The association between albumin‐dNLR score and disease activity in patients with rheumatoid arthritis

Abstract

Background Recently, clinical studies have described an association between albumin and the derived neutrophil to lymphocyte ratio (dNLR) with several diseases. This study was aimed to investigate the albumin‐dNLR (ALB‐dNLR) score in rheumatoid arthritis (RA) patients and assess its relationship with clinical and laboratory parameters of RA. Methods We retrospectively enrolled 127 RA patients, 155 osteoarthritis (OA) patients, and 155 healthy controls. The ALB‐dNLR score was based on serum albumin level, neutrophil count, and white cell count. The Spearman's rank test was used to measure the correlations between ALB‐dNLR score and disease activity as well as laboratory indexes. Results The ALB‐dNLR score was significantly higher in RA patients than in OA patients (P < 0.001) and in healthy controls (P < 0.001). The proportion of higher ALB‐dNLR score has been raised along with increased disease activity (P < 0.001). The Spearman's rank test showed that ALB‐dNLR score was positively associated with DAS28 score, CRP, ESR, IgA, and platelet count. Moreover, the receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of ALB‐dNLR was 0.693 (95% CI: 0.631‐0.755), which was higher than that of albumin (AUC: 0.625, 95% CI: 0.559‐0.692) and dNLR (AUC: 0.680, 95% CI: 0.617‐0.743) alone. Conclusions The results demonstrate that the ALB‐dNLR score increased in RA patients. The ALB‐dNLR score may be a useful marker to estimate the disease activity of RA patients.

Significance of serum albumin and derived neutrophil-to-lymphocyte ratio score in assessment of disease activity in rheumatoid arthritis patients

“…Combination of albumin concentration with dNLR in one index (albumin-dNLR score) was speculated to be a valuable biomarker to reflect inflammatory status in gastric cancer [36], pancreatic cancer [37], and RA [14]. We observed a higher albumin-dNLR score in our RA patients compared to healthy subjects.…”

“…To best of our knowledge, only one retrospective study reported the association of albumin-dNLR score with disease activity parameters among their RA patients [14]. Moreover, they suggested that it can enhance the efficacy of RA diagnosis.…”

“…Serum albumin was assessed by colorimetric method (BioSystems, Barcelona, Spain), CBC was measured using Sysmex-XP300, and dNLR was calculated according to the following equation: neutrophil count/(leukocyte-neutrophil count) [10]. Albumin-dNLR score was estimated according to the principle of Chen et al [14]: score 2 was considered if the patient had both hypoalbuminemia (≤ 3.76 gm/dl) and raised dNLR (> 1.37); score 1 was considered if the patient had only one abnormality, while score 0 was given for those who did not have neither raised dNLR nor hypoalbuminemia.…”

“…Also, derived neutrophil-to-lymphocyte ratio (dNLR) is a cytological indicator that reflects the intensity of the inflammatory process in various systemic diseases such as sepsis [9], malignancy [10], multiple sclerosis [11], RA [12], and systemic vasculitis [13]. Chen et al [14]suggested that combination of albumin and dNLR in one measurement (albumin-dNLR score) can be a simple non-invasive marker that reflects both of disease activity and nutritional status in RA patients.…”

Diagnostic accuracy of different blood cells-derived indexes in rheumatoid arthritis

“…Moreover, apart from NLR and PLR, new blood-cell-derived indexes, such as the derived NLR (dNLR) [ 26 ] and the lymphocyte to monocyte ratio (LMR) [ 17 ] have gained interest in recent years, as potential diagnostic tools in RA. Conversely, no data are available about the performance of the systemic inflammation response index (SIRI) and the aggregate inflammation systemic index (AISI) in RA.…”