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Sayed OA, Abdel-Magied RA, Ahmed Abu Elela M, Safwat AM, Abdel-Nasser AM. Value of Serum Asymmetric Dimethylarginine (ADMA) As a Novel Biomarker for Uveitis in Behçet's Disease. Ocul Immunol Inflamm 2025; 33:33-39. [PMID: 38626414 DOI: 10.1080/09273948.2024.2342378] [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: 12/13/2023] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE To evaluate the serum asymmetric dimethylarginine (ADMA) level as a biomarker for uveitis in Behçet's Disease (BD). METHODS In this cross-sectional study, two groups of BD patients were examined: 33 with uveitis and 27 without uveitis. All patients were clinically evaluated, with disease activity measured by Behçet's Disease Current Activity Form (BDCAF) score. They also underwent thorough ophthalmic evaluation, and routine laboratory investigations, including serum ADMA. RESULTS Patients with BD who experienced active or inactive uveitis had higher levels of serum ADMA compared to those without uveitis. Anterior (ρ = 0.34, p < 0.01), posterior (ρ = 0.3, p < 0.05), and pan uveitis (ρ = 0.35, p < 0.01) were significantly correlated with serum ADMA levels. However, there was no significant correlation between ADMA and other BD manifestations. ROC curve analysis showed that increased serum ADMA levels in BD patients predicted uveitis with a sensitivity of 61.8%, specificity of 96.2%, and AUC of 0.78(95% CI: 0.66-0.9, p < 0.001). CONCLUSION Serum ADMA level can serve as a novel biomarker of uveitis in BD and its severity with good diagnostic accuracy, regardless of its site or activity.
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Affiliation(s)
- Omima Ahmed Sayed
- Rheumatology and Rehabilitation Department, Minia University, Minia, Egypt
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2
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Hong H, Zhou S, Zheng J, Shi H, Chen Y, Li M. Metabolic Assessment in Non-Dialysis Patients with Chronic Kidney Disease. J Inflamm Res 2024; 17:5521-5531. [PMID: 39176038 PMCID: PMC11339343 DOI: 10.2147/jir.s461621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024] Open
Abstract
Purpose The aim of this study was to investigate the changes of different metabolites in the body fluids of non-dialysis patients with chronic kidney disease (CKD) using a metabolomics approach. The goal was to identify early biomarkers of CKD progression through metabolic pathway analysis. Patients and Methods Plasma samples from 47 patients with stages 1-4 CKD not requiring dialysis and 30 healthy controls were analyzed by liquid chromatography-mass spectrometry (LC-MS). Using multivariate data analysis, specifically a partially orthogonal least squares discriminant analysis model (OPLS-DA), we investigated metabolic differences between different stages of CKD. The sensitivity and specificity of the analysis were evaluated using the Area Under Curve (AUC) method. Furthermore, the metabolic pathways were analyzed using the Met PA database. Results Plasma samples from CKD patients and controls were successfully differentiated using an OPLS-DA model. Initially, twenty-five compounds were identified as potential plasma metabolic markers for distinguishing CKD patients from healthy controls. Among these, six compounds (ADMA, D-Ornithine, Kynurenine, Kynurenic acid, 5-Hydroxyindoleacetic acid, and Gluconic acid) were found to be associated with CKD progression It has been found to be associated with the progression of CKD. Changes in metabolic pathways associated with CKD progression include arginine and ornithine metabolism, tryptophan metabolism, and the pentose phosphate pathway. Conclusion By analyzing the metabolic pathways of different metabolites, we have identified the significant impact of CKD progression. The main metabolic pathways involved are Arginine and Ornithine metabolism, Tryptophan metabolism, and Pentose phosphate pathway. ADMA, D-Ornithine, L-Kynurenine, Kynurenic acid, 5-Hydroxyindoleacetic acid, and Gluconic acid could serve as potential early biomarkers for CKD progression. These findings have important implications for the early intervention and treatment of CKD, as well as for further research into the underlying mechanisms of its pathogenesis.
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Affiliation(s)
- Hao Hong
- Department of Intensive Care Unit, The First Affiliated Hospital of Soochow University, Soochow, Suzhou, People’s Republic of China
| | - Suya Zhou
- Laboratory Nephrology, Jinshan hospital of Fudan University, Shanghai, People’s Republic of China
| | - Junyao Zheng
- Laboratory Nephrology, The First Affiliated Hospital of Soochow University, Soochow, Suzhou, People’s Republic of China
| | - Haimin Shi
- Laboratory Nephrology, The First Affiliated Hospital of Soochow University, Soochow, Suzhou, People’s Republic of China
| | - Yue Chen
- Laboratory Nephrology, The First People’s Hospital of Kunshan, Soochow, Suzhou, People’s Republic of China
| | - Ming Li
- Laboratory Nephrology, The First Affiliated Hospital of Soochow University, Soochow, Suzhou, People’s Republic of China
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Adane T, Melku M, Worku YB, Fasil A, Aynalem M, Kelem A, Getawa S. The Association between Neutrophil-to-Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Diabetes Res 2023; 2023:3117396. [PMID: 37305430 PMCID: PMC10257553 DOI: 10.1155/2023/3117396] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/18/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
Background Glycated hemoglobin (HbA1c) is a commonly used clinical marker to monitor the control of type 2 diabetes mellitus patients (T2DM). However, it is unable to identify the ongoing inflammatory changes in the body. These factors could be easily identified and monitored by the neutrophil-to-lymphocyte ratio (NLR). Therefore, this study is aimed at investigating the relationship between NLR and glycemic control in T2DM. Method A comprehensive search of eligible studies was performed in various databases published until July 2021. A random effect model was used to estimate the standardized mean difference (SMD). A metaregression, subgroup, and sensitivity analysis were conducted to search for potential sources of heterogeneity. Result A total of 13 studies were included in this study. Accordingly, the SMD of the NLR values between the poor and good glycemic control groups was 0.79 (95% CI, 0.46-1.12). Our study also showed that high NLR was significantly associated with poor glycemic control in T2DM patients (OR = 1.50, 95% CI: 1.30-1.93). Conclusion The results of this study suggest an association between high NLR values and an elevated HbA1C in T2DM patients. Therefore, NLR should be considered a marker of glycemic control in addition to HbA1c in T2DM patients.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yilkal Belete Worku
