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Could systemic immune inflammation index be a new parameter for diagnosis and disease activity assessment in systemic lupus erythematosus?

  • Nephrology - Original Paper
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Abstract

Purpose

Systemic immune inflammation index (SII) has been used as a marker of inflammatory status in various diseases, but its role in systemic lupus erythematosus (SLE) is unknown. We aimed to investigate the role of SII in SLE and its association with disease activity and renal involvement.

Methods

In this retrospective study, 76 patients with SLE were compared with 76 age- and gender-matched healthy control group in terms of SII, neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR). SLE Disease Activity Index 2000 system (SLEDAI-2 K) was used to divide the SLE patients into an inactive group (SLEDAI-2 K < 9) and an active group (SLEDAI-2 K ≥ 9). Correlations between the ratios and both disease activity and renal involvement were analyzed.

Results

SLE patients had a higher level of SII compared with controls. The ability of SII in predicting SLE (AUC = 0.626) was lower than NLR (AUC = 0.723) and PLR (AUC = 0.666). SII was positively correlated with C-reactive protein (r = 0.288. p = 0.01), but no association between SII and SLEDAI-2 K scores was found. Significantly higher values of NLR, but not SII, were detected in patients with nephritis (p = 0.04). The best NLR cut-off value to predict SLE patients with nephritis was 2.32, with 78.5% sensitivity and 56.2% specificity.

Conclusion

For the first, we demonstrated that SII level was elevated in patients with SLE. However, NLR is a better marker than SII in predicting SLE and could serve as an indicator of nephritis. Larger-scale studies should be carried out to confirm our results.

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References

  1. Jeleniewicz R, Suszek D, Majdan M (2015) Clinical picture of late-onset systemic lupus erythematosus in a group of Polish patients. Pol Arch Med Wewn 125(78):538–544. https://doi.org/10.20452/pamw.2963

    Article  Google Scholar 

  2. Bertsias GK, Tektonidou M, Amoura Z, Aringer M, Bajema I, Berden JH, Boletis J et al (2012) European league against rheumatism and european renal association-european dialysis and transplant association. joint european league against rheumatism and european renal association-european dialysis and transplant association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis 71(11):1771–1782. https://doi.org/10.1136/annrheumdis-2012-201940

    Article  CAS  Google Scholar 

  3. Mikdashi J, Nived O (2015) Measuring disease activity in adults with systemic lupus erythematosus: the challenges of administrative burden and responsiveness to patient concerns in clinical research. Arthritis Res Ther 17(1):183. https://doi.org/10.1186/s13075-015-0702-6

    Article  Google Scholar 

  4. Haitao Y, Lili J, Liqiong Y, Chao G, Xinwen H, Ruiqi L, Na S (2018) Predictive value of the neutrophil-to-lymphocyte ratio and hemoglobin in systemic lupus erythematosus. Exp Ther Med 16(2):1547–1553. https://doi.org/10.3892/etm.2018.6309

    Article  CAS  Google Scholar 

  5. Qin B, Ma N, Tang Q, Wei T, Yang M, Fu H, Hu Z et al (2016) Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol 26(3):372–376. https://doi.org/10.3109/14397595.2015.1091136

    Article  Google Scholar 

  6. Wu Y, Chen Y, Yang X, Chen L, Yang Y (2016) Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol 36:94–99. https://doi.org/10.1016/j.intimp.2016.04.006

    Article  CAS  Google Scholar 

  7. Liu P, Li P, Peng Z, Xiang Y, Xia C, Wu J, Yang B et al (2020) Predictive value of the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-neutrophil ratio, and neutrophil-to-monocyte ratio in lupus nephritis. Lupus 29(9):1031–1039. https://doi.org/10.1177/0961203320929753

    Article  CAS  Google Scholar 

  8. He H, Guo W, Song P, Liu L, Zhang G, Wang Y, Qiu B et al (2020) Preoperative systemic immune-inflammation index and prognostic nutritional index predict prognosis of patients with pulmonary neuroendocrine tumors after surgical resection. Ann Transl Med 8(10):630. https://doi.org/10.21037/atm-19-4476

