Abstract
Psoriasis is a chronic, inflammatory skin disorder characterized by well-demarcated erythematous lesions with surface scaling. The disease is underpinned by a dysregulated immune response with a shift in the balance of neutrophils, lymphocytes and platelets. We sought to evaluate the novel systemic inflammatory markers, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as psoriatic indicators. Pubmed, Web of Science and Scopus were systematically searched for relevant studies. Twenty-four studies consisting of a total of 2,275 psoriatic patients (1,301 males and 974 females) and 2,334 healthy controls (1,401 males and 933 females) were identified for inclusion in the quantitative analysis. The NLR and PLR were found to be significantly increased in psoriatic patients [standardized mean difference (SMD) = 0.68, 95% CI 0.56–0.80, p < 0.01, and SMD = 0.37, 95% CI 0.14–0.60, p < 0.01, respectively]. However, no association between the NLR and PLR with psoriasis severity was detected (p = 0.93, and p = 0.83, respectively). In conclusion, the NLR and PLR are simple and cost-effective markers of psoriatic presence, but their value as severity markers requires further study.
Similar content being viewed by others
Data availability
The data for this article will be shared upon reasonable request to the corresponding author.
References
Dopytalska K, Sobolewski P, Błaszczak A, Szymańska E, Walecka I (2018) Psoriasis in special localizations. Reumatologia 56(6):392–398. https://doi.org/10.5114/reum.2018.80718
Hao Y et al (2021) Metabolic syndrome and psoriasis: mechanisms and future directions. Front Immunol. https://doi.org/10.3389/fimmu.2021.711060
Boehncke W-H, Schön MP (2015) Psoriasis. Lancet 386(9997):983–994. https://doi.org/10.1016/S0140-6736(14)61909-7
Kim WB, Jerome D, Yeung J (2017) Diagnosis and management of psoriasis. Can Fam Physician 63(4):278–285
Feldman SR, Krueger GG (2005) Psoriasis assessment tools in clinical trials. Ann Rheum Dis 64(2):ii65–ii68. https://doi.org/10.1136/ard.2004.031237
Lew-Kaya D, Lue J, Sefton J, Walker P (2004) Evaluating psoriasis severity: limitations of the PASI and advantages of the overall lesional assessment1. J Am Acad Dermatol 50(3):P153. https://doi.org/10.1016/j.jaad.2003.10.535
Papp KA et al (2021) The proposed PASI-HD provides more precise assessment of plaque psoriasis severity in anatomical regions with a low area score. Dermatol Ther (Heidelb) 11(4):1079–1083. https://doi.org/10.1007/s13555-021-00572-2
Chiang C-C, Cheng W-J, Korinek M, Lin C-Y, Hwang T-L (2019) Neutrophils in psoriasis. Front Immunol 10:2376. https://doi.org/10.3389/fimmu.2019.02376
Kagami S, Rizzo HL, Lee JJ, Koguchi Y, Blauvelt A (2010) Circulating Th17, Th22, and Th1 cells are increased in psoriasis. J Invest Dermatol 130(5):1373–1383. https://doi.org/10.1038/jid.2009.399
Hu P et al (2021) The role of helper T cells in psoriasis. Front Immunol 12:788940. https://doi.org/10.3389/fimmu.2021.788940
Guérard S, Allaeys I, Martin G, Pouliot R, Poubelle PE (2013) Psoriatic keratinocytes prime neutrophils for an overproduction of superoxide anions. Arch Dermatol Res 305(10):879–889. https://doi.org/10.1007/s00403-013-1404-z
Zeb A et al (2019) The role of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as markers of disease activity in ankylosing spondylitis. Cureus 11(10):e6025. https://doi.org/10.7759/cureus.6025
Buonacera A, Stancanelli B, Colaci M, Malatino L (2022) Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci 23(7):3636. https://doi.org/10.3390/ijms23073636
Zahorec R (2021) Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 122(7):474–488. https://doi.org/10.4149/BLL_2021_078
Gasparyan AY, Ayvazyan L, Mukanova U, Yessirkepov M, Kitas GD (2019) The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med 39(4):345–357. https://doi.org/10.3343/alm.2019.39.4.345
Lee PY et al (2021) Neutrophil-to-lymphocyte ratio predicts development of immune-related adverse events and outcomes from immune checkpoint blockade: a case-control study. Cancers (Basel) 13(6):1308. https://doi.org/10.3390/cancers13061308
Jiang J et al (2019) The neutrophil-lymphocyte count ratio as a diagnostic marker for bacteraemia: a systematic review and meta-analysis. Am J Emerg Med 37(8):1482–1489. https://doi.org/10.1016/j.ajem.2018.10.057
Arman M, Payne H, Ponomaryov T, Brill A (2015) Role of platelets in inflammation. In: Kerrigan S, Moran N (eds) The non-thrombotic role of platelets in health and disease. IntechOpen, Rijeka, p 3
Balta S, Ozturk C (2015) The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets 26(7):680–681. https://doi.org/10.3109/09537104.2014.979340
Templeton AJ et al (2014) Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 23(7):1204–1212. https://doi.org/10.1158/1055-9965.EPI-14-0146
