifferentiated Inflammatory Arthritis. Diagnostics (Basel) 2022; 12:diagnostics12071702. [PMID: 35885606 PMCID: PMC9317908 DOI: 10.3390/diagnostics12071702] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background: To investigate the diagnostic performance of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) in the diagnosis of rheumatoid arthritis (RA) in subjects with undifferentiated inflammatory arthritis (UIA). Methods: This retrospective cohort study investigated 201 female patients with UIA (≥1 swollen joint) and 280 age-matched, healthy female controls. “Clinical RA” was defined based on the clinical judgment of a rheumatologist and “disease-modifying anti-rheumatic drugs (DMARDs) RA” was defined as a case of initiating DMARDs treatment within 6 months after the first visit. “Classified RA” was defined as fulfilling the 2010 classification criteria for RA. Receiver operating characteristics were used to determine the optimal cut-off value. Results: UIA patients had a significantly higher NLR, PLR, and MLR than the controls. Among the 201 UIA patients, 65 (32.3%), 63 (31.3%), and 61 (30.3%) subjects were classified as clinical RA, DMARDs RA, and classified RA, respectively. At a cut-off of 0.24, MLR showed moderate accuracy for the diagnosis of DMARDs RA (sensitivity, 65.1%; specificity, 62.3%; area under the curve [AUC], 0.701; p < 0.001). However, the diagnostic accuracies of NLR and PLR were low. Conclusions: MLR may be used as a complementary diagnostic indicator for RA diagnosis in patients with UIA.
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Coradduzza D, Solinas T, Balzano F, Culeddu N, Rossi N, Cruciani S, Azara E, Maioli M, Zinellu A, De Miglio MR, Madonia M, Falchi M, Carru C. miRNAs as molecular biomarkers for prostate cancer. J Mol Diagn 2022; 24:1171-1180. [PMID: 35835374 DOI: 10.1016/j.jmoldx.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/05/2022] [Accepted: 05/23/2022] [Indexed: 01/10/2023] Open
Abstract
MicroRNAs (miRNAs) are short noncoding RNA able to regulate specific mRNA stability, thus influencing target gene expression. Disrupted levels of several miRNA have been associated with prostate cancer, the leading cause of cancer death among men and the fifth leading cause of death worldwide. Here, we investigated whether miR-145, miR-148, and miR-185 circulating levels in plasma could be used as molecular biomarkers, to allow distinguishing between individuals with benign prostatic hyperplasia, precancerous lesion, and prostate cancer. In this study, we recruited 170 urological clinic patients with suspected prostate cancer who underwent prostate biopsy. Total RNA was isolated from plasma, and TaqMan MicroRNA assays were used to analyze miR-145, miR-185, and miR-148 expression. First, differential miRNA expression among patient groups was evaluated. Then, miRNA levels were combined with clinical assessment outcomes, including results from invasive tests, using multivariate analysis to examine their ability in discriminating among the three patient groups. Our results suggest that miRNA is a promising molecular tool for clinical management of at-risk patients.
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Affiliation(s)
| | - Tatiana Solinas
- Urologic Clinic, Dep. of Clinical and Experimental Medicine, University of Sassari
| | - Francesca Balzano
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Nicola Culeddu
- Institute of Biomolecular Chemistry, National Research Council, Sassari, Italy
| | - Niccolò Rossi
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Sara Cruciani
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Emanuela Azara
- Institute of Biomolecular Chemistry, National Research Council, Sassari, Italy
| | - Margherita Maioli
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Massimo Madonia
- Urologic Clinic, Dep. of Clinical and Experimental Medicine, University of Sassari
| | - Mario Falchi
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; University Hospital of Sassari (AOU), Sassari, Italy.
