Relationship between Neutrophil-lymphocyte, Platelet-lymphocyte Ratio and Rheumatoid Arthritis Activity

Sung Jun Kim; Ji Hyun Lee; Seong Man Kim; Min Gi Park; Su Ho Park; Dong Kyu Kim; Ji Yeon Hwang; Joon Sul Choi; Suk Ki Park

doi:10.4078/jrd.2016.23.2.96

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Kim, Lee, Kim, Park, Park, Kim, Hwang, Choi, and Park: Relationship between Neutrophil-lymphocyte, Platelet-lymphocyte Ratio and Rheumatoid Arthritis Activity

Original Article

J Rheum Dis 2016;23(2):96-100.

Published online: 31 October 2016

DOI: https://doi.org/10.4078/jrd.2016.23.2.96

Relationship between Neutrophil-lymphocyte, Platelet-lymphocyte Ratio and Rheumatoid Arthritis Activity

Sung Jun Kim¹, Ji Hyun Lee¹, Seong Man Kim², Min Gi Park¹, Su Ho Park¹, Dong Kyu Kim¹, Ji Yeon Hwang¹, Joon Sul Choi¹, Suk Ki Park¹

¹Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea

²Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea

Corresponding to: Ji Hyun Lee, Division of Rheumatology, Department of Internal Medicine, Maryknoll Medical Center, 121 Junggu-ro, Jung-gu, Busan 48972, Korea. E-mail: ete@lycos.co.kr

Received 14 July 2015 Revised 18 August 2015 Revised 1 September 2015 Revised 15 September 2015 Accepted 15 September 2015

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Although previous trials suggested a relationship between neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic inflammatory response, clinical utility of NLR and PLR in rheumatoid arthritis (RA) is not well defined. This study was conducted to assess the efficiency of NLR and PLR as an inflammatory index in patients with RA.

Methods

A total of 107 patients with newly diagnosed RA who had never used steroid and a control group of 50 age- and gender-matched healthy subjects whose high sensitive C-reactive protein (hsCRP) was within normal range were included. Those with cerebrovascular diseases, diabetes, malignancies, or any cardiovascular diseases were excluded from both groups. The patients were divided into two groups according to the Disease Activity Score of 28 joints (DAS28). Group 1 included patients with a DAS28 score of 3.2 and lower (low disease activity) and group 2 included patients with a score higher than 3.2 (moderate to high disease activity).

Results

NLR and PLR in the patient group were 2.99±2.04, 170.90±86.49, significantly higher than that of the control group. NLR and PLR in group 2 were 4.16±2.50, 225.23±93.21, significantly higher than those of group 1 patients (2.26±1.22, 137.15±61.92). NLR and PLR both showed correlation with rheumatoid factor, hsCRP, serum albumin, Korean Heath Assesment Questionnaire, and DAS28.

Conclusion

These data showed a positive correlation between NLR or PLR level and RA disease activity, suggesting that NLR or PLR can be used as an additional inflammatory marker in patients with RA.

Keywords: Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Rheumatoid arthritis, Inflammatory markers

REFERENCES

1. Amos RS, Constable TJ, Crockson RA, Crockson AP, McConkey B. Rheumatoid arthritis: relation of serum C-reactive protein and erythrocyte sedimentation rates to radiographic changes. Br Med J. 1977; 1:195–7.

2. Margolis KL, Manson JE, Greenland P, Rodabough RJ, Bray PF, Safford M, et al. Women's Health Initiative Research Group. Leukocyte count as a predictor of cardiovascular events and mortality in postmenopausal women: the Women's Health Initiative Observational Study. Arch Intern Med. 2005; 165:500–8.

3. Grau AJ, Boddy AW, Dukovic DA, Buggle F, Lichy C, Brandt T, et al. CAPRIE Investigators. Leukocyte count as an independent predictor of recurrent ischemic events. Stroke. 2004; 35:1147–52.

4. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008; 102:653–7.

5. Park JK, Oh HG, Park TH. Neutrophil to lymphocyte ratio at admission: prognostic factor in patients with acute ischemic stroke. J Korean Neurol Assoc. 2010; 28:172–8.

6. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Intermountain Heart Collaborative Study Group. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005; 45:1638–43.

7. Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One. 2013; 8:e67688.

8. Kwon HC, Kim SH, Oh SY, Lee S, Lee JH, Choi HJ, et al. Clinical significance of preoperative neutrophil-lymphocyte versus platelet-lymphocyte ratio in patients with operable colorectal cancer. Biomarkers. 2012; 17:216–22.

9. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010; 62:2569–81.

10. Bruce B, Fries JF. The Stanford Health Assessment Questionnaire: dimensions and practical applications. Health Qual Life Outcomes. 2003; 1:20.

11. Prevoo ML, van't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995; 38:44–8.

12. Turak O, Özcan F, Işleyen A, Başar FN, Gül M, Yilmaz S, et al. Usefulness of neutrophil-to-lymphocyte ratio to predict in-hospital outcomes in infective endocarditis. Can J Cardiol. 2013; 29:1672–8.

13. Choi WJ. A review of WBC count and neutrophil/lymphocyte ratio in patients with acute appendicitis. J Korean Soc Coloproctol. 2000; 16:456–61.

14. Lopez Hänninen E, Kirchner H, Atzpodien J. Interleukin-2 based home therapy of metastatic renal cell carcinoma: risks and benefits in 215 consecutive single institution patients. J Urol. 1996; 155:19–25.

