Assessment of systemic inflammation with neutrophil-lymphocyte ratio in lichen planus

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are positively correlated with disease activity of bullous pemphigoid

Bullous pemphigoid (BP) is a complex inflammatory process with elevated levels of autoantibodies, eosinophils, neutrophils, and various cytokines. Hematological inflammatory biomarkers can reflect inflammatory state in various diseases. Up to now, the correlations of hematological inflammatory biomarkers and disease activity of BP remain unknown. The purpose of this study was to clarify the associations between hematological inflammatory biomarkers and disease activity of BP. The levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR) and mean platelet volume (MPV) of 36 untreated BP patients and 45 age and gender matched healthy controls were detected by routine blood tests. The correlations between hematological inflammatory markers and clinical characteristics of BP were statistically analyzed. The Bullous Pemphigoid Disease Area Index (BPDAI) was used to measure disease activity of BP. The mean levels of NLR, PLR, PNR and MPV in 36 untreated BP patients were 3.9, 157.9, 45.7 and 9.4 fl, respectively. Increased NLR (p < 0.001), PLR (p < 0.01), and MPV (p < 0.001) but decreased PNR (p < 0.001) were observed in BP patients when compared with healthy controls. In BP patients, the levels of NLR were positively correlated to BPDAI Erosion/Blister Scores (p < 0.01); and the levels of NLR and PLR were both positively correlated to BPDAI without Damage Score (both p < 0.05) and BPDAI Total Score (both p < 0.05). No correlation was found in other statistical analyses between hematological inflammatory markers and clinical characteristics in BP patients involved in the present study. Therefore, NLR and PLR are positively correlated with disease activity of BP.

Relationships Between Disease Severity and the C-reactive Protein/Albumin Ratio and Various Hematological Parameters in Patients With Acne Vulgaris

OBJECTIVE

Acne vulgaris, an inflammatory disease, was investigated in this study with the claim that the C-reactive protein (CRP)/albumin ratio and some hematological parameter ratios have the potential to be used as inflammatory markers to monitor disease severity and prognosis.

METHODS

A descriptive cross-sectional study was conducted with two groups of patients aged 18-65 years, 61 patients diagnosed with acne vulgaris and 35 healthy control patients, and routine hemogram and biochemical parameters were compared. The Global Acne Severity Index was used to determine the severity of acne vulgaris.

RESULTS

The median age of acne patients was 22.0 (IQR=5.0) and the median age of healthy volunteers was 30.0 (IQR=14.0). There were 75.4% (n=46) women in the acne group and 77.1% (n=27) women in the control group. Among the acne patients, 42.6% (n=26) had mild acne, and 41% (n=25) had moderate acne severity. A significant difference was found between the study groups in terms of CRP/albumin ratio, CRP, monocyte/lymphocyte ratio (MLR), lymphocyte/albumin ratio (LAR), and monocyte/CRP ratio (MCR) according to laboratory test results and calculated test ratios (p<0.05). The area under the curve (AUC) value of the CRP/albumin ratio in the receiver operating characteristic (ROC) analysis between the acne and control groups was 0.660, and its cut-off value was found to be 0.236 with 68.6% sensitivity and 68.9% specificity.

CONCLUSION

This study is the first to compare the CRP/albumin ratio with the severity of acne vulgaris in the literature. CRP/albumin ratio and MCR may serve as inflammatory markers that can be used to monitor the severity of acne vulgaris.

Transcriptome Profiling and Network Analysis Provide Insights Into the Pathogenesis of Vulvar Lichen Sclerosus

Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis that affects female anogenital skin. Although VLS is considered a T cell-mediated autoimmune disease, the diagnosis criteria, molecular mechanism, and universally accepted therapies for this disease remain largely unresolved. To explore disease pathogenesis and potential biomarkers, we performed an RNA-Seq-based transcriptome analysis to profile the gene expression of VLS lesions. Differentially expressed gene (DEG) analysis revealed profound changes in expressions of coding genes, microRNAs, and long non-coding RNAs. Pathway and network analysis suggested that T cell activation-associated genes, including CD3G, CD3D, CD8B, LAT, LCK, ZAP70, CCR5, CXCR3, CXCL9, CXCL10, and CXCL11, were highly expressed in VLS, while NR4A family genes (NR4A1, NR4A2, NR4A3), whose coding products inhibit T cell activity, were significantly downregulated, suggesting heightened T cell response in VLS. Neutrophil chemoattractant genes CXCL1, CXCL2, CXCL3, CXCL8, and their cognate receptor CXCR2 were downregulated, suggesting dampened neutrophil activity. We also found the downregulation of genes involved in cell cycle progression, including cyclins (CCNB1, CCNB2, CCNL1, CCNE1, and CCNK) and centrosome factors (CENPA, CENPE, CENPF, and CENPN), while microRNA-203a and let-7, microRNAs known to inhibit cell growth, were found to be upregulated. These data collectively indicate that cell proliferation in VLS is compromised. In sum, these findings comprehensively deciphered key regulatory genes and networks in VLS, which could further our understanding of disease mechanisms and point toward therapeutic strategies.

