Neutrophil‐to‐lymphocyte ratio: a biomarker for predicting systemic involvement in adult IgA vasculitis patients

Abstract

Background IgA vasculitis (IgAV) is a small‐vessel leucocytoclastic cutaneous vasculitis, often associated with kidney and gastrointestinal (GI) manifestations. Although predictive factors for systemic involvement have been extensively studied in children, there is paucity in the literature regarding adult patients. Neutrophil‐to‐lymphocyte ratio (NLR) is an inflammatory marker, used to assess systemic inflammation in various diseases. Objective We sought to evaluate whether NLR can be used for predicting renal and GI involvement in adult IgA vasculitis patients. Methods This was a retrospective review of adult patients who were diagnosed with IgAV at our institution between 2004 and 2016. Results A total of 40 patients met our inclusion criteria. Half of the enrolled patients had clinical symptoms suggestive of systemic involvement, of which 6 (15%) had only renal, 3 (7.5%) had only GI and 11 (27.5%) had both renal and GI involvement. Pretreatment NLR was significantly associated with renal and/or GI manifestations of the disease (P < 0.001). The optimal cut‐off value of NLR, for predicting systemic involvement was 3.34, with a specificity of 95% and a sensitivity of 85%. In addition, pretreatment NLR was also found to be significantly correlated with the severity of the systemic manifestations of IgAV (P = 0.022). Conclusion This study suggests that NLR is a potential indicator for prognosticating systemic involvement in adult IgAV.

Insight into inflammatory cell and cytokine profiles in adult IgA vasculitis

“…Taken together, and to the best of our knowledge, this is the first study to date to determine both, serological and cellular markers in histologically-proven adult treatment-naïve IgAV. We confirmed the association of the NLR with GIT involvement [38][39][40][41] that could be a viable marker in the future. Neutrophils and their surface molecules (CD62L and CD11b), in the presence of low-medium grade inflammation, may all contribute to the vicious cycle of IgAV pathogenesis.…”

Analysis of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and mean platelet volume to platelet count ratio in children with acute stage of immunoglobulin A vasculitis and assessment of their suitability for predicting the course of the disease

“…In our study group, all patients with renal involvement also presented features of GT bleeding; therefore, it was impossible to assess the above ratios in children with only renal involvement. Ozturk and Ekinci (2 patients with only renal involvement) [44] and Nagy et al (6 patients with only renal involvement) [48] suggest that IgAV should be considered as systemic involvement or extracutaneous involvement as a determinant of a severe course of the disease. In the group we studied, we additionally applied an objective scale of disease severity, including joint, renal and GT symptoms (Table 1) [16][17][18].…”

Serologic and Histologic Predictors of Long-Term Renal Outcome in Biopsy-Confirmed IgA Nephropathy (Haas Classification): An Observational Study

“…Baseline NLR may have a predictive value for renal prognosis in both granulomatosis with polyangiitis [28] and lupus nephritis [29]. NLR is also a potential indicator for prognosticating systemic involvement in adult IgA vasculitis (formerly Henoch–Schonlein purpura) [30,31] with the strongest diagnostic value [30]. Kar et al cited that disordered neutrophil activation could be relevant to the pathogenesis of IgAN due to the increased expression of complement 3 receptors on neutrophils from patients with IgAN [32].…”