Paliogiannis P et al (2019) Associations between the neutrophil-to-lymphocyte and the platelet-to-lymphocyte ratios and the presence and severity of psoriasis: a systematic review and meta-analysis. Clin Exp Med 19(1):37–45. https://doi.org/10.1007/s10238-018-0538-x
Wells G et al. 2013 The Newcastle–Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta- analyses
Erek Toprak A, Ozlu E, Uzuncakmak TK, Yalcınkaya E, Sogut S, Karadag AS (2016) Neutrophil/lymphocyte ratio, serum endocan, and nesfatin-1 levels in patients with psoriasis vulgaris undergoing phototherapy treatment. Med Sci Monit Int Med J Exp Clin Res 22:1232–1237. https://doi.org/10.12659/msm.898240
Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14(1):135. https://doi.org/10.1186/1471-2288-14-135
Yorulmaz A, Hayran Y, Akpinar U, Yalcin B (2020) Systemic immune-inflammation index (SII) predicts increased severity in psoriasis and psoriatic arthritis. Curr Heal Sci J 46(4):352–357. https://doi.org/10.12865/CHSJ.46.04.05
Akbayrak A et al (2023) Evaluation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume in pediatric psoriasis patients: a descriptive study. Türkiye Klin Dermatoloji Derg 22(1):14–20
Yavuz GÖ, Yavuz İH (2019) Novel inflammatory markers in patients with psoriasis. East J Med 24(1):63–68
Bowden J, Tierney JF, Copas AJ, Burdett S (2011) Quantifying, displaying and accounting for heterogeneity in the meta-analysis of RCTs using standard and generalised Qstatistics. BMC Med Res Methodol 11(1):41. https://doi.org/10.1186/1471-2288-11-41
Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186
Duval S, Tweedie R (2000) Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463. https://doi.org/10.1111/j.0006-341x.2000.00455.x
Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61(10):991–996. https://doi.org/10.1016/j.jclinepi.2007.11.010
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101
Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54(10):1046–1055. https://doi.org/10.1016/s0895-4356(01)00377-8
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535
Ataseven A, Bilgin AU, Kurtipek GS (2014) The importance of neutrophil lymphocyte ratio in patients with psoriasis. Mater Sociomed 26(4):231–233. https://doi.org/10.5455/msm.2014.231-233
Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N (2014) Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol 33(3):223–227. https://doi.org/10.3109/15569527.2013.834498
Yildiz A et al (2014) Assessment of atrial electromechanical delay and P-wave dispersion in patients with psoriasis. Echocardiography 31(9):1071–1076. https://doi.org/10.1111/echo.12530
Yurtdaş M, Yaylali YT, Kaya Y, Ozdemir M, Ozkan I, Aladağ N (2014) Neutrophil-to-lymphocyte ratio may predict subclinical atherosclerosis in patients with psoriasis. Echocardiography 31(9):1095–1104. https://doi.org/10.1111/echo.12511
Sunbul M et al (2015) Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Heart Vessels 30(3):347–354. https://doi.org/10.1007/s00380-014-0490-y
Kim DS et al (2016) Assessments of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in Korean patients with psoriasis vulgaris and psoriatic arthritis. J Dermatol 43(3):305–310. https://doi.org/10.1111/1346-8138.13061
Çerman AA, Karabay EA, Altunay İK (2016) Evaluation of neutrophil-lymphocyte ratio and mean platelet volume in patients with psoriasis. Med Bull Sisli Etfal Hosp 50(2):137–141. https://doi.org/10.5350/SEMB.20160216020543
Demir Pektas S, Alatas E, Yilmaz N (2016) Plateletcrit is potential biomarker for presence and severity of psoriasis vulgaris. Acta Medica Mediterr. https://doi.org/10.19193/0393-6384_2016_6_164
Polat M, Bugdayci G, Kaya H, Oğuzman H (2017) Evaluation of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in Turkish patients with chronic plaque psoriasis. Acta Dermatovenerologica Alpina, Pannonica, Adriat 26(4):97–100. https://doi.org/10.15570/actaapa.2017.28
Solak B, Dikicier BS, Erdem T (2017) Impact of elevated serum uric acid levels on systemic inflammation in patients with psoriasis. Angiology 68(3):266–270. https://doi.org/10.1177/0003319716657980
Shao S et al (2019) Neutrophil exosomes enhance the skin autoinflammation in generalized pustular psoriasis via activating keratinocytes. FASEB J 33(6):6813–6828. https://doi.org/10.1096/fj.201802090RR
Hammad R, Hamdino M, El-Nasser AM (2020) Role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume in Egyptian patients with psoriasis vulgaris. Egypt J Immunol 27(1):157–168
W.-M. Wang, C. Wu, Y.-M. Gao, F. Li, X.-L. Yu, and H.-Z. Jin, “Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and other hematological parameters in psoriasis patients.,” BMC Immunol., vol. 22, no. 1, p. 64, 2021, doi: https://doi.org/10.1186/s12865-021-00454-4.