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Mishima K, Kamiya Y, Matsushita M, Imagama S, Kitoh H. Predictive ability of inflammatory markers and laboratory parameters in Legg-Calvé-Perthes disease: A single-center retrospective comparative study. Medicine (Baltimore) 2022; 101:e29061. [PMID: 35356926 PMCID: PMC10513341 DOI: 10.1097/md.0000000000029061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/24/2022] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Legg-Calvé-Perthes disease (LCPD) presents with chronic nature of inflammation, characterized by prolonged synovitis. So far, no single blood marker has been identified to guide clinicians in estimating the severity and prognosis. Blood neutrophil to lymphocyte ratio (NLR) or systemic immune inflammation index (SII) is a simple indicator of subclinical inflammation. This study aims to examine the predictive ability of NLR, SII, and common laboratory parameters for estimating the severity of LCPD. The pre-operative laboratory findings at the time of osteotomy and implant removal in patients with unilateral LCPD who had been treated with the Salter innominate osteotomy and followed up until skeletal maturity as well as those of age-matched control patients with idiopathic noninflammatory conditions were analyzed. The datasets of 26 or 38 LCPD patients at the time of osteotomy or implant removal, respectively, and those of 20 control patients were available for analysis. At the time of osteotomy, compared to the control group, a significantly higher mean NLR or SII and a significantly lower mean alkaline phosphatase value were observed in the LCPD group. The alkaline phosphatase levels of patients with the modified lateral pillar (LP) group-A hips were significantly lower than those with the non-LP-A hips, whereas no significant differences were observed in any of the parameters between patients with favorable LP-A or -B hips and those with unfavorable LP-B|C border or -C hips. In agreement with the conventional opinion, it may be difficult to predict a meaningful prognosis of LCPD with the use of inflammatory markers or common laboratory parameters obtained in the initial stage of the disease.
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Affiliation(s)
- Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan,Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, 7-426 Morioka-Cho, Obu, Aichi, Japan
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15
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Xu Y, He H, Zang Y, Yu Z, Hu H, Cui J, Wang W, Gao Y, Wei H, Wang Z. Systemic inflammation response index (SIRI) as a novel biomarker in patients with rheumatoid arthritis: a multi-center retrospective study. Clin Rheumatol 2022; 41:1989-2000. [PMID: 35266094 DOI: 10.1007/s10067-022-06122-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate the potential ability of systemic inflammation response index (SIRI) as a novel biomarker in patients with rheumatoid arthritis (RA) and explore the mechanisms. METHOD Patients fulfilling the 2010 ACR/EULAR classification criteria for RA were enrolled in this study. Demographic, clinical, and laboratory characteristics of all subjects were collected. Neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), and SIRI were calculated. Statistical analysis was performed, and P-values < 0.05 were considered statistically significant. RESULTS One thousand four hundred ninety-nine RA patients from five hospitals were included, with 366 healthy volunteers served as controls. The NLR, MLR, PLR, and SIRI significantly increased in RA patients. Receiver operating characteristics (ROC) curve analysis showed SIRI, and NLR could distinguish RA from healthy controls. Correlation analysis and multiple linear regression analysis indicated that SIRI and PLR positively correlated with disease activity in RA. The NLR, MLR, and SIRI increased significantly in patients with RA-associated interstitial lung disease (ILD). There was a good accuracy of SIRI in differentiating RA-ILD from RA patients without ILD. SIRI was also found to be higher in RA patients with tumor and could differentiate them from RA patients without tumor. CONCLUSIONS SIRI could be evaluated as a novel, non-invasive, and suitable biomarker for assisting in the diagnosis process and demonstrating the disease activity of RA, as well as predicting RA-ILD and tumor development of RA patients. Key Points • As a novel biomarker, systemic inflammation response index (SIRI) may assist in the diagnosis process and indicate the disease activity of RA patients • SIRI may predict the development of RA-associated interstitial lung disease (RA-ILD) and tumor in RA patients • SIRI is more satisfactory than other blood cells-based indexes in the assessment of RA patients.
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Affiliation(s)
- Yunyun Xu
- Department of Rheumatology and Immunology, Taixing People's Hospital, 98 Runtai South Road, Taixing, 225400, Jiangsu, China.
