Clinical relevance of neutrophil-to-lymphocyte ratio and mean platelet volume in pediatric Henoch–Schonlein Purpura: a meta-analysis

Abstract

The association of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) with the severe gastrointestinal (GI) involvement in pediatric Henoch-Schonlein Purpura (HSP) has been reported in many studies. However, the conclusions from the previous studies were controversial. Therefore, for the first time, we performed a meta-analysis to systematically evaluate the relationship of NLR and MPV to the severe GI involvements. We retrieved PubMed, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) (up to October 2020) thoroughly to acquire eligible studies. The pooled standard mean difference (SMD) with 95% confidence interval (CI) was used to describe the correlation of NLR and MPV with the severe GI involvement. A total of 1 2 studies comprising 2168 patients with HSP were included in this meta-analysis. Our combined analysis showed that NLR in HSP patients with the severe GI involvement was significantly higher than that in those without the severe GI involvement (SMD = 1.37; 95% CI: 0.70-2.05; p < 0.01). In addition, a lower MPV was observed in children with severe GI involvement (SMD = −0.29; 95% CI: −0.56 -−0.01, p = 0.042). Our sensitivity analysis and publication bias evaluation indicated that our combined results were reliable. Taken together, our study suggested NLR and MPV may be used as biomarkers for predicting or diagnosing the severe GI involvement in children with HSP. Nevertheless, more homogeneous studies with a larger sample size are required to validate these findings.

Age‐ and sex‐specific pediatric reference intervals for neutrophil‐to‐lymphocyte ratio, lymphocyte‐to‐monocyte ratio, and platelet‐to‐lymphocyte ratio

“…In the study of Kim et al, higher NLR was associated with increased risk of renal impairment or gastrointestinal involvement due to HSP. 17,18 In our dataset, NLR was a weak parameter to predict HSP in general. However, we were only able to evaluate whether patients with HSP showed increased values, we did not investigate whether there was a higher incidence of renal involvement.…”

Inflammatory skin diseases and wounds

“…The extent of therapy is individually adapted on the severity and sites of manifestation. Thus, in an uncomplicated course of immunoglobulin (Ig)A vasculitis, symptomatic supportive treatment and the administration of analgesics for pain relief may be sufficient 21 . Evidence‐based recommendations for the systemic treatment of patients with vasculitis are very limited (Table 8).…”

“…Thus, in an uncomplicated course of immunoglobulin (Ig)A vasculitis, symptomatic supportive treatment and the administration of analgesics for pain relief may be sufficient. 21 Evidence-based recommendations for the systemic treatment of patients with vasculitis are very limited (Table 8). The supportive efficacy of highly potent topical glucocorticoids in vasculitic ulcers is recommended based on empirically supported expert experience.…”

Immunological Features of Children with Gastrointestinal Bleeding Due to Henoch-Schönlein Purpura

“…[12][13][14] Some studies have indicated that elevated blood NLR and decreased MPV can be good predictors of HSP in patients with symptoms of gastrointestinal involvement. 15,16 Skin rash and elevated D-dimer levels may also cause GI bleeding. Considering the importance of the immune response in HSP, we hypothesized that immune function abnormalities may cause gastrointestinal bleeding in children with HSP.…”