Renal arterial resistive index as a noninvasive biomarker of disease activity in lupus nephritis patients

Aim of the workTo evaluate the renal resistive index (RI) in lupus nephritis (LN) patients and to study its association with clinical features, laboratory investigations and LN pathological classes in systemic lupus erythematosus (SLE) patients.Patients and methodsThe study included 45 SLE patients and 25 matched controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into LN (renal SLEDAI ≥ 4) and no-renal activity (NRA) (renal SLEDAI = 0). Ultrasound Doppler renal examination was done to measure RI. Renal biopsies were performed in 30 LN patients.ResultsThe mean age of patients was 29.8 ± 10.1 years and disease duration 4.3 ± 3.9 years. They were 40 females and 5 males (F:M 8:1). Their SLEDAI was 10.9 ± 8.2 and renal SLEDAI was 5.2 ± 5.1. They were 30 with LN and 15 NRA SLE patients. Renal RI was significantly higher in LN patients compared to NRA SLE patients and controls (0.61 ± 0.04 vs. 0.55 ± 0.01 vs. 0.55 ± 0.02; p < 0.0001). RI significantly correlated with anti-double stranded deoxyribonucleic acid (anti-dsDNA) positivity (r = 0.33, p = 0.03), 24-hour proteins in urine (r = 0.38, p = 0.01) and negatively with creatinine clearance (r = -0.33, p = 0.03). Renal RI significantly correlated with pathological classes of renal biopsy (r = 0.65, p < 0.0001). At renal RI cut-off value 0.57 renal RI can detect renal activity with sensitivity of 83.3%, specificity of 82.5%, p < 0.0001. Renal RI ≥ 0.57 had higher activity index score compared to those with normal RI (5.7 ± 0.6 vs. 9 ± 3.3, p = 0.04). Conclusion: Renal RI was significantly increased in LN compared to NRA patients and was associated with laboratory parameters and pathological classes.     

Hematologic parameters and disease activity in patients with primary Sjögren's syndrome

Aim of the workTo evaluate hematologic parameters in patients with primary Sjögren's syndrome (PSS) and their association with disease activity.Patients and methodsSixty-five PSS patients and 65 age and sex matched control were studied. Neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), red blood cells distribution width (RDW), platelet to lymphocyte ratio (PLR) and platelet count were evaluated. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. The European league against rheumatism (EULAR) Sjögren's syndrome disease activity index (ESSDAI) was assessed.ResultsThe mean age of patients was 47.8 ± 12.1 years and disease duration 5.71 ± 1.2 years and they were 63 females and 2 males. The mean ESSDAI was 6.4 ± 7.9 (3–25). 11 had neurological involvement. 92.3% of patients received low-dose prednisolone (<10 mg/day) and hydroxychloroquine (HCQ). The mean NLR (1.83 ± 0.8), PLR (131.9 ± 32.5) and MPV (8.82 ± 1.4) in patients was significantly higher than in control (NLR 1.57 ± 0.56, PLR 109.9 ± 24.7 and MPV 7.71 ± 1.3; p = 0.036, p < 0.001 and p < 0.001 respectively). The RDW tended to be higher in patients (13 ± 1.56) compared to control (12.83 ± 1.13) (p = 0.46). There was a significant correlation between ESSDAI with NLR (r = 0.29, p = 0.02), RDW (r = 0.37, p = 0.002), ESR (r = 0.32, p = 0.01) and CRP (r = 0.33, p = 0.007) and between MPV with CRP (r = 0.27, p = 0.03) and between RDW and ESR (r = 0.36, p = 0.003).On regression analysis, NLR and RDW were significant predictors of disease activity (p = 0.01 and p = 0.02 respectively).ConclusionThe MPV, PLR and NLR, were significantly increased in PSS. NLR and RDW can be used as indicators of disease activity.     

