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Zinellu A, Paliogiannis P, Mangoni AA. A systematic review and meta-analysis of the diagnostic accuracy of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio in systemic lupus erythematosus. Clin Exp Med 2024; 24:170. [PMID: 39052098 PMCID: PMC11272706 DOI: 10.1007/s10238-024-01438-5] [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: 04/23/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
The wide range of clinical and serological manifestations in systemic lupus erythematosus (SLE) and the lack of accepted diagnostic criteria warrant the identification of novel, more accurate biomarkers. Hematological indices derived from full blood cell counts, particularly the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have shown promise in SLE; however, a critical appraisal of their diagnostic accuracy is lacking. We sought to address this issue by conducting a systematic review and meta-analysis of the diagnostic accuracy of the NLR and PLR in SLE. The electronic databases PubMed, Scopus, and Web of Science were systematically searched from inception to 15 March 2024 for studies reporting the sensitivity and specificity of the NLR and PLR, obtained by receiver operating characteristic (ROC) curve analysis, for the presence of SLE, disease severity, organ involvement (lupus nephritis, pericarditis, and pleural disease), and complications (infections). The risk of bias was assessed using the JBI Critical Appraisal Checklist (PROSPERO registration number: CRD42024531446). The NLR exhibited good accuracy for the diagnosis of SLE (eight studies; area under the curve, AUC = 0.81, 95% CI 0.78-0.85) and lupus nephritis (nine studies; AUC = 0.81, 95% CI 0.77-0.84), but not for severe disease (nine studies; AUC = 0.69, 95% CI 0.65-0.73) or infections (six studies; AUC = 0.73, 95% CI 0.69-0.77). The PLR exhibited good accuracy for the diagnosis of severe disease (six studies; AUC = 0.85, 95% CI 0.81-0.87). There were an insufficient number of studies to assess the accuracy of the PLR for the diagnosis of SLE, lupus nephritis, or infections. No study investigated the NLR and PLR in SLE patients with pericarditis or pleural disease. Therefore, the NLR and the PLR have a relatively high diagnostic accuracy for the presence of SLE and lupus nephritis (NLR) and severe disease (PLR). Further studies are warranted to determine whether the NLR and PLR, in combination with clinical evaluation and other serological biomarkers, can enhance the diagnosis and management of SLE.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Panagiotis Paliogiannis
- Department of Medicine, Surgery, and Pharmacy, University of Sassari, Sassari, Italy
- Anatomic Pathology and Histology Unit, Sassari University Hospital (AOU), Sassari, Italy
| | - Arduino A 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, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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Zhang Y, Qian H, Kuang YH, Wang Y, Chen WQ, Zhu W. Evaluation of the inflammatory parameters as potential biomarkers of systemic inflammation extent and the disease severity in psoriasis patients. Arch Dermatol Res 2024; 316:229. [PMID: 38787405 DOI: 10.1007/s00403-024-02972-8] [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: 10/24/2023] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024]
Abstract
The disease severity of psoriasis is mainly assessed subjectively via psoriasis area and severity index (PASI) and body surface area (BSA), while an optimal measure of cutaneous response, may overlook systemic inflammation in psoriasis patients. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), monocyte to high density lipoprotein ratio (MHR), and systemic immune-inflammation index (SII) exhibit notable associations with the inflammation severity in multiple diseases. The aim of this retrospective study was to explore the associations between inflammatory parameters and the skin lesions' severity of psoriasis. After analysis, we found that patients with psoriasis had higher NLR, MLR, PLR, MHR, and SII levels compared to the control group. At baseline, the parameters of NLR (r = 0.124, P = 0.003), MLR (r = 0.153, P < 0.001), MHR (r = 0.217, P < 0.001) and SII (r = 0.141, P = 0.001) had a positive correlation with PASI in psoriasis patients. At the same time, we analyzed the patients who received different systemic therapy. We observed a significant decrease in NLR, PLR, MLR, and SII in psoriasis patients after treatment. Notably, TNF-α inhibitors and IL-17A inhibitors subgroups showed a more significant reduction than IL-23/IL-12/23 inhibitors and MTX medication. Additionally, we found the change of NLR (r = 0.194, P < 0.001), PLR (r = 0.104, P = 0.014), MLR (r = 0.191, P < 0.001), MHR (r = 0.106, P = 0.012), and SII (r = 0.228, P < 0.001) had a positive correlation with the change of PASI in psoriasis patients. In conclusion, this study suggests that NLR, MLR, and SII may serve as useful biomarkers for assessing systemic inflammation extent and disease severity in psoriasis patients.
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Affiliation(s)
- Ying Zhang
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Hua Qian
- The Department of Dermatology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ye-Hong Kuang
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Ying Wang
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China
| | - Wang-Qing Chen
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China.
| | - Wu Zhu
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Changsha, Hunan, China.
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Changsha, Hunan, China.
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Systemic immune-inflammation index and other inflammatory parameters in patients receiving biological or targeted synthetic DMARDs for inflammatory rheumatic disease. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1186732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: To investigate the short – and long-term dynamics in inflammation markers [systemic immune-inflammation index (SII),
neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/ monocyte ratio (LMR)] before and after
biological disease-modifying antirheumatic drugs (bDMARD) or targeted synthetic DMARD (tsDMARD) treatment.
Patients and Methods: wo hundred twenty-six patients (115 women, 47±13.8 years) were included. Age, gender, disease duration, and
treatments were recorded retrospectively. Complete blood counts including neutrophil, lymphocyte, platelet, monocyte and acute
phase reactants were noted at the visit before the biological treatment, at the 3rd month, 6th month, and the last visit on medication.
SII, NLR, PLR and LMR were calculated, and their dynamics over time were compared.
Results: Significant changes were observed over time in all parameters reflecting inflammation (SII, NLR, PLR, LMR, ESR, and CRP)
(p
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