Neutrophil-to-lymphocyte ratio in systemic lupus erythematosus is influenced by steroids and may not completely reflect the disease activity

Kr Anupama,Panchagnula R,S Chandrashekara

doi:10.15305/ijrci/v8i1/319

Kr Anupama, Panchagnula R + Show 1 more

Open Access

https://doi.org/10.15305/ijrci/v8i1/319

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Abstract

Objectives: Neutrophil-to-lymphocyte ratio (NLR) has emerged as an important parameter in inflammatory network and could pave the way for newer treatment strategies in systemic lupus erythematosus (SLE). The study evaluated NLR as a predictor of disease activity in SLE and attempted to relate the factors influencing the NLR. Methods: The study included 117 SLE patients fulfilling the systemic lupus international collaborating clinics/American College of Rheumatology (SLICC/ACR) criteria (2010). The subjects were classified into mild, moderate, and severe systemic lupus erythematosus disease activity index 2000 (SLEDAI 2K) groups and compared. NLR values were classified as ≤2, >2–4 and >4 groups and its relationship with study variables was evaluated by Notched box-and-Whisker plots, Spearman correlation and Mountain plot. ROC and multiple linear regression were used to verify discriminatory ability and factors influencing NLR respectively. Results: Approximately 24% (n=28) of patients each had mild and moderate SLEDAI disease activities, and 52.14% (n=61) had severe activity. Patients with severe disease activity were significantly younger (31.69±10.09 years) and were on more immunosuppressants/DMARDs. The patients in the >4 NLR group had significantly elevated total leucocyte count (TLC) 5560 (3360-11480) cells/mm3 and CRP 4.46 (0.3-48.2) mg/L and more patients were on steroid therapy. The >2-4 NLR group had moderate inverse correlation with SLEDAI. NLR, ESR, CRP, and C3 did not show agreement with SLEDAI. The NLR was associated with CRP and steroid usage and could not discriminate disease severity. Conclusion: The relationship of the NLR with SLEDAI was not consistent. NLR was associated with CRP and steroid use. NLR as a marker of inflammation or as a predictor of SLE disease activity needs further investigation.

Highlights

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple autoantibodies and varied clinical features including pancytopenia
The analysis demonstrated that C-reactive protein (CRP) and steroids were predictors of neutrophil-to-lymphocyte ratio (NLR) with weak association (Table 3)
The present study demonstrated that NLR, erythrocyte sedimentation rate (ESR) and complement factor 3 (C3) does not discriminate the patients with severe disease activity from those with mild-moderate disease activity

Summary

Introduction

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple autoantibodies and varied clinical features including pancytopenia. Quantifying the disease for the purpose of disease assessment is still a challenge. Complement levels, ESR, presence of auto-antibodies and their titers, especially of the anti-ds DNA, are the laboratory parameters that are considered for disease assessment in routine practice.[1] SLE disease activity index (SLEDAI), Safety of estrogens in lupus erythematosus national assessment (SELENA) and British. Isles Lupus Assessment Group (BILAG) are the commonly used scores in clinical trials and in certain academic clinical settings. The SLEDAI score is commonly used in clinical practice.[2]. Recent studies have highlighted the relationship of NLR with disease activity.[4,5,6,7] The NLR has been found to correlate with clinical disease activity in rheumatoid arthritis, Internet Journal of Rheumatology and Clinical Immunology

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