Clinical significance of platelet-lymphocyte ratio in systemic lupus erythematosus patients: Relation to disease activity and damage

Aim of the workTo assess platelet–lymphocyte ratio (PLR) in systemic lupus erythematosus (SLE) patients and study its clinical significance, its relation to disease activity and damage.Patients and methodsThis study included 52 adult SLE patients and 50 matched control. All patients were subjected to full clinical examination, disease activity was measured by SLE disease activity index (SLEDAI), and damage was assessed by using Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI). Laboratory and immunology profiles included the complete blood count (CBC) with differential white blood cell (WBC) counts and estimation of PLR, erythrocyte sedimentation rate (ESR), liver and kidney function, alkaline phosphatase (ALP), serum calcium (Ca) and phosphorous (P), lipid profile, 24hr urinary protein, renal biopsy, anti-nuclear antibody (ANA), anti-double stranded deoxyribonucleic acid (anti-dsDNA), serum complements (C3,C4).ResultsThe mean age of SLE patients was 33.1 ± 9.2 years (20–58 years), with mean disease duration of 5.4 ± 5.02 years (0.25–20 years). The PLR was significantly higher in patients (189.9 ± 136.4; 23.9–782.9) than control (95 ± 29.9; p < 0.0001). The WBC and platelets count was comparable between patients and control (7.1 ± 1.7 x10³/mm³ and 243.4 ± 51.3 x10³/mm³; p = 0.3 and p = 0.51 respectively). The lymphocytic count was significantly lower in patient compared to control (1.9 ± 1.1 x10³/mm³ vs 2.7 ± 0.8 x10³/mm³)(p < 0.0001). PLR would significantly predict activity (p = 0.02) with a sensitivity of 94.3% and specificity of 100% at a cut-off value of 33.6. There was no association of PLR with the damage index.ConclusionPLR might be considered a valuable and un-expensive tool in assessment and prediction of SLE disease activity.     

Neutrophil to lymphocyte and platelet to lymphocyte ratios in systemic lupus erythematosus: Relation with disease activity and lupus nephritis

ObjectivesTo investigate the role of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as activity markers in systemic lupus erythematosus (SLE) without nephritis and lupus nephritis (LN) patients.Patients and methodsThis study included 60 SLE patients with LN, 60 SLE patients without renal involvement and 30 healthy controls. We analyzed correlations between NLR and PLR and both disease activity and renal affection.ResultsThe NLR of SLE patients was much higher than those of the controls. Both ratios showed significantly increased values in SLE patients with active disease. NLR and PLR were positively correlated with SLEDAI, ESR, and CRP and negatively correlated with C4. SLE patients with LN had higher levels of NLR than those without nephritis. NLR showed positive correlations with BUN, serum urea, serum creatinine and 24 h urinary protein. We found NLR to be related to anti-ds-DNA level and renal biopsy classes. While PLR was related only to anti ds-DNA. The best NLR to predict SLE active disease was 2.2 and the best PLR cut-off value was 132.9.ConclusionNLR and PLR are useful inflammatory markers to evaluate disease activity in SLE patients. Also, NLR could reflect renal involvement in SLE patients and is associated with the different classes of its histological staging.     

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

Objective: Although there have been extensive investigations on neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) in many diseases, their roles in systemic lupus erythematosus (SLE) remain unclear. The purpose of the present study was to evaluate NLR, PLR, and MPV levels in adult SLE patients and explore their clinical significance.

Methods: A retrospective study involving 154 adult SLE patients and 151 healthy controls was performed. All clinical characteristics of the SLE patients were extracted from their medical records. NLR, PLR, and MPV levels between SLE patients and healthy controls were compared, and correlations between these indexes and clinical characteristics were analyzed.

Results: Increased NLR, PLR, and MPV were observed in SLE patients. NLR was positively correlated with C-reaction protein (r?=?0.509, p?<?0.01), erythrocyte sedimentation rate (r?=?0.610, p?<?0.01), and SLE Disease Activity Index (SLEDAI) scores (r?=?0.471, p?<?0.01). PLR was positively correlated with SLEDAI scores (r?=?0.44, p?<?0.01). SLE patients with nephritis had higher NLR and PLR levels than those without nephritis (p?<?0.01, p?=?0.03). In addition, an NLR level of 2.065 was determined as predictive cut-off value of SLE (sensitivity 74.7%, specificity 77.5%, AUC?=?0.828). Multiple regression analysis suggested that NLR was independently associated with SLE disease activity.

Conclusions: NLR and PLR could reflect inflammatory response and disease activity in SLE patients.     