Increased Level of Serum Wingless-Type Mouse Mammary Tumor Virus Integration Site Family Member 5a in Patients with Cutaneous Lichen Planus

Purpose

Methods

Results

Conclusion

Efficacy of Intralesional Bacillus Calmette-Guérin Polysaccharide Nucleic Acid and Vitamin D Injections in the Treatment of Lichen Planus

BACKGROUND: Lichen planus is a multifactorial chronic inflammatory disease with diverse clinical manifestations involving the skin, hair, nails, and mucous membranes. OBJECTIVE: We evaluated the clinical efficacy and adverse effects of Bacillus Calmette-Guérin polysaccharide nucleic acid (BCG-PSN) injection, vitamin D injection, and the combination of both in the treatment of different types of lichen planus. METHODS: Thirty patients ranging in age from 12 to 70 years with clinically diagnosed lichen planus were enrolled in this study and divided into three groups according to treatment regimen. RESULTS: A partial therapeutic response in three patients and no improvement in seven patients were achieved in the intramuscular vitamin D injection group. Meanwhile, the intralesional injection of BCG-PSN was associated with complete response in three patients, partial response in three patients, and no response in four patients. The combination of both intralesional injection of BCG-PSN and intramuscular injection of vitamin D was associated with complete response in two patients, partial response in four patients, and no response in four patients. CONCLUSION: BCG-PSN alone appears to be efficacious in the treatment of lichen planus, and vitamin D in combination with BCG-PSN had no effect on cutaneous lichen planus.

Hematological Inflammatory Markers in Patients with Pemphigus Vulgaris

BACKGROUND

Emerging evidence indicates that several hematological markers can be used to evaluate treatment response, prediction, and early relapse detection in different inflammatory conditions. This study aimed to investigate the correlation between the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet-to-neutrophil ratio, mean platelet volume, and disease activity in patients with pemphigus vulgaris.

METHODS

Fifty-six patients (20 men, 36 women; mean age 54 ± 14 years) diagnosed with pemphigus vulgaris were included in this retrospective study. Patients were divided into those treated and not treated with rituximab (groups 1 and 2), and into those who did and did not develop relapse (groups 3 and 4). The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet-to-neutrophil ratio and mean platelet volume were evaluated at the time of diagnosis, remission, and relapse. The relationship between each marker and disease stage was analyzed using the Wilcoxon rank-sum test for pairwise comparisons.

RESULTS

The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio showed a positive correlation with disease activity, while the platelet-to-neutrophil ratio and mean platelet volume showed a negative correlation. The neutrophil-to-lymphocyte ratio significantly decreased in remission (p < 0.001) and significantly increased in relapse (p < 0.01). The platelet-to-lymphocyte ratio significantly decreased in remission (p < 0.001) and showed no significant change in relapse. The platelet-to-neutrophil ratio significantly increased in remission (p < 0.001) and significantly decreased at relapse (p < 0.001). The mean platelet volume significantly increased in remission (p < 0.001) and decreased non-significantly at relapse. A more significant decrease in the neutrophil-to-lymphocyte ratio in remission was found in patients not treated with rituximab. No significant differences were observed between patients who developed relapse and those who did not.

CONCLUSION

Our results suggest that the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet-to-neutrophil ratio, and mean platelet volume can be useful markers for monitoring treatment response, while the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio can also assist in detecting early relapse.

Investigation of monocyte HDL ratio as an indicator of inflammation and complete blood count parameters in patients with acne vulgaris

AIMS

Acne vulgaris is a common inflammatory skin disease that affects the pilosebaceous unit. Increased sebum production, hyperkeratosis in follicular infundibulum, inflammation and Propionibacterium acnes are among aetiological factors. Complete blood count (CBC) parameters are used as diagnosis biomarkers for many diseases related with inflammatory processes. Although monocyte/HDL ratio (MHR) has been defined as an inflammatory marker recently, we did not come across any studies about MHR in acne, which is known to be an inflammatory disease. The present study was conducted to compare CBC parameters and MHR levels in acne vulgaris patients and healthy controls (HCs).

