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Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio as potential makers for digital ulcers and interstitial lung disease in patients with systemic sclerosis: cross-sectional analysis of data from a prospective cohort study

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Abstract

In this study, we aimed to investigate the association of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) with clinical manifestations in patients with systemic sclerosis (SSc). We conducted a cross-sectional analysis of data collected from a cohort study of 114 female patients with SSc and of 304 age-matched, healthy, female controls recruited from a tertiary rheumatology center. Patients with digital ulcers (DU) included those with either active or healed ulcers. Interstitial lung disease (ILD) was diagnosed on detection of diffuse ground-glass opacity or pulmonary fibrosis on chest X-ray or on high-resolution computed tomography. Patients with SSc had significantly higher PLR and NLR than ealthy controls. Of 114 patients with SSc, 35 (30.7%) and 54 (47.4%) patients had DU (active: 12, healed: 23) and ILD, respectively. PLR and NLR in SSc patients with concurrent DU or ILD were significantly higher than that in those without these respective complications. The PLR (OR = 1.008, 95% CI 1.002–1.015), but not the NLR, was independently associated with the presence of DU in SSc patients, based on multivariable logistic regression models. Additionally, both PLR (OR = 1.008, 95% CI 1.001–1.014) and NLR (OR = 1.515, 95% CI 1.066–2.155) correlated independently with the presence of ILD. However, both the PLR and NLR showed no significant association with the modified Rodnan skin score, pulmonary arterial hypertension, and gastrointestinal involvement. Our results suggest that PLR and NLR could be considered as potential biomarkers of DU and ILD, in patients with SSc.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-Ro, Seo-Gu, Busan, 49241, South Korea

    Aran Kim & Seung-Geun Lee

  2. Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea

    Aran Kim & Seung-Geun Lee

  3. Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea

    Yunkyung Kim & Geun-Tae Kim

  4. Division of Rheumatology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea

    Eunyoung Ahn & Min Wook So

  5. Department of Microbiology and Immunology, Pusan National University School of Medicine, Yangsan, South Korea

    Dong Hyun Sohn

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  1. Aran Kim
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Contributions

AK: study design, data collection and analysis and writing manuscript, YKK: data interpretation, GTK: data interpretation and revision of manuscript, MWS: data interpretation and revision of manuscript, EA: data interpretation, DHS: data interpretation and revision of manuscript, SGL: study design, data analysis and interpretation, writing manuscript and coordination of entire study. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Seung-Geun Lee.

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The authors have declared no conflicts of interest.

Ethical approval

All procedure of the current study was approved by the Research and Ethical Review Board of the Pusan National University Hospital (IRB no. 1906-021-080 and approval date 2019-06-19) and was conducted in accordance with the principles within the Declaration of Helsinki.

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Written informed consent was obtained from all enrolled study participants.

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296_2020_4604_MOESM1_ESM.tif

Supplementary figure 1. Correlations of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio values with modified Rodnan skin score (A and B), C-reactive proteins (C and D) and erythrocyte sedimentation rate (E and F) in patients with systemic sclerosis (TIF 924 kb)

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Kim, A., Kim, Y., Kim, GT. et al. Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio as potential makers for digital ulcers and interstitial lung disease in patients with systemic sclerosis: cross-sectional analysis of data from a prospective cohort study. Rheumatol Int 40, 1071–1079 (2020). https://doi.org/10.1007/s00296-020-04604-6

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