Clinical utility of urinary soluble CD163 in evaluation of lupus nephritis patients

Aim of the workTo assess urinary soluble CD163 (sCD136) in systemic lupus erythematosus (SLE) patients compared to healthy controls. In addition to determine its association with different SLE clinical features, laboratory investigations and pathological indices focusing on those suggest renal disease activity.Patients and methodsThe study included 58 SLE patients and 30 controls. SLE disease activity index (SLEDAI) was assessed and patients subdivided into active lupus nephritis (ALN) (renal SLEDAI ≥ 4) and no-renal activity (NRA) SLE patients (renal SLEDAI = 0). Urinary sCD163 was measured by Enzyme-Linked Immunosorbent Assay (ELISA). Urine values were normalized to urinary creatinine excretion. Renal biopsies were performed in 21 ALN patients.ResultsThey were 54 females and 4 males with a mean age 31.8 ± 9.1 years and disease duration 6.2 ± 4.8 years. They were 31 with ALN and 27 NRA SLE patients. Urinary sCD163 level was significantly higher in SLE patients (1.85 ± 0.3) than controls (0.5 ± 0.36, p < 0.001). In ALN, it was significantly higher (2.91 ± 2.52) compared to NRA SLE patients (0.64 ± 0.38) and controls (p < 0.001 in both). The optimum cut-off value above which normalized urinary sCD136 can predict renal activity was > 0.82 with sensitivity of 90.3%, specificity of 88.89%, p < 0.001. Urinary sCD163 significantly correlated with renal (r = 0.75, p < 0.001) but not with extra-renal SLEDAI. It correlated with activity index of renal biopsy (r = 0.46, p = 0.038).ConclusionUrinary sCD163 is a potential biomarker for LN activity. Its level is associated with clinical features, laboratory investigations and pathological indices that indicate renal disease activity.     

Interleukin-23 serum level in systemic lupus erythematosus patients: Relation to disease activity and different disease parameters

Aim of the workTo assess serum level of interleukin 23 (IL-23) in systemic lupus erythematosus (SLE) patients and to evaluate its association with disease parameters and activity.Patients and methodsThe study involved 40 SLE patients and 40 controls. The SLE disease activity index (SLEDAI) and damage index (SDI) were assessed. Serum level of IL-23 was measured by enzyme linked immunosorbant assay (ELISA).ResultsPatients were 38 females and 2 males (F:M 19:1),with a mean age of 31.3 ± 7.5 years (17–50 years) and disease duration 4.8 ± 2.9 years (1–13 years). Their mean SLEDAI was 14.3 ± 6.8 (3–32) and SDI 0.4 ± 0.5 (0–2). 85% of patients had photosensitivity, alopecia in 60%, malar rash in 57.5%, oral ulcers 52.5%, arthralgia/arthritis 47.5%, serositis and lupus nephritis in 27.5%, discoid rash in 22.5% and neuropsychiatric in 2.5%. Mean serum level of IL-23 was significantly elevated in patients (107.9 ± 17.3 ng/L; 72.7–165.5 ng/mL) compared to controls (91.6 ± 19.1 ng/L; 57.6–140.3 ng/mL; p < 0.001). IL-23 was significantly elevated in patients with oral ulcers (p = 0.03), arthritis (p < 0.001), lupus nephritis (p = 0.01), alopecia (p = 0.02) and positive anti-dsDNA (p < 0.001). IL-23 significantly correlated with SLEDAI (r = 0.89, p < 0.001), complement C3 (r = -0.55, p < 0.001) and C4 (r = -0.5, p = 0.001). IL-23 could significantly predict SLE at a cut-off 93.1 ng/L (sensitivity 80% and specificity 55%).ConclusionIL-23 may be involved in the pathogenesis of SLE; especially in renal, mucocutaneous and musculoskeletal manifestations and it can be used as a disease activity biomarker. These findings support the possibility of its use as a therapeutic target in SLE.     

Serum beta2-microglobulin level in systemic lupus erythematosus patients: Relation to disease activity