METHODS

Sixty-five acne vulgaris patients followed in our clinic between January 2018 and December 2019 and 36 HCs matching in terms of age and sex were included in the study. Patients and HCs were compared in terms of CBC parameters [neutrophil, monocyte, platelet, lymphocyte, neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR), platelet/lymphocyte (PLR)], HDL and MHR ratio.

RESULTS

When compared with the HCs, acne vulgaris patients had statistically significantly higher neutrophil, NLR ratio and HDL (P = .042, P = .011 and P = .014, respectively). No statistically significant difference was found between acne vulgaris patients and the HCs in terms of other CBC parameters and MHR ratio (P > .05).

CONCLUSIONS

We believe that prospective studies consisting of large patient series are needed to understand whether CBC parameters and MHR ratio can be used as an inflammatory marker in acne vulgaris patients.

The effect of biological agent treatment on neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume, and C-reactive protein in psoriasis patients

Introduction

In recent years, the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV) and C reactive protein (CRP) have been shown to be important indicators of systemic inflammation. Studies have shown that NLR, PLR, MPV and CRP are higher in psoriasis patients than in the control group.

Aim

To investigate the NLR, PLR, MPV and serum CRP levels in patients who were treated with biological agents for psoriasis.

Material and methods

In our study, 75 patients who were followed up and had a diagnosis of psoriasis vulgaris and took a biological agent therapy between January 2014 and December 2017 in the Dermatology Clinic of the Dicle University Medical Faculty Hospital were evaluated before treatment, and 3 and 6 months after treatment.

Results

Neutrophil count, lymphocyte count, thrombocyte count, NLR, PLR, MPV and CRP values before the biological agent treatment were statistically higher than the values at 3 and 6 months of treatment. There was no statistically significant difference between pre-treatment neutrophil, lymphocyte, leukocyte, platelet, NLR, PLR, MPV, CRP values and values at 3 and 6 months after treatment when we compared four different biological agents.

Conclusions

It was seen that NLR, PLR, MPV and CRP values decreased independently of the type of the biological agent used in our study. Therefore, we think that these parameters can be used to evaluate the effects of biological agent treatment on systemic inflammation in psoriasis patients and to monitor the course of the disease.

Serum and Salivary Level of Nitric Oxide (NOx) and CRP in Oral Lichen Planus (OLP) Patients

STATEMENT OF THE PROBLEM

Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease with unclear etiology while a few cases of disease become malignant.

PURPOSE

This study aimed to evaluate the level of nitric oxide (NOx) and C-reactive protein (CRP) as oxidative stress and inflammation status in sample of OLP patients.

MATERIALS AND METHOD

In this case-control study, serum and salivary NOx and CRP levels were evaluated in twenty two OLP patients as the case group confirmed by clinical and histopathological diagnosis, and twenty two healthy control groups collected from Tooba Oral Pathology Laboratory in Sari in 2016. The data were analyzed by using independent-samples t-test, Mann-Whitney U-test and Chi-square by using SPSS version 21. The statistical significant level was considered at p< 0.05.

RESULTS

Salivary and serum NOx levels in case group showed statistically significantly higher than healthy control group (p= 0.035 and p= 0.001, respectively). CRP values were significantly higher both in serum (p= 0.001) and in saliva (p= 0.035). A significant correlation was found between CRP and NOx values in serum (r= 0.521, p= 0.0001) and saliva (r= 0.427, p= 0.045).

CONCLUSION

Oxidative stress causes damage to organs in the human body. Correct understanding of oxidative stress and its association with free radicals and inflammatory markers related to oral disease are important for effective treatments. The results of the study advocate the effects of NOx and CRP levels in pathogenesis of OLP. Therefore, antioxidant drugs might probably be considered in the treatment of OLP.

Body Mass Index and Modified Glasgow Prognostic Score Are Useful Predictors of Surgical Site Infection After Spinal Instrumentation Surgery: A Consecutive Series

STUDY DESIGN

Retrospective observational study.

OBJECTIVE

To analyze a large consecutive cohort of patients who had undergone spinal instrumentation surgery, to characterize a patient population with surgical site infections (SSI), and to identify preoperative risk factors associated with SSI.

SUMMARY OF BACKGROUND DATA

Malnutrition is a risk factor for SSI in many health conditions; however, the evidence connecting preoperative malnutrition with SSI in spinal instrumentation surgery is limited because of the small number of retrospective studies. While the modified Glasgow prognostic score (mGPS), C-Reactive protein (CRP)-albumin ratio (CAR), controlling nutritional status index (CONUT), prognostic nutritional index (PNI), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) are established methods for evaluating nutritious status, little has been reported on the predictive value of these indicators with respect to postoperative spinal infection.