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Fasil
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amanuel Kelem
- Department of Medical Laboratory Sciences, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mok CC, Ho LY, Tse SM, Chan KL, To CH. Prevalence and risk factors of herpes zoster infection in patients with rheumatic diseases not receiving biologic or targeted therapies. Clin Rheumatol 2023; 42:1019-1026. [PMID: 36385600 DOI: 10.1007/s10067-022-06450-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective was to study the prevalence and risk factors of herpes zoster (HZ) infection in patients with rheumatic diseases. METHODS Consecutive patients with rheumatic diseases not receiving biologic/targeted DMARDs who attended our rheumatology clinics between March and August 2019 were retrospectively reviewed. Episodes of HZ infection since their first clinic attendance were identified. Laboratory results (total white cell count, neutrophil-to-lymphocyte ratio (NLR), serum albumin, globulin, and creatinine) and use of immunosuppressive medications were compared between those with (preceding infection) and without (preceding last visit) HZ infection. Cox regression analysis was performed to identify factors associated with the first HZ infection in all patients. RESULTS 1,479 patients were studied (88.3% women, age 45.0 ± 15.8 years). Systemic lupus erythematosus (SLE) (38.7%) and rheumatoid arthritis (28.3%) were the commonest rheumatic diseases. After a follow-up of 14,715 patient-years (9.9 ± 7.0 years), 219 (14.8%) patients developed 258 episodes of HZ infection, giving an overall prevalence of 1.75/100-patient years. The prevalence rates of HZ were highest in SLE and inflammatory myopathies (2.54 and 2.58 per 100 patient-years, respectively). Patients who experienced HZ reactivation were younger, more likely to have SLE, and had significantly lower serum albumin/globulin levels but higher NLR. Significantly more patients with HZ reactivation were using prednisolone and other immunosuppressive drugs in the visits preceding HZ infection. The cumulative risk of having HZ reactivation at 24 and 48 months was 4.9% and 7.6%, respectively. Cox regression analysis revealed that a diagnosis of SLE, increasing age, higher NLR, use of cyclophosphamide, and increasing doses of prednisolone, azathioprine, hydroxychloroquine and leflunomide were independently associated with HZ infection. CONCLUSIONS Reactivation of HZ is fairly common in patients with rheumatic diseases. Underlying SLE, age, neutrophil/lymphocyte ratio, and immunosuppressive therapies are independent risk factors. Key Points • Herpes zoster (HZ) infection is fairly common in patients with rheumatic diseases undergoing conventional DMARD or immunosuppressive therapies. • Underlying SLE, increasing age, higher neutrophil/lymphocyte ratio and increasing dosages of immunosuppressive drugs are independent risk factors. • Patients with rheumatic diseases, particularly SLE, should be encouraged to receive HZ vaccination.
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Affiliation(s)
- Chi Chiu Mok
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China.
| | - Ling Yin Ho
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China
| | - Sau Mei Tse
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China
| | - Kar Li Chan
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China
| | - Chi Hung To
- Departments of Medicine, Tuen Mun and Pok Oi Hospital, Hong Kong, SAR, China
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Joncour AL, Cacoub P, Boulaftali Y, Saadoun D. Neutrophil, NETs and Behçet's disease: A review. Clin Immunol 2023; 250:109318. [PMID: 37019424 DOI: 10.1016/j.clim.2023.109318] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
Behçet's disease (BD) is a chronic systemic vasculitis characterized by recurrent oral and genital ulcers, skin lesions, articular, neurological, vascular and sight-threatening ocular inflammation. BD is thought to share both autoimmune and autoinflammatory disease features. BD is triggered by environmental factors such as infectious agents in genetically predisposed subjects. Neutrophils seem to play an instrumental role in BD and recent works regarding the role of neutrophils extracellular traps (NETs) provides new insight in the pathophysiology of BD and the mechanisms involved in immune thrombosis. This review provides a recent overview on the role of neutrophils and NETs in the pathogenesis of BD.
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Arbrile M, Radin M, Medica D, Miraglia P, Rilat L, Cecchi I, Foddai SG, Barinotti A, Menegatti E, Roccatello D, Sciascia S. Finding the Needle in the Haystack: Serological and Urinary Biomarkers in Behçet's Disease: A Systematic Review. Int J Mol Sci 2023; 24:ijms24033041. [PMID: 36769366 PMCID: PMC9917563 DOI: 10.3390/ijms24033041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/08/2023] Open
Abstract
Urinary and serological markers play an essential role in the diagnostic process of autoimmune diseases. However, to date, specific and reliable biomarkers for diagnosing Behçet's disease (BD) are still lacking, negatively affecting the management of these patients. To analyze the currently available literature on serological and urinary BD biomarkers investigated in the last 25 years, we performed a systematic literature review using the Population, Intervention, Comparison, and Outcomes (PICO) strategy. One hundred eleven studies met the eligibility criteria (6301 BD patients, 5163 controls). Most of them were retrospective, while five (5%) were prospective. One hundred ten studies (99%) investigated serological biomarkers and only two (2%) focused on urinary biomarkers. One hundred three studies (93%) explored the diagnostic potential of the biomolecules, whereas sixty-two (56%) tested their effect on disease activity monitoring. Most articles reported an increase in inflammatory markers and pro-oxidant molecules, with a decrease in antioxidants. Promising results have been shown by the omics sciences, offering a more holistic approach. Despite the vast number of investigated markers, existing evidence indicates a persistent gap in BD diagnostic/prognostic indices. While new steps have been taken in the direction of pathogenesis and disease monitoring, international efforts for the search of a diagnostic marker for BD are still needed.
