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Complete blood count parameters and neutrophil-to-lymphocyte ratio values as markers for differentiation between systemic infectious and non-infectious uveitis

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Abstract

Purpose

To compare complete blood count (CBC) parameters and neutrophil/lymphocyte ratio (NLR) between patients with infectious uveitis (IU) and those with non-infectious uveitis (NIU) during the first acute uveitis attack (AUA).

Methods

The records of 119 patients admitted with the first AUA between 2016 and 2019 and whose diagnosis was unknown at the time of admission were retrospectively reviewed. The patients were divided into two groups, IU and NIU according to diagnoses after ocular and systemic workup. The IU group was also divided into subgroups as uveitis associated with local ocular infections and systemic infections. The complete blood count and associated indices of patients calculated from samples taken during the attack were compared between the groups.

Results

A total of 60 NIU cases (mean age: 43.5 ± 11.6 years) and 59 IU cases (43.3 ± 14.7 years) were examined. Twenty-six of the NIU cases were female and 34 were male, while 32 of the IU cases were female and 27 were male. The localization of uveitis was similar in the IU and NIU groups (anterior: 11 vs. 18, intermediate: 3 vs. 6, posterior: 28 vs. 14, panuveitis: 17 vs. 22). The NLR values were significantly increased in patients with IU compared to those with NIU (p = 0.047). When the NLR is compared between NIU and subgroups of IU, this value was only found significantly increased in uveitis due to a systemic infection (n = 12) (p < 0.001). The mean white blood cell (WBC) count (p < 0.001) and neutrophil values (p < 0.001) were also observed significantly higher in the uveitis associated with systemic infectious diseases when compared with uveitis associated with local ocular infections and NIU group.

Conclusion

In the current study, NLR values are compared with autoimmune uveitis and systemic infectious uveitis for the first time in patients with AUA. This ratio has been found significantly higher in uveitis associated with systemic infections. The use of CBC parameters and indices, especially the NLR, may be instrumental in assessing patients presenting with first AUA, particularly when there is no clear explanation or underlying cause.

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References

  1. Groen F, Ramdas W, de Hoog J, Vingerling J, Rothová A (2016) Visual outcomes and ocular morbidity of patients with uveitis referred to a tertiary center during first year of follow-up. Eye 30(3):473–480

    Article  CAS  Google Scholar 

  2. Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C, Androudi S (2018) A focus on the epidemiology of uveitis. Ocular Immunol Inflam 26(1):2–16

    Article  Google Scholar 

  3. Miserocchi E, Fogliato G, Modorati G, Bandello F (2013) Review on the worldwide epidemiology of uveitis. Eur J Ophthalmol 23(5):705–717

    Article  Google Scholar 

  4. Forget P, Khalifa C, Defour J-P, Latinne D, Van Pel M-C, De Kock M (2017) What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes 10(1):12–12. https://doi.org/10.1186/s13104-016-2335-5

    Article  PubMed  PubMed Central  Google Scholar 

  5. Liu CC, Ko HJ, Liu WS, Hung CL, Hu KC, Yu LY, Shih SC (2019) Neutrophil-to-lymphocyte ratio as a predictive marker of metabolic syndrome. Medicine (Baltimore) 98(43):e17537. https://doi.org/10.1097/md.0000000000017537

    Article  CAS  Google Scholar 

  6. Chen G, Zhu L, Yang Y, Long Y, Li X, Wang Y (2018) Prognostic role of neutrophil to lymphocyte ratio in ovarian cancer: a meta-analysis. Technol Cancer Res Treat 17:1533033818791500. https://doi.org/10.1177/1533033818791500

    Article  PubMed  PubMed Central  Google Scholar 

  7. Karagoz I, Yoldas H (2019) Platelet to lymphocyte and neutrophil to lymphocyte ratios as strong predictors of mortality in intensive care population. Revista da Associação Médica Brasileira 65:633–636

    Article  Google Scholar 

  8. Guo J, Chen S, Chen Y, Li S, Xu D (2018) Combination of CRP and NLR: a better predictor of postoperative survival in patients with gastric cancer. Cancer Manag Res 10:315–321. https://doi.org/10.2147/CMAR.S156071

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Moosazadeh M, Maleki I, Alizadeh-Navaei R, Kheradmand M, Hedayatizadeh-Omran A, Shamshirian A, Barzegar A (2019) Normal values of neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio among Iranian population: results of Tabari cohort. Caspian J Intern Med 10(3):320–325. https://doi.org/10.22088/cjim.10.3.320

    Article  PubMed  PubMed Central  Google Scholar 

  10. Li J, Chen Q, Luo X, Hong J, Pan K, Lin X, Liu X, Zhou L, Wang H, Xu Y, Li H, Duan C (2015) Neutrophil-to-lymphocyte ratio positively correlates to age in healthy population. J Clin Lab Anal 29(6):437–443. https://doi.org/10.1002/jcla.21791

    Article  CAS  PubMed  Google Scholar 

  11. Afari ME, Bhat T (2016) Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update. Expert Rev Cardiovasc Therapy 14(5):573–577

    Article  CAS  Google Scholar 

  12. Li MX, Liu XM, Zhang XF, Zhang JF, Wang WL, Zhu Y, Dong J, Cheng JW, Liu ZW, Ma L (2014) Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer 134(10):2403–2413

    Article  CAS  Google Scholar 

  13. Karaca EE, Özmen MC, Ekici F, Yüksel E, Türkoglu Z (2014) Neutrophil-to-lymphocyte ratio may predict progression in patients with keratoconus. Cornea 33(11):1168–1173

