The Clinical Significance of the Neutrophil-to-lymphocyte Ratio in Hemorrhagic Vasculitis Coexisting with Nonalcoholic Steatohepatosis

Abstract

Hemorrhagic vasculitis (HV) is a systemic disease of widespread inflammation in small vessels, arterioles, small capillaries, and perivascular edema with blood cells infiltration. The pathogenesis of HV are currently not well understood, and insufficient investigators attention is given to this disease. It has been established that patients with HV often have sonographic signs of the liver damage with normal liver tests, which indicates the presence of hepatic steatosis (HS). The ratio of neutrophilic granulocytes to lymphocytes (N/L) is widely used by doctors to determine the activity of the process, but in patients with HV, depending on the presence of HS, it was not evaluated. The objective: to analyze the diagnostic capabilities of the N/L ratio in HV adult patients. Materials and methods. The retrospective analyse of the hospital examination results of 50 patients with HV was performed and included data from 20 men and 30 women aged 45.96±2.04 years. The patients were divided into two groups: the main group – 15 men and 16 women with HS, and the control group – 5 men and 14 women with sonographically and laboratory intact liver, in whom the N/L index was additionally determined. Statistic of the study was performed by use Statistica 6.0 program, correlations were assessed by Pearson method (r); p<0.05 was taken as the significance threshold. Results. In patients with HV, the N/L index was 3.29±0.40. It was slightly higher than in SP (3.48±0.53 vs 2.69±0.34; p>0.05). The N/L index exceeded 3.3 was determined in 38.71% and >3.5 – in 22.6 of HV patients with SP. Such patients had worse structural and functional parameters of the heart. According to the correlation analysis, an increase in the N/L index >3.3–3.5 was associated with hypertrophy and dilatation of the ventricles with stretching of the valves and development of dysfunction, activation of neutrophilic inflammation, and suppression of the immune cellular component. It has been established that an increase in the N/L index can be not only a prognostic sign of gastrointestinal and renal lesions, but also a sign of heart changes – hypertrophy and dilatation with impaired systolic and diastolic functions. Conclusion. The ratio of neutrophilic granulocytes to lymphocytes is a simple and informative indicator of the activity of inflammation which is easily calculated in practice and is associated with the structural and functional changes in heart in patients with hemorrhagic vasculitis and hepatic steatosis.