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Affiliation(s)
- Marta Arbrile
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
| | - Massimo Radin
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
- Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit, San Giovanni Bosco Hub Hospital, University of Turin, 10124 Turin, Italy
- Correspondence: ; Tel.: +39-3923741973
| | - Davide Medica
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
| | - Paolo Miraglia
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
| | - Letizia Rilat
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
| | - Irene Cecchi
- Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit, San Giovanni Bosco Hub Hospital, University of Turin, 10124 Turin, Italy
| | - Silvia Grazietta Foddai
- Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit, San Giovanni Bosco Hub Hospital, University of Turin, 10124 Turin, Italy
| | - Alice Barinotti
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
| | - Elisa Menegatti
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
- Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit, San Giovanni Bosco Hub Hospital, University of Turin, 10124 Turin, Italy
| | - Dario Roccatello
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
- Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit, San Giovanni Bosco Hub Hospital, University of Turin, 10124 Turin, Italy
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10124 Turin, Italy
- Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit, San Giovanni Bosco Hub Hospital, University of Turin, 10124 Turin, Italy
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Selim ZI, Mostafa NM, Ismael EO, Kamal D. Platelet lymphocyte ratio, lymphocyte monocyte ratio, mean platelet volume, and neutrophil lymphocyte ratio in Behcet’s disease and their relation to disease activity. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2023. [DOI: 10.1186/s43166-022-00168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Background
Behcet’s disease (BD) does not have specific laboratory finding or pathological physical examination sign, and only few studies have investigated Neutrophil to lymphocyte ratio (NLR), platelets to lymphocytes ratio (PLR), lymphocytes to monocytes ratio (LMR), or mean platelet volume (MPV) values in patients with BD. We conducted this study to investigate the relationship between these indices and Behcet’s disease (BD) and to determine their relation to BD disease activity.
Results
This study is a case-control study that included 36 Behcet’s disease patients and 36 healthy controls. BD patients showed significant increase in the mean of NLR and PLR in comparison to control (P = 0.008 and 0.011) respectively, and highly significant decrease in LMR and MPV levels in BD patients in comparison to control (P < 0.001 and < 0.001) respectively. Also, we found that NLR, PLR, and LMR were significantly related to BD activity, and there were significant associations between the studied hematological parameters with some of muco-cutaneous, articular, gastrointestinal, eye, and nervous system manifestations in BD patients.
Conclusion
The blood indices NLR, PLR, LMR, and MPV are potential inflammatory markers that can be used to evaluate inflammatory status and disease activity in patients with BD. NLR and PLR showed positive relation being higher in active disease and also higher in highly active disease than in low disease activity. Also, LMR was significantly decreased in Behcet’s disease patients in relation to disease activity. Furthermore, NLR and PLR levels were significantly more associated with muco-cutaneous and nervous system involvement while, LMR levels were significantly associated with muco-cutaneous, articular, gastrointestinal and eye manifestations and MPV levels were associated with articular manifestations being significantly related to disease activity. These easily evaluated markers could help in the management of this disease with multisystem affection that are sometimes serious and potentially life threatening.
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Protein Z (rs3024735; G79A and rs3024719; G-103A) gene polymorphisms in Behçet’s disease patients. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Visual Prognostic Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Behçet’s Uveitis. Retina 2022; 42:1189-1198. [DOI: 10.1097/iae.0000000000003417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Erdogan T. Role of systemic immune-inflammation index in asthma and NSAID-exacerbated respiratory disease. CLINICAL RESPIRATORY JOURNAL 2020; 15:400-405. [PMID: 33249745 DOI: 10.1111/crj.13314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/08/2020] [Accepted: 11/19/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Asthma is a heterogeneous disease characterized by chronic progressive airway inflammation. Although the disease has numerous phenotypes, there are no practical biomarkers for distinguishing the phenotypes from one another. To address this challenge, we aimed to reveal whether the systemic immune-inflammation index (SII), an important indicator of systemic inflammation and prognosis in various malignancies and vasculitis, can be used for distinguishing between asthma and NSAID-exacerbated respiratory disease (NERD). METHODS The study enrolled 105 patients (asthma: n = 69; NERD: n = 36). SII was calculated using the formula of neutrophil X platelet/lymphocyte number. Major risk factors, namely ACT score, eosinophil level, total IgE level, N-L ratio (NLR), P-L ratio (PLR), and SII, were evaluated by logistic regression analysis. RESULTS No significant differences were found between the clinical features of the two study groups. Patients with an SII value ≥895.6 had a probability of having NERD with a sensitivity of 30.56%, whereas those with a lower SII had a probability of having asthma with a sensitivity of 92.65%. In the logistic regression analysis, no risk factor was determined for identifying asthma or NERD. The N-L ratio was found to be the risk factor affecting categorized SII (OR = 264.2, 95% CI 9.9-7046.5, P = 0.001). CONCLUSION This is the first study to evaluate SII as a tool for differentiating asthma phenotypes. The presence of SII below the cutoff value can help exclude the diagnosis of NERD. There is a need for large-scale prospective studies to compare different phenotypes and determine the optimal cutoff value.
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Affiliation(s)
- Tuba Erdogan
- Faculty of Medicine, Department of Chest Disease, Division of Immunology and Allergy, Osmangazi University, Eskişehir, Turkey
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11
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Risk factors of disease activity in patients with Behçet's syndrome. Clin Rheumatol 2020; 40:1465-1471. [PMID: 32918637 DOI: 10.1007/s10067-020-05386-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the clinical characteristics and laboratory data in Behçet's syndrome (BS) patients in China and analyze the risk factors of disease activity. METHOD A retrospective analysis method was used and the demographic data and laboratory results were collected from 174 BS patients. Univariate and multivariate logistic regression analyses were used to analyze the demographic data and laboratory indexes whether that are risk factors or not of disease activity. RESULTS The most common clinical manifestations of BS patients enrolled were mouth ulceration (48.85%), followed by erythema nodosum (20.69%), and eye involvement (13.75%), while the least common was headache (0%). Most active BS patients (96.55%) used 2 or ≥ 3 immunosuppressants to control disease, while most inactive patients (75%) used 0 or 1 immunosuppressant. The associated risk factors of disease activity consisted of disease duration, neutrophil-to-lymphocyte ratio (NLR), white blood cells, red blood cells, hemoglobin, platelets, fibrin degradation products, IgG, IgM, complement 3, complement 4, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, albumin-to-globulin ratio (AGR), and high-density lipoprotein (HDL) (P < 0.05 or P = 0.00). Disease duration (≤ 60 months) (OR 8.49, 95% CI 2.09-34.49, P = 0.003), NLR (≥ 2) (OR 8.68, 95% CI 2.12-35.49, P = 0.003), CRP (≥ 10 mg/L) (OR 41.12, 95% CI 8.43-200.70, P = 0.000), ESR (≥ 20 mm/H) (OR 9.60, 95% CI 2.41-38.18, P = 0.001), and AGR (< 1.5) (OR 12.42, 95% CI 2.92-52.80, P = 0.001) were the independent risk factors of disease activity in BS patients. CONCLUSIONS Attention should be paid to the risk factors of disease activity and the medicine should be adjusted correspondingly. Key Points • The current diagnosis and efficacy evaluation of Behçet's syndrome (BS) mainly relied on clinical symptoms, while there are no specific laboratory biomarkers for reference. • In this study, we found that disease duration (≤ 60 months), neutrophil-to-lymphocyte ratio (≥ 2), C-reactive protein (≥ 10 mg/L), erythrocyte sedimentation rate (≥ 20 mm/H), and albumin-to-globulin ratio (< 1.5) were the independent risk factors of disease activity in BS patients. • In the ROC curve analysis, we found that erythrocyte sedimentation rate, C-reactive protein, and neutrophil-to-lymphocyte ratio could predict whether BS patients were active.