Aim of the workTo assess the level of β2-microglubulin (β2M) in systemic lupus erythematosus (SLE) patients and its association with disease activity and other disease parameters.Patients and methods40 SLE patients and 22 matched controls were studied. Serum β2M was assessed using enzyme-linked immunosorbent assay (ELISA). SLE Disease Activity Index (SLEDAI) and the damage index were assessed.ResultsThe patients were 36 females and 4 males (F:M 9:1) with a mean age of 28.5 ± 7.9 years and disease duration of 6.7 ± 3.3 years. The SLEDAI was 9.3 ± 5.2 and the damage index 1.83 ± 1.84. The mean level of serum β2M was significantly higher in SLE patients (6.42 ± 2.46 mg/L) than control (2.47 ± 0.4 mg/L) (p < 0.01).The serum level of β2M was significantly higher in patients with nephritis (n = 22) (7.45 ± 2.47 mg/L) compared to those without (n = 18) (5.17 ± 1.82 mg/L)(p = 0.002), And it was similar in those with and without arthritis (7.24 ± 2.3 mg/L vs 5.88 ± 2.4 mg/L (p0.07).The β2M significantly correlated with disease activity (r = 0.86, p 0.001), serum creatinine (r = 0.52, p > 0.001), urea (r = 0.63, p < 0.001), 24 h urinary protein (r = 0.56, p < 0.001), hematuria (r = 0.4, p < 0.01) and pyuria (r = 0.41; p < 0.01), ESR (r = 0.48; p < 0.01) and inversely with hemoglobin level (r = ?0.34; p = 0.03). No significant correlation was found with C-reactive protein or with disease damage. Serum (β2M) significantly predicted nephritis and disease activity (sensitivity 63.6 %, specificity 77.8 %; p < 0.001 and 95 %CI: 0.25–0.41; p < 0.001 respectively).ConclusionSerum β2M is significantly associated with disease activity and lupus nephritis, suggesting that serum β2M may serve as a potential biomarker to monitor the disease activity and predicting lupus nephritis. However its association to disease severity needs further longitudinal studies.     

Neutrophil/lymphocyte ratio but not platelet/lymphocyte ratio and mean platelet volume can be an indicator of subclinical inflammation in patients with Familial Mediterranean Fever

Aim of the work: To evaluate the value of three hematological indices to determine subclinical inflammation in Familial Mediterranean Fever (FMF) patients during attack-free period. Patients and methods: This study included 60 FMF patients without FMF-related symptoms or signs in the preceding month and 50 age and sex matched healthy control. Subclinical inflammation was defined as the presence of elevated C-reactive protein (CRP) > 5 mg/dL and/or serum amyloid A (SAA) levels > 6.4 mg/L in the absence of any FMF related clinical signs and symptoms. The neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) were evaluated. Results: The median age of the patients was 32 and 80% were females. They were 12 (80%) with subclinical inflammation and 48 (80%) without. Mutations of MEFV gene were analyzed in 43 (56.6%) patients and were homozygous in 21, heterozygous in 12 and compound heterozygous in 10. The most common mutation was of M694V. The NLR and PLR were significantly higher and MPV lower in patients with inflammation (p = 0.002, p = 0.02, p = 0.03, respectively) but was comparable to the values in the control. Only NLR was significantly higher in those with inflammation compared to those without (p = 0.009) whereas MPV and PLR were similar (p = 0.45 and p = 0.22, respectively). The best cut-off value for NLR in predicting subclinical inflammation in patients was 2.94 (sensitivity 66.7%, specificity 94.9%;p = 0.009). Conclusions: Only NLR increased in FMF patients with subclinical inflammation which may be used as a marker in determining early activity or flare in addition to other markers.     

Potential role of high sensitivity cardiac troponin T in subclinical coronary atherosclerosis in systemic lupus erythematosus patients

Aim of the workTo determine the role of high sensitivity cardiac troponin T (HS cTnT) in subclinical coronary atherosclerosis in SLE patients at an apparent low risk for CVD according to traditional risk factors.Patients and methodsThe presence of subclinical coronary atherosclerosis was assessed by non-contract coronary computerized tomography and calcium score was measured using Agatston score in 30 SLE patients asymptomatic for CVD and 30 age and sex matched apparently healthy controls. SLE disease activity index (SLEDAI) was assessed. Serum HScTnT concentration was measured using enzyme-linked immunosorbent assay (ELISA).ResultsThe mean age of the patients was 33 ± 5.7 years, disease duration of 33.7 ± 22 months and mean SLEDAI 8.1 ± 5.02. The mean HS cTnT level was 12.8 ± 11.3 ng/L (1–36 ng/L). Their Framingham score was 4.8 ± 3.1 (1–12). Framingham score was low in both SLE patients (range 1–12%) and controls (1–9%) (p = 0.12). 11 (36.7%) patients, but none of the controls, had coronary artery calcification (CAC). Serum HScTnT concentration was detectable (>3 ng/L) in 16 (53.3%) patients and 2 (6.7%) control (p < 0.001). Interestingly, it was detectable in all patients with CAC, but in only 26.3% of patients without (p < 0.001). HScTnT significantly correlated with Agatston (r = 0.63, p = 0.04), with erythrocyte sedimentation rate (r = ?0.65, p = 0.03), and with C-reactive protein (r = 0.76, p = 0.03) in SLE patients with CAC.ConclusionSerum HScTnT level is high and associated with CAC in SLE patients who are at an apparently low risk for CVD according to the Framingham risk score. HS cTnT may be a useful biomarker for SLE-associated subclinical atherosclerosis.     