| | - Hongjun He
- Department of Rheumatology and Immunology, Taixing People's Hospital, 98 Runtai South Road, Taixing, 225400, Jiangsu, China
| | - Yinshan Zang
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Zhe Yu
- Department of Rheumatology and Immunology, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, Jiangsu, China
| | - Huaixia Hu
- Department of Rheumatology and Immunology, Second People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Jiajia Cui
- Department of Rheumatology and Immunology, Second People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Wenwen Wang
- Department of Rheumatology and Immunology, Affiliated Hospital 2 of Nantong University and Nantong First People's Hospital, Nantong, Jiangsu, China
| | - Yingying Gao
- Department of Rheumatology and Immunology, Affiliated Hospital 2 of Nantong University and Nantong First People's Hospital, Nantong, Jiangsu, China
| | - Hua Wei
- Department of Rheumatology and Immunology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Zhuqing Wang
- Department of Laboratory Medicine, Taixing People's Hospital, Taixing, Jiangsu, China
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Zinellu A, Paliogiannis P, Sotgiu E, Mellino S, Fois AG, Carru C, Mangoni AA. Platelet Count and Platelet Indices in Patients with Stable and Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. COPD 2021; 18:231-245. [PMID: 33929925 DOI: 10.1080/15412555.2021.1898578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Platelets play an important role in the pathophysiology of chronic obstructive pulmonary disease (COPD) by mediating thrombotic, inflammatory, and immune processes in the lung. We conducted a systematic review and meta-analysis of studies investigating the platelet count and three platelet indices, mean platelet volume (MPV), platelet distribution width (PDW), and platelet to lymphocyte ratio (PLR) in stable COPD vs. non-COPD patients and in stable COPD vs. acute exacerbation of COPD (AECOPD) patients (PROSPERO registration number: CRD42021228263). PubMed, Web of Science, Scopus and Google Scholar were searched from inception to December 2020. Twenty-seven studies were included in the meta-analysis, 26 comparing 4,455 stable COPD patients with 7,128 non-COPD controls and 14 comparing 1,251 stable COPD with 904 AECOPD patients. Stable COPD patients had significantly higher platelet counts (weighted mean difference, WMD = 13.39 x109/L, 95% CI 4.68 to 22.11 x109/L; p < 0.001) and PLR (WMD = 59.52, 95% CI 29.59 to 89.44; p < 0.001) than non-COPD subjects. AECOPD patients had significantly higher PLR values than stable COPD patients (WMD = 46.03, 95% CI 7.70 to 84.35; p = 0.02). No significant differences were observed in MPV and PDW. Between-study heterogeneity was extreme. In sensitivity analysis, the effect size was not modified when each study was sequentially removed. The was no evidence of publication bias. In our meta-analysis, specific platelet biomarkers were associated with stable COPD (platelet count and PLR) and AECOPD (PLR). However, the observed heterogeneity limits the generalizability of the findings. Further studies are required to determine their prognostic utility and the effects of targeted interventions in COPD.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | | | - Elisabetta Sotgiu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Sabrina Mellino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Alessandro G Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia
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New Inflammatory Marker Associated with Disease Activity in Rheumatoid Arthritis: The Systemic Immune-Inflammation Index. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:553-557. [PMID: 35444819 PMCID: PMC8987472 DOI: 10.12865/chsj.47.04.11] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to discover a new index for disease activity by reviewing the relationship between the Systemic Immune-Inflammation Index and Systemic Inflammation Response Index in rheumatoid arthritis. METHOD A total of 109 patients with rheumatoid arthritis and 31 healthy controls were involved in the study. Based on disease activity score (DAS-28) calculated by the erythrocyte sedimentation rate, rheumatoid arthritis patients were divided into two groups: Group 1 comprised patients in remission (DAS-28<2.6); Group 2 was the active patient group (DAS-28>2.6). The Systemic Immune Inflammation Index and the Systemic Inflammation Response Index compared between the groups. RESULTS The Systemic Immune-Inflammation Index is 666.415±33.00 in the patient group and 596.71±57.64 in the control group, and the difference between the groups is statistically significant (p=0.002). The Systemic Immune-Inflammation Index was 574.69±34.72 in group 1 and 702.25±39.56 in group 2. There was a significant statistical difference between the active and remission patients (p=0.030). The Systemic Inflammation Response Index was not statistically significant between the groups. Different cut-off points were compared to detect the optimal cut-off value for SII. Based on the ROC curve analysis, SII cut-off point of 574.20 showed 56.3% sensitivity and 45.5% specificity and with the Area Under Curve (AUC) 95% was the optimal cut-off point for active RA. CONCLUSION This is the first study to review the Systemic Immune-Inflammation Index in rheumatoid arthritis. The obtained conclusion verified that the Systemic Immune-Inflammation Index could be used as a new tool, showing disease activity.
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