Arısoy A et al (2017) Evaluation of ventricular repolarization features with novel electrocardiographic parameters (Tp-e, Tp-e/QT) in patients with psoriasis. Anatol J Cardiol 18(6):397–401. https://doi.org/10.14744/AnatolJCardiol.2017.7901
Meng X et al (2022) RIPK1 downregulation enhances neutrophil extracellular traps in psoriasis. Postep dermatologii i Alergol 39(1):72–80. https://doi.org/10.5114/ada.2022.113803
Nguyen HT, Vo LDH, Pham NN (2023) Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory markers in psoriasis: a case-control study. Dermatol Rep 15(1):9516. https://doi.org/10.4081/dr.2022.9516
Pujani M et al (2022) Platelet parameters, neutrophil–lymphocyte ratio, platelet lymphocyte ratio, red cell distribution width: can they serve as biomarkers in evaluation of severity of psoriasis? J Appl Hematol 13(2):95–102. https://doi.org/10.4103/joah.joah_195_20
Mishra S, Kadnur M, Jartarkar SR, Keloji H, Agarwal R, Babu S (2022) Correlation between serum uric acid, C-reactive protein, and neutrophil-to-lymphocyte ratio in patients with psoriasis: a case-control study. Turkderm-Turk Arch Dermatol Venereol 56:28–33. https://doi.org/10.4274/turkderm.galenos.2021.69797
Sugimoto E et al (2023) Impact of pretreatment systemic inflammatory markers on treatment persistence with biologics and conventional systemic therapy: a retrospective study of patients with psoriasis vulgaris and psoriatic arthritis. J Clin Med 12(8):3046. https://doi.org/10.3390/jcm12083046
Arunadevi D, Raghavan V, Nott A (2022) Comparative and correlative study of hematologic parameters and selective inflammatory biomarkers in psoriasis. Int J Nutr Pharmacol Neurol Dis 12(1):34–38
Langewouters AMG, van Erp PEJ, de Jong EMGJ, van de Kerkhof PCM (2008) Lymphocyte subsets in peripheral blood of patients with moderate-to-severe versus mild plaque psoriasis. Arch Dermatol Res 300(3):107–113. https://doi.org/10.1007/s00403-007-0819-9
Özkur E, Şeremet S, Afşar FŞ, Altunay İK, Çalıkoğlu EE (2020) Platelet count and mean platelet volume in psoriasis patients. Sisli Etfal Hastan Tip Bul 54(1):58–61. https://doi.org/10.14744/SEMB.2018.69370
Herrero-Cervera A, Soehnlein O, Kenne E (2022) Neutrophils in chronic inflammatory diseases. Cell Mol Immunol 19(2):177–191. https://doi.org/10.1038/s41423-021-00832-3
Harrison CN et al (2010) Guideline for investigation and management of adults and children presenting with a thrombocytosis. Br J Haematol 149(3):352–375. https://doi.org/10.1111/j.1365-2141.2010.08122.x
Komiyama M et al (2021) Neutrophil/lymphocyte ratio is correlated with levels of inflammatory markers and is significantly reduced by smoking cessation. J Int Med Res 49(6):3000605211019223. https://doi.org/10.1177/03000605211019223
Ulich TR, del Castillo J, Keys M, Granger GA, Ni RX (1987) Kinetics and mechanisms of recombinant human interleukin 1 and tumor necrosis factor-alpha-induced changes in circulating numbers of neutrophils and lymphocytes. J Immunol 139(10):3406–3415
Ulich TR, del Castillo J, Guo KZ (1989) In vivo hematologic effects of recombinant interleukin-6 on hematopoiesis and circulating numbers of RBCs and WBCs. Blood 73(1):108–110
Jo S, Jeong T, Lee JB, Jin Y, Yoon J, Park B (2020) The prognostic value of platelet-to-lymphocyte ratio on in-hospital mortality in admitted adult traffic accident patients. PLoS ONE 15(6):e0233838. https://doi.org/10.1371/journal.pone.0233838
Parisi R, Iskandar IYK, Kontopantelis E, Augustin M, Griffiths CEM, Ashcroft DM (2020) National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study. BMJ 369:m1590. https://doi.org/10.1136/bmj.m1590
Damiani G et al (2021) The global, regional, and national burden of psoriasis: results and insights from the global burden of disease 2019 study. Front Med 8:743180. https://doi.org/10.3389/fmed.2021.743180
Acknowledgements
J.H.Y. was supported by a Medical Research Council Clinical Research Training Fellowship (MR/T028009/1).
Author information
Authors and Affiliations
Contributions
Conceptualization: JHY, YZ, KN, SY; Methodology: JHY, YZ, SY; Literature Search and Data analysis: JHY, YZ; Writing—original draft preparation: JHY; Writing—review and editing: YZ, KN, SY.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Ye, J.H., Zhang, Y., Naidoo, K. et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in psoriasis: a systematic review and meta-analysis. Arch Dermatol Res 316, 85 (2024). https://doi.org/10.1007/s00403-024-02823-6
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00403-024-02823-6