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Huang L, Shen C, Zhong Y, Ooi JD, Zhou YO, Chen JB, Wu T, Meng T, Xiao Z, Lin W, Ao X, Tang R, Xiao X, Zhou Q, Xiao P. The association of neutrophil-to-lymphocyte ratio with all-cause mortality in Chinese patients with MPO-ANCA associated vasculitis. Clin Exp Med 2020; 20:401-408. [PMID: 32318926 DOI: 10.1007/s10238-020-00629-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
Neutrophil-to-lymphocyte ratio (NLR) has been recently reported to be a promising inflammatory marker to assess systemic inflammation in many disorders. However, there are only a few studies looking at NLR in patients with myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This study was thus undertaken to explore the relationship between NLR at diagnosis with inflammatory response and disease activity among MPO-AAV patients in a single Chinese center. Furthermore, we evaluated whether NLR could predict the renal prognosis and patient outcome. 188 patients with MPO-AAV were included in this study. Baseline NLR was positively correlated with CRP (r = 0.404, P < 0.001) and negatively with serum levels of C3 (r = - 0.163, P = 0.035), but it had no obvious correlation with Birmingham Vasculitis Activity Score (BVAS). Patients with MPO-AAV having NLR ≥ 9.53 exhibited higher risk for all-cause mortality than those having NLR < 9.53 (P < 0.0001). However, no significant difference was found in the kidney survival between patients having NLR ≥ 9.53 and those NLR < 9.53 at diagnosis. In multivariate analysis, NLR was positively associated with all-cause mortality (P = 0.037, HR = 1.98, 95% CI 1.04-3.78). There was no association between NLR with ESRD observed using univariate analysis or multivariate analysis. This large retrospective study of MPO-AAV patients in a single Chinese center demonstrates that NLR positively correlates with CRP and negatively correlates with serum levels of C3 in Chinese patients with MPO-AAV. Importantly, higher NLR predicts increased mortality and is, therefore, a useful independent prognostic in MPO-AAV.
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Affiliation(s)
- Li Huang
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Chanjuan Shen
- Department of Hematology, The Affiliated Zhuzhou Hospital Xiangya Medical College, Central South University, Zhuzhou, Hunan Province, China
| | - Yong Zhong
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
| | - Joshua D Ooi
- Centre for Inflammatory Diseases, Monash University, Clayton, VIC, 3168, Australia
| | - Ya-Ou Zhou
- Department of Rheumatology and Immunology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jin-Biao Chen
- Department of Medical Records and Information, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Ting Wu
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Ting Meng
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhou Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Wei Lin
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xiang Ao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Rong Tang
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xiangcheng Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Qiaoling Zhou
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Ping Xiao
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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Prognostic Value of Neutrophil-To-Lymphocyte Ratio and Platelet-To-Lymphocyte Ratio for Renal Outcomes in Patients with Rapidly Progressive Glomerulonephritis. J Clin Med 2020; 9:jcm9041128. [PMID: 32326552 PMCID: PMC7230792 DOI: 10.3390/jcm9041128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/07/2020] [Accepted: 04/12/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Rapidly progressive glomerulonephritis (RPGN) is a syndrome characterized by a rapid decline in renal function that often causes end-stage renal disease. Although it is important to predict renal outcome in RPGN before initiating immunosuppressive therapies, no simple prognostic indicator has been reported. The aim of this study was to investigate the associations of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) to renal outcomes in patients with RPGN. METHODS Forty-four patients with a clinical diagnosis of RPGN who underwent renal biopsy were enrolled. The relationships between NLR and PLR and renal outcome after 1 year were investigated. RESULTS NLR and PLR were significantly higher in patients with preserved renal function in comparison to patients who required maintenance hemodialysis (p < 0.05 and p < 0.01, respectively). An NLR of 4.0 and a PLR of 137.7 were the cutoff values for renal outcome (area under the curve, 0.782 and 0.819; sensitivity, 78.4% and 89.2%; specificity, 71.4% and 71.4%, respectively). Furthermore, an NLR of 5.0 could predict recovery from renal injury in patients requiring hemodialysis (area under the curve, 0.929; sensitivity, 83.3%; specificity, 85.7%). CONCLUSION NLR and PLR could be candidates for predicting renal outcomes in patients with RPGN.
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Zhang Z, Su Q, Zhang L, Yang Z, Qiu Y, Mo W. Diagnostic value of hemoglobin and neutrophil-to-lymphocyte ratio in Behcet Disease. Medicine (Baltimore) 2019; 98:e18443. [PMID: 31876725 PMCID: PMC6946511 DOI: 10.1097/md.0000000000018443] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The purpose of our study was to investigate the diagnostic value of NLR, hemoglobin (HB) and combine NLR with HB in the BD patients.Sixty-seven patients with BD were diagnosed in the rheumatology or dermatology between June 2015 and June 2019; 92 matching healthy physical examiners were included in our study. SPSS was used for statistical analysis.Compared with the healthy control, NLR was increased (P < .001), while the HB level was decreased (P < .001) in the patients of BD. In addition, ESR and CRP were increased in BD patients. NLR has no relationship with CRP and ESR, while the HB levels were negatively correlated with CRP and ESR (r = -0.293, P = .046; r = -0.431, P = .002). ROC curve analysis revealed the AUC of NLR and HB were 0.797 and 0.798 (P < .001). When combined NLR with HB, the AUC was 0.897 (P < .001). Besides, logistic regression analysis demonstrated that NLR and HB were independent risk factors in the BD patients.We observed that the diagnostic value of NLR, HB and combined NLR with HB in the BD patients were high, particularly when combine NLR with HB. NLR and HB were independent risk factors in the BD patients. In addition, HB levels related to the disease activity of BD patients.