15. Han SW, Kang SY, Kim SK, Youn HJ, Jung SH. Clinical significance of blood neutrophil-to-lymphocyte ratio in patients with papillary thyroid carcinoma. Korean J Endocr Surg. 2014; 14:184–9.

16. Jilma B, Blann A, Pernerstorfer T, Stohlawetz P, Eichler HG, Vondrovec B, et al. Regulation of adhesion molecules during human endotoxemia. No acute effects of aspirin. Am J Respir Crit Care Med. 1999; 159:857–63.

17. Prentice RL, Szatrowski TP, Fujikura T, Kato H, Mason MW, Hamilton HH. Leukocyte counts and coronary heart disease in a Japanese cohort. Am J Epidemiol. 1982; 116:496–509.

18. Olivares R, Ducimetière P, Claude JR. Monocyte count: a risk factor for coronary heart disease? Am J Epidemiol. 1993; 137:49–53.

19. Sweetnam PM, Thomas HF, Yarnell JW, Baker IA, Elwood PC. Total and differential leukocyte counts as predictors of ischemic heart disease: the Caerphilly and Speedwell studies. Am J Epidemiol. 1997; 145:416–21.

20. Shim WS, Kim HJ, Kang ES, Ahn CW, Lim SK, Lee HC, et al. The association of total and differential white blood cell count with metabolic syndrome in type 2 diabetic patients. Diabetes Res Clin Pract. 2006; 73:284–91.

21. Uslu AU, Küçük A, Şahin A, Ugan Y, Yılmaz R, Güngör T, et al. Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis. 2015; 18:731–5.

22. Fu H, Qin B, Hu Z, Ma N, Yang M, Wei T, et al. Neutrophil- and platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clin Lab. 2015; 61:269–73.

Table 1.

Subjects' characteristics

Characteristic	RA patients (n=107)	Controls (n=50)	p-value
Age (yr)	56.28±11.99	58.60±9.02	0.181
Sex (male)	33 (30.8)	16 (32.0)	0.884
WBC count (×10³/μ L)	7,587.85±2,630.90	5,978.00±1,548.18	＜0.001
PML (%)	63.34±10.99	52.78±9.46	＜0.001
Lymphocyte (%)	26.58±9.60	37.25±9.39	＜0.001
NLR	2.99±2.04	1.64±1.10	＜0.001
Monocyte	7.42±2.28	6.91±2.03	0.178
Eosinophil	2.11±2.36	2.53±2.14	0.285
Hemoglobin (g/dL)	12.71±1.49	13.84±1.58	＜0.001
Platelet count (×10³/μ L)	285.35±100.64	234.00±49.42	＜0.001
PLR	170.90±86.49	117.01±43.40	＜0.001
RF (IU/mL)	143.61±189.00	5.15±4.12	＜0.001
hsCRP (mmol/L)	15.94±28.00	0.29±0.23	＜0.001
Albumin (g/dL)	4.19±0.38	4.49±0.25	＜0.001

Values are presented as mean±standard deviation or number (%). hsCRP: high sensitivity C-reactive protein, NLR: neutrophil-lymphocyte ratio, PLR: platelet-lymphocyte ratio, PML: polymorphonuclear leukocyte, RA: rheumatoid arthritis, RF: rheumatoid factor, WBC: white blood cell.

Table 2.

Subjects' characteristics according to the DAS28

Characteristic	Group 1 (DAS28＜3.2)	Group 2 (DAS28≥3.2)	p-value
Age (yr)	57.94±10.57	53.61±13.70	0.088
Duration (mo)	18.20±22.98	8.80±7.82	0.003
Sex (male)	18 (27.3)	15 (36.6)	0.311
RF (IU/ mL)	112.57±165.41	193.58±214.57	0.030
hsCRP (mmol/L)	2.99±4.50	36.78±36.37	＜0.001
Albumin (g/dL)	4.29±0.28	4.03±0.45	0.001
Platelet (×10³/μ L)	242.16±91.84	354.90±69.26	＜0.001
NLR	2.26±1.22	4.16±2.50	＜0.001
PLR	137.15±61.92	225.23±93.21	＜0.001
KHAQ	1.17±0.48	2.01±0.34	＜0.001

Values are presented as mean±standard deviation or number (%). DAS28: Disease Activity Score with 28 joints, hsCRP: high sensitivity C-reactive protein, KHAQ: Korean Health Assessment Questionnaire, NLR: neutrophil-lymphocyte ratio, PLR: platelet-lymphocyte ratio, RF: rheumatoid factor.

Table 3.

Correlation coefficients between clinical parameters and NLR, PLR

Characteristic	NLR		PLR
Characteristic	r	p	r	p
Age	0.023	0.815	0.001	0.992
Duration	−0.116	0.235	−0.185	0.057
RF	0.375	＜0.001	0.380	＜0.001
hsCRP	0.419	＜0.001	0.371	＜0.001
Albumin	−0.370	＜0.001	−0.359	＜0.001
NLR	Uncalculable	Uncalculable	0.751	＜0.001
PLR	0.751	＜0.001	Uncalculable	Uncalculable
KHAQ	0.520	＜0.001	0.480	＜0.001
DAS28	0.533	＜0.001	0.486	＜0.001

DAS28: Disease Activity Score with 28 joints, hsCRP: high sensitivity C-reactive protein, KHAQ: Korean Health Assessment Questionnaire, NLR: neutrophil-lymphocyte ratio, PLR: platelet-lymphocyte ratio, RF: rheumatoid factor.

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