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Systemic immune-inflammation index combined with ferritin can serve as a reliable assessment score for adult-onset Still’s disease

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Abstract

Objective

The diagnosis of adult-onset Still’s disease (AOSD) is based on nonspecific symptoms and laboratory data, and several infectious, autoimmune, and malignant diseases must be ruled out. This study aimed to elucidate the value of various laboratory inflammatory scores, including the systemic immune-inflammation index (SII), C-reactive protein/albumin ratio (CAR), albumin/globulin ratio (AGR), prognostic nutritional index (PNI), and ferritin/erythrocyte sedimentation rate ratio (FER) as assessment factors for diagnosis and evaluation of disease activity in AOSD.

Methods

The medical records of patients suspected of AOSD between January 1999 and June 2019 were examined. The inflammatory scores were compared between AOSD and non-AOSD groups, and receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic utility.

Results

A total of 164 patients diagnosed with AOSD had higher values of SII, CAR, and FER, as well as lower values of AGR and PNI, than non-AOSD patients (n = 61). For an AOSD diagnosis, the area under the receiver operating characteristic curve (AUC) was 0.859 (95% confidence interval [CI], 0.806–0.911) for the SII, 0.769 (95% CI, 0.702–0.837) for the CAR, 0.749 (95% CI, 0.615–0.782) for the AGR, 0.699 (95% CI, 0.675–0.823) for the PNI, and 0.764 (95% CI, 0.693–0.834) for the FER, with optimal cut-off values of 2195.7, 1.8, 1.38, 48.8, and 17, respectively. The SII had the largest AUC and the highest specificity (91.5%). In further analysis, the AUC for the combination of SII and ferritin was 0.904 (95% CI, 0.863–0.945), with a cut-off value of 2615.4.

Conclusions

Laboratory inflammatory scores can be used as a practical tool for diagnosing AOSD. The SII and ferritin combination proved to be the most powerful assessment tool.

Key Points

• The systemic immune-inflammation index (SII), C-reactive protein/albumin ratio (CAR), ferritin/erythrocyte sedimentation rate ratio (FER), prognostic nutritional index (PNI), and albumin/globulin ratio (AGR) can be used as initial assessment scores for AOSD.

• SII combined with ferritin (AUC = 0.904; 95% CI, 0.863–0.945) appears to be the most effective and valuable assessment score for AOSD.

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Funding

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant numbers: HI14C1731 and HI16C0992).

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Authors and Affiliations

  1. Department of Rheumatology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea

    Ji-Won Kim, Ju-Yang Jung, Chang-Hee Suh & Hyoun-Ah Kim

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  1. Ji-Won Kim
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  2. Ju-Yang Jung
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  4. Hyoun-Ah Kim
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Correspondence to Hyoun-Ah Kim.

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This study was approved by the Institutional Review Board of Ajou University Hospital (AJIRB-MED-OBS-20-113).

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Kim, JW., Jung, JY., Suh, CH. et al. 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 (2021). https://doi.org/10.1007/s10067-020-05266-2

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