    Article  Google Scholar 

  14. Dursun A, Ozturk S, Yucel H, Ozec AV, Dursun FG, Toker MI, Erdoğan H, Arici MK, Topalkara A (2015) Association of neutrophil/lymphocyte ratio and retinal vein occlusion. Eur J Ophthalmol 25(4):343–346

    Article  Google Scholar 

  15. Avci A, Avci D, Erden F, Ragip E, Cetinkaya A, Ozyurt K, Atasoy M (2017) Can we use the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume values for the diagnosis of anterior uveitis in patients with Behcet’s disease? Ther Clin Risk Manag 13:881–886. https://doi.org/10.2147/TCRM.S135260

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Ozgonul C, Sertoglu E, Ayyildiz O, Mumcuoglu T, Kucukevcilioglu M, Gokce G, Durukan AH (2017) Novel biomarkers for patients with idiopathic acute anterior uveitis: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. Int J Ophthalmol 10(2):262–266. https://doi.org/10.18240/ijo.2017.02.13

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jabs DA, Nussenblatt RB, Rosenbaum JT (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 140:509–516

    Article  Google Scholar 

  18. Verhagen C, Bruinenberg M, Rothova A, Baarsma G, Der Lelıj AV, Ooyman F, Bollemeijer J, Derhaag P, Kijlstra A (1996) Serologic and polymerase chain reaction analysis of intraocular fluids in the diagnosis of infectious uveitis. Am J Ophthalmol 121(6):650–658

    Article  Google Scholar 

  19. Rosenbaum JT (2017) New developments in uveitis associated with HLA B27. Curr Opin Rheumatol 29(4):298–303

    Article  CAS  Google Scholar 

  20. Holland GN (1994) Standard diagnostic criteria for the acute retinal necrosis syndrome. Am J Ophthalmol 117(5):663–666

    Article  CAS  Google Scholar 

  21. Hamade IH, Tabbara KF (2010) Complications of presumed ocular tuberculosis. Acta Ophthalmol 88(8):905–909

    Article  Google Scholar 

  22. Herbort CP, Rao NA, Mochizuki M, Sarcoidosis tmotSCotFIWoO (2009) International criteria for the diagnosis of ocular sarcoidosis: results of the first international workshop on ocular sarcoidosis (IWOS). Ocular Immunol Inflam 17(3):160–169

    Article  CAS  Google Scholar 

  23. Silman A (1990) Criteria for diagnosis of behcets-disease. Lancet 335(8697):1078–1080

    Google Scholar 

  24. Smith RE, Nozik RA (1989) Uveitis: a clinical approach to diagnosis and management. Williams & Wilkins, Philadelphia

    Google Scholar 

  25. Kurtul BE, Ozer PA (2019) Neutrophil-to-lymphocyte ratio in ocular diseases: a systematic review. Int J Ophthalmol 12(12):1951–1958. https://doi.org/10.18240/ijo.2019.12.18

    Article  PubMed  PubMed Central  Google Scholar 

  26. Loonen AJ, de Jager CP, Tosserams J, Kusters R, Hilbink M, Wever PC, van den Brule AJ (2014) Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PLoS One 27(1):e87315

    Article  Google Scholar 

  27. Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H (2017) Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection 45(3):299–307

    Article  CAS  Google Scholar 

  28. Sutherland JS, Jeffries DJ, Donkor S, Walther B, Hill PC, Adetifa IM, Adegbola RA, Ota MO (2009) High granulocyte/lymphocyte ratio and paucity of NKT cells defines TB disease in a TB-endemic setting. Tuberculosis 89(6):398–404

    Article  CAS  Google Scholar 

  29. Broca-Garcia BE, Saavedra MA, Martínez-Bencomo MA, Montes-Cortes DH, Jara LJ, Medina G, Vera-Lastra O, Cruz-Dominguez MP (2019) Utility of neutrophil-to-lymphocyte ratio plus C-reactive protein for infection in systemic lupus erythematosus. Lupus 28(2):217–222. https://doi.org/10.1177/0961203318821176

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors alone are responsible for the content and writing of the paper.

Funding

The authors declared that this study received no financial support.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Tıbbiye Cad. No: 40, 34668, Üsküdar, Istanbul, Turkey

    Sevcan Yildiz Balci & Ece Turan-Vural

  2. Department of Ophthalmology, Istanbul Medeniyet University School of Medicine, 34730, Istanbul, Turkey

    Ozlem Turkyilmaz & Fehim Esen

  3. Department of Medical Microbiology, Haydarpasa Numune Training and Research Hospital, Tıbbiye Cad. No: 40, 34668, Üsküdar, Istanbul, Turkey

    Sebahat Aksaray

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  1. Sevcan Yildiz Balci
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  2. Ece Turan-Vural
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Contributions

SYB and ETV were involved in the design and conduct of the study; SYB and ETV helped in the preparation and review of the study; SYB, ETV, OT, FE and SA contributed to data collection. All authors contributed to the text and provided critical feedback.

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Correspondence to Sevcan Yildiz Balci.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Yildiz Balci, S., Turan-Vural, E., Turkyilmaz, O. et al. Complete blood count parameters and neutrophil-to-lymphocyte ratio values as markers for differentiation between systemic infectious and non-infectious uveitis. Int Ophthalmol 40, 3033–3041 (2020). https://doi.org/10.1007/s10792-020-01487-1

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