METHODS

We retrospectively investigated 384 patients who underwent spinal instrumentation surgery. We evaluated the significance of risk factors, including mGPS, CAR, CONUT, PNI, PLR, and NLR. We then performed stepwise logistic regression analysis to analyze the concurrent effects of various factors on the prevalence of SSI.

RESULTS

Of the 384 patients analyzed, 14 were diagnosed with SSIs. Univariate analysis showed that preoperative BMI, lymphocyte count, albumin, erythrocyte sedimentation rate, CRP, CONUT, mGPS, CAR, and PNI were risk factors for SSI. Stepwise logistic regression analysis revealed that higher mGPS and lower BMI before surgery were independent risk factors for SSI. A receiver operating characteristic curve showed that the cut-off values of mGPS and BMI were 1 and 20.39, respectively.

CONCLUSION

The risk factors for SSI after spinal instrumentation surgery were mGPS more than or equal to 1 and BMI less than or equal to 20.39 kg/m. These findings could help to identify patients at higher risk of SSI after spinal instrumentation surgery.

LEVEL OF EVIDENCE

4.

Elevated neutrophil to lymphocyte ratio as an indicator of secondary erythema nodosum, a retrospective observational study

Background/aim

Erythema nodosum (EN) is an inflammatory disorder of subcutaneous tissue. Although etiopathogenesis of the disease is unknown, many predisposing factors such as infections, systemic disease, and drugs have been identified. Neutrophil to lymphocyte ratio (NLR) has been shown to be a novel inflammatory marker in many dermatological diseases. The aim of our study is to investigate NLR in EN patients and evaluate its relation to the underlying cause of the disease.

Materials and methods

Between 2014 and 2018, clinical and laboratory data of 395 patients diagnosed with EN and 395 controls were extracted from patient files. EN patients were grouped as idiopathic EN and secondary EN (EN with an identified underlying cause). Clinical and laboratory characteristics of the two groups were compared

Results

NLR was elevated in EN patients compared to controls (median of 2.38 vs. 1.55, P < 0.001). Among EN patients, NLR was also elevated in patients with secondary EN. In multivariate logistic regression model NLR (> 2.11), RDW-CV (> 13.65), and CRP (> 5.5) were identified as risk factors for secondary EN (relative risks were 17.16, 2.69, and 2, respectively).

Conclusion

Elevated NLR (> 2.11) may be used as a parameter to discriminate secondary EN from idiopathic EN.

Evaluation of ocular findings in patients with lichen planus

Introduction

Lichen planus (LP) is a chronic, inflammatory disease of unknown etiology.

Aim

To evaluate the tear functions and the retinal and choroidal thickness (CT) in patients with LP.

Material and methods

In total, 33 patients and 30 healthy controls were enrolled. All participants were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer 1 test (with anesthesia), tear break-up time (TBUT) test, intraocular pressure (IOP), axial length (AL), and central corneal thickness (CCT). The measurements of retinal thickness (RT) and CT were obtained by spectral domain optical coherence tomography.

Results

No significant difference was observed between the groups in IOP, AL, CCT, or RT (p > 0.05 in each group). There was a significant difference in the Schirmer 1 test, TBUT, and OSDI questionnaire (p < 0.05 in each group). Choroidal thickness in LP patients was thinner than that in the controls (p = 0.001 in each location). There was a moderate negative correlation between the disease duration and Schirmer 1 test, TBUT, and subfoveal CT (r = –0.426, r = –0.555, r = –0.637; p = 0.001, p = 0.001, p = 0.001, respectively). There was a moderate negative correlation between the oral mucosal involvement and Schirmer 1 test, TBUT, and subfoveal CT (r = –0.345, r = –0.392, r = –0.467; p = 0.006, p = 0.001, p = 0.001, respectively). There was a positive correlation between disease duration, oral mucosal involvement and OSDI score (r = 0.717, r = 0.345; p = 0.001, p = 0.006, respectively).

Conclusions

Lichen planus may influence tear function tests and may cause dry eye. Patients with LP had lower CT values than healthy controls. Further studies are needed to clarify the effect of LP on the eyes.

Differentiating between cold agglutinins and rouleaux: a case series of seven patients

We present a case series of seven patients with suspected cold agglutinin antibodies, discovered after initiation of bypass. Laboratory analysis of blood samples intraoperatively determined the cause of the aggregation to be rouleaux formation in three of the patients and cold agglutinins in the other four.