Comparison of neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio ,and red blood cell distribution width during the attack phase of familial Mediterranean fever with the silent phase of the disease in patients referred to the emergency department

Abstract

Objective: As patients with acute-phase familial Mediterranean fever (FMF) require prompt diagnosis for optimal management, we are conducting a study to compare inflammatory markers during the attack and silent phases in individuals referred to the emergency department. Methods: This case-control study involved 184 FMF patients under 16 years old, with data collected at Bo Ali Hospital's emergency department in Ardabil city throughout 2022. Patients in the attack phase were assessed by emergency medicine specialists, while those in the silent phase were recruited from the rheumatology clinic. Hematological parameters were obtained from venous blood samples, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and red blood cell distribution width (RDW) were calculated. Statistical analyses included 1-Sample Kolmogorov-Smirnov, ANOVA, Tukey's-b post hoc, Independent Samples T-test, Kruskal-Wallis, and Pearson Chi-squared tests. Results: In the attack group, the NLR correlated with increased leukocytes (r=0.652, P<0.001) and RDW (r=0.310, P=0.003). The non-attack group showed a correlation between the NLR and higher leukocytes (r=0.384, P<0.001) and ESR (r=0.214, P=0.04). Additionally, the attack group exhibited a correlation between the PLR and higher leukocytes (r=0.711, P=0.009), and ESR (r=0.285, P=0.014) while no correlation was found in the non-attack group. Conclusion: Our study revealed that RDW levels were significantly higher in FMF patients, indicating clinical inflammation. During FMF attacks, NLR and PLR ratios were notably elevated, making them key markers for systemic inflammation in these patients.