Red blood cell distribution width-to-platelet ratio as a disease activity-associated factor in systemic lupus erythematosus

Siyan Xie, Xuejie Chen, Siyan Xie, Xuejie Chen

Abstract

Background: Although different clinical and experimental parameters have been used to estimate disease activity in systemic lupus erythematosus (SLE) patients, the relationship between red blood cell distribution width-to-platelet ratio (RPR) and disease activity in SLE has not been previously illuminated. Therefore, the aim of this study was to investigate the association between RPR levels and disease activity in SLE.

Methods: This study enrolled 105 SLE patients and 105 healthy subjects. We divided the patients into 2 groups using the SLE Disease Activity Index (SLEDAI) 2000. Group 1 included patients with SLEDAI score ≤9 (mild disease activity group) and group 2 with SLEDAI >9 (severe disease activity group). Correlations between RPR and disease activity were then analyzed. A subgroup follow-up analysis of 93 patients was conducted to explore the effect of SLE-related glucocorticoid therapy.

Results: The PLR and RPR values of SLE patients were significantly higher compared with the controls (both P < .001), whereas mean platelet volume was decreased (P < .05). The RPR level was found to be positively correlated with SLEDAI (r = 0.368, P < .001) and erythrocyte sedimentation rate (r = 0.313, P = .027). According to the receiver-operating characteristic (ROC) curve, the optimal cut-off value for predicting SLE using RPR was 0.073, and the area under ROC curve was 0.817. RPR level was correlated with clinical disease activity in SLE, and its value was normalized after treatment.

Conclusion: RPR may be a useful measurement for the assessment of disease activity in SLE patients.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Comparison of PLR, RPR, and MPV in SLE patients and healthy controls. (A) PLR level was significantly increased in SLE patients. (B) RPR level was significantly increased in SLE patients. (C) MPV was decreased in SLE patients (all P < .05). MPV = mean platelet volume, PLR = platelet-to-lymphocyte ratio, RPR = red blood cell distribution width-to-platelet ratio, SLE = systemic lupus erythematosus.
Figure 2
Figure 2
Comparison of PLR, RPR, and anti-dsDNA before and after treatment. All 3 indicators of SLE were reduced after treatment (P < .05). dsDNA = antidouble-stranded antibody, PLR = platelet-to-lymphocyte ratio, RPR = red blood cell distribution width-to-platelet ratio, SLE = systemic lupus erythematosus.
Figure 3
Figure 3
Correlation between SLEDAI and RPR, MPV, anti-dsDNA, and PLT in SLE patients. Spearman correlation analysis was performed to examine the association between SLEDAI and RPR, and other laboratory parameters. (A) RPR level was positively correlated with SLEDAI score. (B) MPV was positively correlated with SLEDAI score. (C) Anti-dsDNA was positively correlated with SLEDAI score. (D) PLT was negatively correlated with SLEDAI score (all P < .05). dsDNA = antidouble-stranded antibody, MPV = mean platelet volume, RPR = red blood cell distribution width-to-platelet ratio, SLE = systemic lupus erythematosus, SLEDAI = Systemic Lupus Erythematosus Disease Activity Index.
Figure 4
Figure 4
Receiver-operating characteristic (ROC) curves of RPR for the differentiation of SLE patients from healthy controls. RPR yielded a higher AUC than either PLR and MPV. MPV = mean platelet volume, RPR = red blood cell distribution width-to-platelet ratio, SLE = systemic lupus erythematosus.