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Yu Y, Yao X, Liang J, Lu C, Yan T, Lin J. Is Helicobacter pylori associated with Behçet's syndrome? A meta-analysis. Helicobacter 2019; 24:e12663. [PMID: 31617289 DOI: 10.1111/hel.12663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/21/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Preceding studies have reported the relationship between Helicobacter pylori (H pylori) and Behçet's syndrome (BS), but there still exists controversy. In this study, we firstly conducted a meta-analysis to clarify the relationship of these two diseases. METHODS Articles published until July 1, 2019, in the PubMed, MEDLINE, and Embase databases with restriction of English-language studies were searched and reviewed. According to the inclusion criteria, relevant statistical data were extracted and analyzed. RESULTS Six articles were finally included. The result showed that BS individuals were 1.39 times more susceptible to H pylori infection (OR = 1.39, 95% CI = (1.03, 1.87)). In addition, it found that oral ulceration (OR = 27.98, 95% CI = (3.49, 224.49)), genital ulceration (OR = 3.15, 95% CI = (1.51, 6.56)), and cutaneous lesions (OR = 4.29, 95% CI = (2.14, 8.61)) were alleviated after H pylori eradication. Publication bias and sensitivity analysis showed no statistical heterogeneity. CONCLUSIONS BS patients had higher rate of H pylori infection, and clinical symptoms including oral ulceration, genital ulceration, and cutaneous lesions can be improved after H pylori eradication. The results indicated that H pylori may be an etiological factor to BS.
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Affiliation(s)
- Ye Yu
- Division of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Yao
- Division of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Junyu Liang
- Division of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chao Lu
- Division of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tianlian Yan
- Division of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jin Lin
- Division of Rheumatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Abaza NM, El-Latif EMA, Gheita TA. Clinical Significance of Neutrophil/lymphocyte Ratio in Patients With Granulomatosis With Polyangiitis. REUMATOLOGÍA CLÍNICA (ENGLISH EDITION) 2019; 15:363-367. [DOI: 10.1016/j.reumae.2017.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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17
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HAYRAN Y, ÖKTEM A, ŞAHİN B, İNCEL UYSAL P, ALLI N, YALÇIN B. Elevated neutrophil to lymphocyte ratio as an indicator of secondary erythema nodosum, a retrospective observational study. Turk J Med Sci 2019; 49:624-634. [PMID: 30997978 PMCID: PMC7018376 DOI: 10.3906/sag-1810-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Yıldız HAYRAN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Ayşe ÖKTEM
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Buket ŞAHİN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Pınar İNCEL UYSAL
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Nuran ALLI
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
| | - Başak YALÇIN
- Department of Dermatology, Ankara Numune Training and Research Hospital, AnkaraTurkey
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Meta-Analysis of Asymmetric Dimethylarginine Concentrations in Rheumatic Diseases. Sci Rep 2019; 9:5426. [PMID: 30932011 PMCID: PMC6443686 DOI: 10.1038/s41598-019-41994-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/15/2019] [Indexed: 02/06/2023] Open
Abstract
Raised circulating concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase (NOS), have been reported in several rheumatic diseases (RDs). However, the strength of this relationship is unclear. Therefore, the aim of this systematic review and meta-analysis was to evaluate the magnitude and the robustness of the association between ADMA concentrations and RDs. We calculated standardized mean differences (SMD, with 95% confidence intervals, CI). Study heterogeneity was evaluated by meta-regressions and sensitivity analyses according to type of RDs, conventional cardiovascular risk factors, inflammatory markers, and type of ADMA assessment methodology. Thirty-seven studies with a total of 2,982 subjects (1,860 RDs patients and 1,122 healthy controls) were included in our meta-analysis. Pooled results showed that ADMA concentrations were significantly higher in patients with RDs than in healthy controls (SMD = 1.27 µmol/L, 95% CI 0.94–1.60 µmol/L; p < 0.001). However, the between-studies heterogeneity was high. Differences in ADMA concentrations between controls and RDs patients were not significantly associated with inflammatory markers, increasing age, lipid concentrations, body mass index, blood pressure, or methodology used to assess ADMA. Furthermore, subgroup analysis showed no difference across RDs. This meta-analysis showed that, in the context of significant between-study heterogeneity, circulating concentrations of ADMA are positively related to RDs.
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Mohammad WH, Ahmad AB, Al-Maghraby MH, Abdelrhman MZ, Ezzate S. Is neutrophil-lymphocyte ratio a novel biomarker for macrovascular and microvascular complications of type 2 diabetes? THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2019. [DOI: 10.4103/ejim.ejim_54_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Lee YH, Song GG. Neutrophil-to-lymphocyte ratio, mean platelet volume and platelet-to-lymphocyte ratio in Behçet’s disease and their correlation with disease activity: A meta-analysis. Int J Rheum Dis 2018; 21:2180-2187. [DOI: 10.1111/1756-185x.13404] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/26/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Young Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Korea University Medical Center; Korea University College of Medicine; Seoul Korea
| | - Gwan Gyu Song
- Division of Rheumatology, Department of Internal Medicine, Korea University Medical Center; Korea University College of Medicine; Seoul Korea
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21
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Elden MS, Hmmad G, Farouk H, Fawzy RM, Abdelwhaba B. Neutrophil-to-lymphocyte ratio: relation to disease activity and carotid intima-media thickness in Behçet’s disease. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_26_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ahn SS, Jung SM, Song JJ, Park YB, Lee SW. Neutrophil to lymphocyte ratio at diagnosis can estimate vasculitis activity and poor prognosis in patients with ANCA-associated vasculitis: a retrospective study. BMC Nephrol 2018; 19:187. [PMID: 30064369 PMCID: PMC6069981 DOI: 10.1186/s12882-018-0992-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Neutrophil to lymphocyte ratio (NLR) was introduced to predict poor prognosis in various diseases, but not all variants of ANCA-associated vasculitis (AAV). In this study, we aimed to investigate whether NLR at diagnosis can estimate vasculitis activity at diagnosis and poor prognosis during follow-up in patients with AAV. METHODS We retrospectively reviewed the medical records of 160 patients with AAV. We collected clinical and laboratory data at diagnosis and obtained remission and death as poor prognosis. We stratified AAV patients into three groups according to tertile and defined the lower limit of each highest tertile as the optimal cut-off (5.9 for NLR and 15.0 of Birmingham vasculitis activity score [BVAS] for severe AAV). RESULTS The mean age at diagnosis was 55.2 years and 48 patients were men. In the univariable linear regression analysis, BVAS was negatively correlated with lymphocyte count and positively correlated with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and NLR. In the multivariable linear regression analyses of ESR and CRP with either lymphocyte count or NLR, lymphocyte count (β = - 0.160) and NLR (β = 0.169) were associated with BVAS. Patients having NLR ≥ 5.9 exhibited severe AAV more frequently than those having NLR < 5.9 at diagnosis (relative 2.189, P = 0.023). Patients having NLR ≥ 5.9 exhibited a higher frequency of AAV relapse, but not death, than those having NLR < 5.9 (P = 0.016). CONCLUSIONS NLR at diagnosis can estimate vasculitis activity at diagnosis and predict relapse during follow-up in patients with AAV.