    Article  CAS  Google Scholar 

  9. Hu X, Shao YX, Yang ZQ, Dou WC, Xiong SC, Li X (2020) Preoperative systemic immune-inflammation index predicts prognosis of patients with non-metastatic renal cell carcinoma: a propensity score-matched analysis. Cancer Cell Int 20:222. https://doi.org/10.1186/s12935-020-01320-w

    Article  CAS  Google Scholar 

  10. Hua X, Long ZQ, Zhang YL, Wen W, Guo L, Xia W, Zhang WW et al (2020) Prognostic valuethe of preoperative systemic immune-inflammation index in breast cancer: a propensity score-matching study. Front Oncol 10:580. https://doi.org/10.3389/fonc.2020.00580

    Article  Google Scholar 

  11. Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, Lin SJ et al (2020) Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest 50(5):e13230. https://doi.org/10.1111/eci.13230

    Article  CAS  Google Scholar 

  12. Hou D, Wang C, Luo Y, Ye X, Han X, Feng Y, Zhong P et al (2020) Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci 131(12):1203–1208. https://doi.org/10.1080/00207454.2020.1784166

    Article  CAS  Google Scholar 

  13. Tanacan A, Uyanik E, Unal C, Beksac MS (2020) A cut-off value for systemic immune-inflammation index in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes. J Obstet Gynaecol Res 46(8):1333–1341. https://doi.org/10.1111/jog.14320

    Article  CAS  Google Scholar 

  14. Kim JW, Jung JY, Suh CH, Kim HA (2021) Systemic immune-inflammation index combined with ferritin can serve as a reliable assessment score for adult-onset still’s disease. Clin Rheumatol 40:661–668. https://doi.org/10.1007/s10067-020-05266-2

    Article  Google Scholar 

  15. Tanacan E, Dincer D, Erdogan FG, Gurler A (2021) A cutoff value for the systemic immune-inflammation index in determining activity of Behçet disease. Clin Exp Dermatol 46(2):286–291. https://doi.org/10.1111/ced.14432

    Article  CAS  Google Scholar 

  16. Kim Y, Choi H, Jung SM, Song JJ, Park YB, Lee SW (2019) Systemic immune-inflammation index could estimate the cross-sectional high activity and the poor outcomes in immunosuppressive drug-naïve patients with antineutrophil cytoplasmic antibody-associated vasculitis. Nephrology (Carlton) 24(7):711–717. https://doi.org/10.1111/nep.13491

    Article  CAS  Google Scholar 

  17. Weening JJ, D’agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE et al (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 65(2):521–530. https://doi.org/10.1111/j.1523-1755.2004.00443.x

    Article  Google Scholar 

  18. Austin HA, Boumpas DT, Vaughan EM, Austin HA, Boumpas DT, Vaughan EM (1994) Predicting renal outcomes in severe lupus nephritis: contributions of clinical and histologic data. Kidney Int 45(2):544–550. https://doi.org/10.1038/ki.1994.70

    Article  Google Scholar 

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Acknowledgements

We would like to thank Emire Bor, EMPIAR Statistic, for performing statistical analysis of the study.

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Authors and Affiliations

  1. Department of Nephrology, University of Health Sciences, Bakirkoy Dr.Sadi Konuk, Education and Research Hospital, Zuhuratbaba, Tevfik Saglam Cad. No:11, Bakirkoy, 34147, Istanbul, Turkey

    Arzu Ozdemir, Erdem Baran & Murvet Yılmaz

  2. Department of Rheumatology, University of Health Sciences, Bakirkoy Dr.Sadi Konuk, Education and Research Hospital, Zuhuratbaba, Tevfik Saglam Cad. No:11, Bakirkoy, 34147, Istanbul, Turkey

    Muhammed Kutu & Selda Celik

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  1. Arzu Ozdemir
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  2. Erdem Baran
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Correspondence to Arzu Ozdemir.

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This study was not supported by any third party and the work was made pro bono. Each author read the manuscript and agree with this submission. The authors declare that there is no conflict of interest with regard to the publication of this paper.

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Ozdemir, A., Baran, E., Kutu, M. et al. Could systemic immune inflammation index be a new parameter for diagnosis and disease activity assessment in systemic lupus erythematosus?. Int Urol Nephrol 55, 211–216 (2023). https://doi.org/10.1007/s11255-022-03320-3

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  • DOI: https://doi.org/10.1007/s11255-022-03320-3

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