Abstract
Immunoglobulin A (IgA) vasculitis is the most common systemic vasculitis of childhood. It can affect the gastrointestinal system (GS) and the renal system. To evaluate the monocyte-to-lymphocyte ratio (MLR) and other hematological markers in predicting GS and renal system complications of IgA vasculitis in children. One hundred and fifteen children with IgA vasculitis and 95 healthy children were included in this study. Demographic characteristics, organ involvement, and laboratory findings, including neutrophil, lymphocyte, monocyte and platelet (Plt) counts, red blood cell volume distribution width (RDW), platelet distribution width (PDW), mean platelet volumes (MPV), monocyte/platelet counts, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR), were evaluated. Among 115 children with IgA vasculitis, 34 (29.5%) cases had GS involvement, and renal involvement was observed in 12 children (10.4%). Neutrophil, monocyte and Plt count and MLR, NLR and PLR values were higher in the IgA vasculitis group than in control groups. Moreover, the neutrophil count and NLR and MLR levels were significantly higher in children with GS involvement than in those without GS involvement. Logistic regression analysis showed MLR was the sole risk factor for GS involvement among these parameters. Furthermore, a cut-off MLR value of 0.245 differentiated children with IgA vasculitis with GS involvement from those without GS involvement (area under the curve (AUC) 0.694, with a sensitivity of 52.9% and specificity of 77.8%). An elevated MLR value could serve as a useful marker in predicting GS involvement in IgA vasculitis in children. Therefore, monitoring the blood MLR value may serve as an important novel indicator to pediatricians regarding the involvement of GS and disease severity of IgA vasculitis.
Highlights
Immunoglobulin A (IgA) vasculitis is the most common systemic vasculitis of childhood
An elevated monocyte-to-lymphocyte ratio (MLR) value could serve as a useful marker in predicting gastrointestinal system (GS) involvement in IgA vasculitis in children
The white blood cell (WBC), neutrophil, monocyte and Plt counts and mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), MLR and platelet-to-lymphocyte ratio (PLR) values were significantly higher in the IgA vasculitis group compared with control groups
Summary
Immunoglobulin A (IgA) vasculitis is the most common systemic vasculitis of childhood.[1] The average annual incidence of this disease in children is about 20/100,000.2 the disease is most often characterized by a mild, self-limiting course with a good prognosis, it may present a progressive course and high recurrence in some cases.[3] It affects the small vessels of the skin, and the gastrointestinal and renal systems in some cases, including severe gastrointestinal bleeding and renal insufficiency.[4] accessible and cost-effective laboratory parameters that can be used to predict the severity of the disease are needed. NLR and PLR were reported to be associated with gastrointestinal bleeding among children with recent IgA vasculitis.[12] Of note, monocyte-to-lymphocyte ratio (MLR) was suggested as a new inflammatory marker, and its clinical value has been investigated in patients with cancer,[13] cirrhosis[14] and retinopathy.[15] few studies have investigated the relationship between MLR and severity of IgA vasculitis in children
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