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Affiliation(s)
- Sung Soo Ahn
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jason Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.,Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. .,Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Hammad M, Shehata OZ, Abdel-Latif SM, El-Din AMM. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in Behçet's disease: which and when to use? Clin Rheumatol 2018; 37:2811-2817. [PMID: 29980877 DOI: 10.1007/s10067-018-4194-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/04/2018] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
Abstract
Behçet's disease (BD) is an uncommon autoimmune/autoinflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were investigated in many diseases as a marker of inflammation. In this study, we investigated NLR and PLR in patients with BD as a marker of disease activity and its association with different clinical manifestations. The study included 23 BD patients; their mean age was (32.5 ± 6.76) and M:F ratio was 16:7. Complete blood picture was done for all patients. NLR and PLR were compared in both active and inactive BD patients and its relation with different clinical manifestations was assessed. NLR was higher in active BD patients than in inactive BD patients (P < 0.01). Although both NLR and PLR were correlated with Behçet's Disease Current Activity Form (BDCAF), the correlation of NLR with BDCAF was much stronger than that of PLR. NLR was associated with some mucocutaneous lesions. Both NLR and PLR were associated with articular and GIT manifestations, but also NLR showed more significant results. In our studied patients, both NLR and PLR were not informative about any ongoing ocular activity (P > 0.05). Both ratios were not affected by the presence of neurologic deficits nor previous vascular events (P > 0.05). NLR was superior to PLR as an indicator of disease activity. NLR was closely related to skin manifestations while PLR was not. In our study, both were not considered reliable in representing ocular activity.
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Affiliation(s)
- Marwa Hammad
- Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Omaima Zakaria Shehata
- Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Icli A, Cure MC, Cure E, Arslan S, Unal M, Sakiz D, Ozucan M, Toker A, Turkmen K, Kucuk A. Soluble Tumor Necrosis Factor (TNF)-Like Weak Inducer of Apoptosis (Tweak) Independently Predicts Subclinical Atherosclerosis in Behcet's Disease. ACTA MEDICA (HRADEC KRALOVE) 2018; 61:86-92. [PMID: 30543512 DOI: 10.14712/18059694.2018.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vasculopathy is a major cause of mortality and morbidity in Behcet's Disease (BD). Subclinical atherosclerosis can even be detected in the early stage of BD. Soluble tumor necrosis factor-like (TNF) weak inducer of apoptosis (TWEAK) is known as a good marker of the inflammation in vascular tree. The aim of this study is to examine the relationship between carotid artery intima-media thickness (cIMT) and serum TWEAK levels in patients with BD. MATERIALS AND METHODS In line with International BD Study Group criteria, 48 BD, and 30 controls were included in our study. Disease activity was evaluated according to BD current activity form (BDCAF). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lipid parameters, serum TWEAK levels, and cIMT were measured. RESULTS Disease activity score of BD patients was found as 2 (range 0-7). cIMT, serum TWEAK, CRP and ESR levels of BD patients were significantly higher comparing to cIMT (0.62 ± 0.13 mm vs. 0.43 ± 0.09 mm, p < 0.001), serum TWEAK (667.5 ± 130.6 vs. 603.4 ± 89.6 pg/ml, p = 0.015), CRP (3.9 ± 4.3 vs. 1.4 ± 1.0 mg/dl, p < 0.001) and ESR (10.2 ± 10.0 vs. 5.6 ± 3.7 mm/h, p = 0.005) levels of the control group. There was a positive correlation between serum TWEAK level and disease activity (r = 0.251, p = 0.030) and cIMT (r = 0.463, p < 0.001). Our study also revealed an independent correlation between cIMT and serum TWEAK levels (beta = 0.354, p < 0.001). CONCLUSION Increased serum TWEAK levels can play a part in the development of atherosclerotic heart disease in BD. Due to their liability to atherosclerosis, patients with BD must followed closely.
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Affiliation(s)
- Abdullah Icli
- Department of Cardiology, Necmettin Erbakan University, Konya, Turkey
| | | | - Erkan Cure
- Department of Internal Medicine, Camlica Erdem Hospital, Istanbul, Turkey.
| | - Sevket Arslan
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Unal
- Department of Dermatology, Konya Numune Hospital, Konya, Turkey
| | - Davut Sakiz
- Division of Endocrinology, Department of Internal Medicine, Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Miyase Ozucan
- Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Aysun Toker
- Department of Biochemistry, Necmettin Erbakan University, Konya, Turkey
| | - Kultigin Turkmen
- Division of Nephrology, Department of Internal Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Adem Kucuk
- Division of Rheumatology, Department of Internal Medicine, Malatya State Hospital, Malatya, Turkey
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Abaza NM, El-Latif EMA, Gheita TA. Clinical Significance of Neutrophil/lymphocyte Ratio in Patients With Granulomatosis With Polyangiitis. ACTA ACUST UNITED AC 2017; 15:363-367. [PMID: 29274703 DOI: 10.1016/j.reuma.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine to neutrophil-to-lymphocyte ratio (NLR) in granulomatosis with polyangiitis (GPA) patients and to study its relation to disease manifestations and activity. METHODS The study included 44 GPA patients and 44 matched age and sex controls. Full history taking, thorough clinical examination with more attention to ocular examination, laboratory and radiological investigations were considered. Disease activity was assessed using the Birmingham Vasculitis Activity Score (BVAS). RESULTS The patients (21 males and 23 females) had a mean age of 45.66±7.24 years, disease duration 6.8±3.6 years and BVAS 50.1±14.3. All patients had a positive cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) while only 5 had a positive p-ANCA. The NLR was significantly increased in the GPA patients (5.1±2.4) compared to the control (1.5±0.8) (P<.0001). Ten patients with uveitis had a significantly higher NLR (6.5±1.9) compared to those without (4.7±2.4) (0.03) while those with proptosis (n=10), cutaneous manifestations (n=17) or ischemic heart disease (n=9) had a significantly lower NLR than those without (P=.0001, P=.017 and P=.046 respectively). The NLR did not significantly correlate with any of the patients' characteristics. The NLR inversely yet insignificantly correlated with the disease activity (r=-0.02, P=.93). CONCLUSION The NLR may have a significant role in the pathogenesis of GPA, the development of uveitis or proptosis, cutaneous manifestations and ischemic heart disease. NLR may serve as a future potential companion to c-ANCA positivity in diagnosing and evaluating GPA and may play a role in the tissue-specific and clinical characteristics.
