Association of simple hematological parameters with disease manifestations, activity, and severity in patients with systemic sclerosis
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Date
2020
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Springer Nature
Abstract
Introduction/objectives Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), mean platelet volume (MPV),andredcelldistributionwidth(RDW)maypotentiallyreflectinflammatorystatusinsystemicautoimmunediseases.The aim of this study is to investigate the association between these proposed markers and disease manifestations, activity, and severity in systemic sclerosis (SSc). Method We conducted a cross-sectional study of 69 systemic sclerosis (SSc) patients and 50 healthy volunteers in a single center. Adult patients with SSc and healthy controls were compared in terms of NLR, MLR, MPV, RDW, erythrocyte sedimentation rate (ESR),andC-reactiveprotein(CRP).Venousbloodsamplesweredrawnafteratleast8hoffastinginthemorning.Extensionofskin fibrosiswasevaluatedbyusingmodifiedRodnanskinscore(mRSS).DiseaseseverityandactivitywereassessedbyMedsgerdisease severityandEuropeanSclerodermaTrialsandResearchGroup(EUSTAR)diseaseactivityscores,respectively.Associationsofdisease manifestations,clinical,laboratory,andcapillaroscopicfindings,mRSS,andthediseaseactivityandseverityscoreswiththeproposed hematological markers were evaluated. Multiple regression models were generated for significant associations. Results Theneutrophilnumberwashigher(p=0.004)andlymphocytenumberwaslower(p<0.001)inSScgroupcomparedto controls. SSc group also had higher NLR, MLR, and RDW. In multiple logistic regression, only the NLR (regression coefficient=3.49, p=0.031) and CRP (regression coefficient=0.17, p=0.037) remained significantly different between SSc and healthy control groups (Cox and SnellR2 =0.243,NagelkerkeR2 =0.337,p<0.001). NLR and MLR positively correlated with mRSS, EUSTAR score, and CRP. MLR also positively correlated with Medsger score. Higher monocyte counts independently predicted higher EUSTAR and Medsger scores in multiple linear regressions. Patients with digital ulcers had higher NLR and MLR. We did not find any difference in MPV values between SSc and healthy control groups. Conclusions Globally available and inexpensive hematological tests, particularly the NLR and MLR, may be associated with vascular and cutaneous manifestations as well as disease activity and severity in SSc.
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Keywords
Complete blood count, MLR, Monocyte-to-lymphocyte ratio, Neutrophil-to-lymphocyte ratio, NLR, Scleroderma, Systemic sclerosis