Validation of the neutrophil-to-lymphocyte ratio as a new simple biomarker of adult onset Still’s disease: A STROBE-Compliant prospective observational study

Abstract

This study was performed to investigate the role of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of adult onset Still disease (AOSD) and its performance to improve the sensitivity of the classifications criteria (Yamaguchi and Fautrel Classifications). We conducted a multicenter prospective nationwide case-control study in Internal medicine, Rheumatology and Infectious disease departments, to include successively patients with suspected AOSD (2 or more major criteria of Yamaguchi or Fautrel classifications). All clinical and biological features were collected in a consensual and standardized clinical assessment at baseline and during follow-up. A receiving operating characteristic (ROC) curve was used to reassess the cutoff value of NLR. After determination of the cutoff value for NLR by ROC curve, 2 composite sets (Yamaguchi classification + NLR as a major criterion and Fautrel classification + NLR as a major criterion) were performed and evaluated. One hundred sixty patients were included, 80 patients with AOSD and 60 controls with different diagnoses. Twenty patients with incomplete data were excluded. The cutoff value for NLR equals 4 (area under the curve, AUC: 0.82). The NLR was ≥ 4 in 93.7% (75/80) of AOSD patients with a sensitivity of 93.8% and specificity of 61.7%. The association of NLR as a major criterion with the classification of Yamaguchi or Fautrel improved their sensitivity, respectively for Fautrel (76.3% to 92.5%, P = .004) and Yamaguchi (78.8% to 90%, P = .05). This study validates the NLR as a good simple biomarker of AOSD with a cutoff value of 4 and high sensitivity (93.8%). The addition of NLR (NLR ≥ 4) as a major criterion to the classifications (Yamaguchi and Fautrel) improved significantly their sensitivity and accuracy.

The Independent Value of Neutrophil to Lymphocyte Ratio in Gouty Arthritis: A Narrative Review

“…16,17 In recent years, NLR has been found to predict the activity and prognosis of rheumatic diseases (including GA). [17][18][19][20][21] This review summarizes existing evidence on the relationship between NLR and GA, evaluates whether NLR can guide clinical measures, explores the potential pathophysiological mechanisms of NLR, and thereby provides a foundation for future research.…”

Diagnosing and Treating Systemic Juvenile Idiopathic Arthritis and Adult-Onset Still’s Disease as Part of the Still’s Disease Continuum

“…Recently, a study by Jung et al 69 identified that chemokine (C-C motif) ligand 2 levels in serum correlated with systemic score, leukocyte and neutrophil counts, and CRP, ferritin, lactate dehydrogenase, and albumin levels in patients with AOSD. A prospective observational study 70 validated the neutrophil-to-lymphocyte ratio (NLR) of ≥4 as a biomarker of AOSD, with a sensitivity of 93.8%. The authors observed that the addition of NLR to the Yamaguchi and Fautrel classifications as a major criterion significantly improved their sensitivity while maintaining specificity.…”

Adult-Onset Still’s Disease (AOSD): Advances in Understanding Pathophysiology, Genetics and Emerging Treatment Options

“…The increase in neutrophil count is another typical hallmark of AOSD. A recent observational study identified the neutrophil-to-lymphocyte ratio (cut-off value of ≥ 4) as a promising biomarker of AOSD with a high sensitivity, and that could replace the neutrophil percentage (≥ 80%) in the classification criteria [ 60 ]. Serum calprotectin (a heterodimer of the S100A8 and S100A9 proteins) belongs to the S100 family proteins (S100A8, A9, A12), a group of calcium-binding proteins also called calgranulines.…”