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Affiliation(s)
- Nouran M Abaza
- Rheumatology Department, Faculty of Medicine, Ain Shams University, Egypt
| | | | - Tamer A Gheita
- Rheumatology Department, Faculty of Medicine, Cairo University, Egypt.
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Kankilic N, Aslan A, Karahan O, Demirtas S, Caliskan A, Yavuz C. Investigation of the arterial intima-media thickness in Behcet’s disease patients without vascular complaints. Vascular 2017; 26:356-361. [DOI: 10.1177/1708538117742827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Behcet’s disease is a multisystemic, inflammatory disease. Various factors have been implicated in the disease, including genetics, infections, immunoglobulins, immune complexes, antibodies, and oxidative stress. However, the underlying etiopathogenesis remains unclear. Behcet’s disease can occur with or without vascular involvement. This prospective study investigated the relationship between the intima-media thickness of the major arteries, in addition to other factors affecting the disease process, in Behcet’s disease without vascular involvement. Methods Twenty-four patients (average age: 38.50 ± 10.931) without vascular involvement or any vascular complaints who were diagnosed with Behcet’s disease were included in the study. Sixteen healthy subjects (average age: 39.75 ± 7.793) were included as a control group. Demographic information and medical histories were recorded, and routine blood tests were performed in both groups. The intima-media thickness of the subclavian, axillary, femoral, and carotid arteries of all the participants were recorded using Doppler ultrasonography. The data were then subjected to intergroup statistical and correlation analyses. Results There were no significant differences between the arterial intima-media thickness values of the Behcet’s disease patients and those of the control group ( p > 0.05). However, there was a significant difference between the neutrophil–lymphocyte ratio ( p = 0.004), low-density lipoprotein ( p = 0.007), and triglyceride ( p = 0042) levels of the two groups. Significant correlations were found between intima-media thickness and neutrophil–lymphocyte ratio levels ( p = 0.012) and the disease duration ( p = 0.030). There was also a significant correlation between the intima-media thickness of the femoral artery and disease duration ( p = 0.014). Conclusions The results showed that the duration of illness had a significant effect on arterial intima-media thickness in Behcet’s disease. Blood neutrophil–lymphocyte ratio levels were also associated with increased intima-media thickness.
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Affiliation(s)
- Nazım Kankilic
- Department of Cardiovascular Surgery, Kırklareli State Hospital, Kırklareli, Turkey
| | - Aydın Aslan
- Department of Radiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Oguz Karahan
- Department of Cardiovascular Surgery, Medical School of Dicle University, Diyarbakir, Turkey
| | - Sinan Demirtas
- Department of Cardiovascular Surgery, Medical School of Dicle University, Diyarbakir, Turkey
| | - Ahmet Caliskan
- Department of Cardiovascular Surgery, Elazıg Medical Park Hospital, Elazıg, Turkey
| | - Celal Yavuz
- Department of Cardiovascular Surgery, Medical School of Dicle University, Diyarbakir, Turkey
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Cardiovascular disease in patients with autoinflammatory syndromes. Rheumatol Int 2017; 38:37-50. [DOI: 10.1007/s00296-017-3854-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/13/2017] [Indexed: 12/16/2022]
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Knitting the Threads of Silk through Time: Behçet's Disease-Past, Present, and Future. Int J Rheumatol 2017; 2017:2160610. [PMID: 29081805 PMCID: PMC5610876 DOI: 10.1155/2017/2160610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/07/2017] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease (BD) is a chronic relapsing vasculitis that affects vessels of all types and sizes with a broad spectrum of phenotypic heterogeneity and complex immunopathogenesis. Efforts by the scientific community to resolve the unmet needs of BD and gaps in our knowledge have been hampered by considerable challenges that primarily relate to the rare nature of the disease in many parts of the world and its heterogeneity. Controversies remain in many aspects of the disease including the diagnostic criteria, immunopathogenesis and biomarker discovery, geographical variation, and therapeutic considerations. In this review, we highlight recent advances in our scientific understanding of BD, shed new insights into diagnostic and treatment strategies, and discuss residual gaps in our knowledge that will serve as the basis for current and future research.
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Avci A, Avci D, Erden F, Ragip E, Cetinkaya A, Ozyurt K, Atasoy M. Can we use the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume values for the diagnosis of anterior uveitis in patients with Behcet's disease? Ther Clin Risk Manag 2017; 13:881-886. [PMID: 28769565 PMCID: PMC5529084 DOI: 10.2147/tcrm.s135260] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The purpose of this study was to compare the value of hematological parameters, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV), as indicators of anterior uveal segment involvement in patients with Behcet’s disease (BD). Patients and methods Hospital-based records of a total of 912 patients with BD from the dermatology clinic and healthy volunteers from the checkup clinic were assessed retrospectively. After applying the exclusion criteria of the study, 71 of the BD patients with anterior uveitis, 69 of the BD patients without ophthalmological pathology and 151 healthy volunteers were included in the study. MPV, PLR, and NLR values of patients and healthy volunteers were compared. Results All MPV, PLR, and NLR values of patients who had anterior uveitis were significantly higher than those of other patients and healthy volunteers. Statistically, considering area under curves (ratio): NLR was 0.725 (0.653–0.797), P<0.001; PLR was 0.600 (0.523–0.676), P=0.012, and MPV was 0.358 (0.279–0.437), P<0.001. Conclusion MPV, PLR, and NLR are all valuable for assessment of anterior uveal segment involvement in patients with BD. However, the NLR seems to be better than the PLR and MPV for indicating anterior uveitis due to BD.