References

    1. Danchenko N, Satia JA, Anthony MS. Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden. Lupus 2006;15:308–18.
    1. Quartier P, A-M P. Systemic lupus erythematosus. Lancet 2004;23:111.
    1. Goodnow CC. Multistep pathogenesis of autoimmune disease. Cell 2007;130:25–35.
    1. Crampton SP, Morawski PA, Bolland S. Linking susceptibility genes and pathogenesis mechanisms using mouse models of systemic lupus erythematosus. Dis Models Mechanisms 2014;7:1033–46.
    1. Zivković V, Stanković A, Cvetković T, et al. Anti-dsDNA, anti-nucleosome and anti-C1q antibodies as disease activity markers in patients with systemic lupus erythematosus. Srpski Arhiv Za Celokupno Lekarstvo 2014;142:431.
    1. Tamhane UU, Aneja S, Montgomery D, et al. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008;102:653–7.
    1. Ayça B, Akin F, Çelik Ö, et al. Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention. Platelets 2014;26:638.
    1. Clarke K, Sagunarthy R, Kansal S. RDW as an additional marker in inflammatory bowel disease/undifferentiated colitis. Digest Dis Sci 2008;53:2521–3.
    1. Hu ZD, Sun Y, Guo J, et al. Red blood cell distribution width and neutrophil/lymphocyte ratio are positively correlated with disease activity in primary Sjogren's syndrome. Clin Biochem 2014;47:287–90.
    1. Safak S, Uslu AU, Serdal K, et al. Association between mean platelet volume levels and inflammation in SLE patients presented with arthritis. Afr Health Sci 2015;14:919–24.
    1. Fu H, Qin B, Hu Z, et al. Neutrophil- and platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clin Lab 2015;61:269.
    1. Oehadian A, Suryadinata H, Dewi S, et al. The role of neutrophyl lymphocyte count ratio as an inflammatory marker in systemic lupus erythematosus. Acta Med Indones 2013;45:170–4.
    1. Uslu AU, Küçük A, Şahin A, et al. Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis 2015;18:731–5.
    1. Qin B, Ma N, Tang Q, et al. 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 2016;26:372–6.
    1. Li L, Xia Y, Chen C, et al. Neutrophil-lymphocyte ratio in systemic lupus erythematosus disease: a retrospective study. Int J Clin Exp Med 2015;8:11026.
    1. Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75:291–4.
    1. Cetinkaya E, Senol K, Saylam B, et al. Red cell distribution width to platelet ratio: new and promising prognostic marker in acute pancreatitis. World J Gastroenterol 2014;20:14450–4.
    1. Taefi A, Huang CC, Kolli K, et al. Red cell distribution width to platelet ratio, a useful indicator of liver fibrosis in chronic hepatitis patients. Hepatol Int 2015;9:1–7.
    1. Chen B, Bo Y, Jian Z, et al. RDW to platelet ratio: a novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B. Plos One 2013;8:e68780.
    1. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 2010;40:1725.
    1. Gladman DD, Ibañez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol 2002;29:288–91.
    1. Guiducci C, Gong M, Xu Z, et al. TLR recognition of self nucleic acids hampers glucocorticoid activity in lupus. Nature 2010;465:937–41.
    1. Zahorec R. Ratio of neutrophil to lymphocyte counts: rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102:5–14.
    1. Ahsen A, Ulu MS, Yuksel S, et al. As a new inflammatory marker for familial mediterranean fever: neutrophil-to-lymphocyte ratio. Inflammation 2013;36:1357–62.
    1. Li MX, Liu XM, Zhang XF, et al. Prognostic role of neutrophil-to-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer 2014;134:2403–13.
    1. Huang W, Huang J, Liu Q, et al. Neutrophil–lymphocyte ratio is a reliable predictive marker for early-stage diabetic nephropathy. Clin Endocrinol 2015;82:229–33.
    1. Wu Y, Chen Y, Yang X, et al. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus. Int Immunopharmacol 2016;36:94–9.
    1. Yazici S, Yazici M, Erer B, et al. The platelet indices in patients with rheumatoid arthritis: mean platelet volume reflects disease activity. Platelets 2010;21:122–5.
    1. Gasparyan AY, Ayvazyan L, Mikhailidis DP, et al. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011;17:47–58.
    1. Yavuz S, Ece A. Mean platelet volume as an indicator of disease activity in juvenile SLE. Clin Rheumatol 2014;33:637–41.
    1. Noris P, Melazzini F, Balduini CL. New roles for mean platelet volume measurement in the clinical practice? Platelets 2016;27:607–12.
    1. Murphy G, Isenberg D. Effect of gender on clinical presentation in systemic lupus erythematosus. Rheumatology 2013;52:2108–15.
    1. Chen M, Daha MR, Kallenberg CGM. The complement system in systemic autoimmune disease. J Autoimmun 2010;34:J276–86.
    1. Swaak AJ, Aarden LA, Lw SVE, et al. Anti-dsDNA and complement profiles as prognostic guides in systemic lupus erythematosus. Arthritis Rheum 2010;22:226–35.

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