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Affiliation(s)
- Atil Avci
- Department of Dermatology and Venereology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Deniz Avci
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fatma Erden
- Department of Dermatology and Venereology, Cubuk State Hospital, Ankara, Turkey
| | - Ertas Ragip
- Department of Dermatology and Venereology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ali Cetinkaya
- Internal Medicine Department, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Kemal Ozyurt
- Department of Dermatology and Venereology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Mustafa Atasoy
- Department of Dermatology and Venereology, Kayseri Training and Research Hospital, Kayseri, Turkey
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Conkar S, Güven Yılmaz S, Koska İÖ, Berdeli A, Mir S. Evaluation of development of subclinical atherosclerosis in children with uveitis. Clin Rheumatol 2017; 37:1305-1308. [PMID: 28695435 DOI: 10.1007/s10067-017-3741-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/10/2017] [Accepted: 06/25/2017] [Indexed: 11/24/2022]
Abstract
Uveitis is a chronic inflammatory disease. Chronic inflammation has been shown to have a role in pathogenesis of atherosclerosis. Atherosclerosis is the most important risk factor of cardiovascular diseases and is shown to start as early as childhood. In this study, we investigated the presence of subclinical atherosclerosis in children with uveitis. Seventy five patients who were diagnosed as having uveitis in ophthalmology and pediatric rheumatology clinics were included in the study. Patients with hypertension, obesity, dyslipidemia, diabetes, and with history of early cardiovascular disease were excluded. Arterial stiffness, carotid-femoral pulse wave velocity (PWV), augmentation index (AIx), and carotid artery intima-media thickness (cIMT) were measured for each patient. These measurements were compared with 50 healthy children with similar age and sex as controls. The mean age of patients in this study was 12.24 ± 2.69 years, and the mean age of controls was 11.32 ± 4.52 years. PWV and AIx values were higher in the patient group (p = 0.04, p = 0.03). cIMT levels were not different in patient and control groups. When patients were grouped as having uveitis for more than 5 years or not, patients with longer duration of uveitis had higher PWV, AIx, and cIMT levels (p values were 0.01, 0.02, and 0.04 respectively). Vascular functions deteriorate first with endothelial damage in children with uveitis and as disease continues, increase in cIMT is added. We think that for follow-up of the disease and evaluation of the treatment, non-invasive subclinical atherosclerosis markers should be used along with activation criteria of primary diseases.
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Affiliation(s)
- Seçil Conkar
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey.
| | - Suzan Güven Yılmaz
- Departments of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - İlker Özgür Koska
- Department of Radiology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Afig Berdeli
- Department of Pediatric Rheumatology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Sevgi Mir
- Department of Pediatric Nephrology, Ege University Faculty of Medicine, İzmir, Turkey.,Department of Pediatric Rheumatology, Ege University Faculty of Medicine, Izmir, Turkey
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Abstract
The aim of this study is to determine platelet to lymphocyte ratio (PLR) and lymphocytes to monocytes ratio (LMR) levels in Behçet's disease (BD) and to investigate their relationships with disease activity.Hematological and inflammatory parameters including high-sensitivity C-reactive proteins (hs-CRP), erythrocyte sedimentation rate (ESR), PLR, and LMR were examined in BD and healthy controls.Data from 140 patients with BD (108 with active and 32 with inactive disease) and 107 controls were enrolled. PLR (153.21 ± 65.44, 106.20 ± 28.91, P <.001, respectively) was remarkably higher, whereas LMR (5.37 ± 5.47, 8.95 ± 5.84, P <.001, respectively) was significantly lower in BD than in controls. Active BD patients had significantly higher PLR (159.20 vs 131.14, P = .037), ESR (38.30 vs 24.55, P = .017), and hs-CRP (30.20 vs 17.21, P = .027) than those with inactive BD. However, no significant difference in LMR was found between the groups. Moreover, PLR was positively correlated with BDCAF (r = 0.193, P <.05), hs-CRP (r = 0.402, P <.01), and ESR (r = 0.284, P <.01), whereas LMR was negatively correlated with BDCAF (r = -0.175, P <.05), hs-CPR (r = -0.263, P <.01), and ESR (r = -0.175, P <.05). Additionally, both PLR and LMR were shown to be independent factors for BD by multivariate logistic regression analysis. Furthermore, a PLR level of 124.63 was determined as the best cut-off value by ROC analysis (sensitivity 64.3%, specificity 78.0%, and the area under the ROC curve 0. 753).PLR was elevated in active BD as compared to inactive BD. PLR may be a reliable, cost-effective, and novel potential parameter to help evaluate disease activity in BD.
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Affiliation(s)
| | - Mingcui Zang
- Department of Surgery, First Hospital of Jilin University, Changchun, Jilin Province, China
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High Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Mortality in Chronic Hemodialysis Patients. Mediators Inflamm 2017; 2017:9327136. [PMID: 28316378 PMCID: PMC5339486 DOI: 10.1155/2017/9327136] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/12/2017] [Accepted: 01/29/2017] [Indexed: 12/14/2022] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is a novel simple biomarker of inflammation. It has emerged as a predictor of poor prognosis in cancer and cardiovascular disease in general population. But little was known of its prognostic value in chronic hemodialysis (HD) patients. Here we investigated the association between NLR and cardiovascular risk markers, including increased pulse pressure (PP), left ventricular mass index (LVMI) and intima-media thickness (IMT), and mortality in HD patients. Two hundred and sixty-eight HD patients were enrolled in this study and were followed for 36 months. The primary end point was all-cause mortality and cardiovascular mortality. Multivariable Cox regression was used to calculate the adjusted hazard ratios for NLR on all-cause and cardiovascular survival. We pinpointed that higher NLR in HD patients was a predictor of increased PP, LVMI, and IMT; HD patients with higher NLR had a lower survival at the end of the study; furthermore, high NLR was an independent predictor of all-cause and cardiovascular mortality when adjusted for other risk factors. In conclusion, higher NLR in HD patients was associated with cardiovascular risk factors and mortality.
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