Serum interleukin-26 is a promising biomarker in systemic lupus erythematosus patients: Particular relation to disease activity and nephritis

Aim of the workTo investigate the clinical utility of serum interleukin-26 (IL-26) in patients with systemic lupus erythematosus (SLE).Patients and methodsThe study was carried out on 42 SLE patients and 42 matched controls. SLE disease activity index 2000 (SLEDAI-2K) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI) were assessed. Serum IL-26 was measured.ResultsThe mean age of patients was 28.8±11.4 years with 78.6% females. 76.2% of patients were active; 7.1% very-high grade, 45.2% high, 16.7% moderate and 31% mild. 42.9% of patients had nephritis. The mean SLEDAI-2K was 10.4±6.4 and SLICC-DI 1.19±1.15. IL26 level was significantly higher in patients (64±76.4 pg/ml) compared to control (8.7±2.6 pg/ml), in active cases (79.2±81.9 pg/ml) compared to those inactive (15.3±4.8 pg/ml) and in those with nephritis (n = 18) (113.4±92.2 pg/ml) compared to those without (n = 24) (23.1±7.6 pg/ml).IL-26 level was significantly higher among cases receiving both steroids and mycophenolate mofetil than those receiving steroids with azathioprine (p = 0.005). There was a significant negative correlation between IL26 and serum albumin, hemoglobin and complement 3 (C3) levels (p < 0.001, p < 0.001 and p = 0.006 respectively). There was also a significant correlation between IL26 and both SLEDAI-2K (r = 0.95, p < 0.001) and SLICC-DI (r = 0.68, p < 0.001). At cut off value 16.3 pg/ml, IL26 differentiated patients and control; sensitivity 90.5%, specificity 100% (F. 2) and at 20 pg/ml detects active from non-active; sensitivity and specificity 100%.ConclusionIL-26 is a promising biomarker of SLE with high sensitivity and specificity. There is a relation of IL-26 with disease activity, damage and nephritis.     

Serum level of galectin-9 in systemic lupus erythematosus patients with lupus nephritis: Relation to clinical characteristics and disease activity

Aim of the workTo assess galectin-9 (Gal-9) level in the serum of systemic lupus erythematosus (SLE) patients with and without renal involvement and clarify its relation with disease activity.Patients and methods50 SLE patients; 25 with lupus nephritis (LN) and 25 without as well as 25 controls were studied. Systemic Lupus International Collaborating Clinics (SLICC) renal activity score and SLE disease activity index 2000 (SLEDAI-2 K) were determined. Serum Gal-9 was measured in all participants.ResultsGal-9 level was significantly elevated in SLE patients with (16.7; 11.6–33.7 ng/ml) and without (15.9; 11.8–25 ng/ml) compared to controls (3.9; 2.8–5.4 ng/ml) (p < 0.001) but was comparable between the patients groups (p = 0.83). In LN patients, serum Gal-9 and SLICC renal activity score significantly correlated (r = 0.48, p = 0.016). Serum Gal-9 significantly correlated with SLEDAI-2 K in patients with (r = 0.71, p < 0.001) and without (r = 0.95, p < 0.001) LN, with anti-double stranded deoxyribonucleic acid (anti-ds-DNA) titers (with r = 0.57, p < 0.001 and without r = 0.79, p < 0.001) and inversely with C3 (with r = -0.44, p = 0.027 and without r = -0.63, p < 0.001) and C4 (with r = -0.47, p = 0.018 and without r = -0.43, p = 0.03). Gal-9 had an area under the curve (AUC) of 0.96 to distinguish SLE cases from control. However, AUC between LN group and non-nephritic SLE was 0.48. On regression, SLEDAI-2 K was the only significant factor associated with serum Gal-9 (p < 0.001).ConclusionIn SLE patients, significantly raised Gal-9 levels and relation with disease activity were detected indicating its clinical relevance as biomarker of disease activity and its potential value in the disease diagnosis. Its value in discriminating LN from non-nephritic SLE is limited.     

Value of hematological parameters as biomarkers of disease manifestations and severity in systemic sclerosis

Aim of the workTo investigate the value of neutrophil- lymphocyte ratio (NLR), platelet- lymphocyte ratio (PLR), red blood cell distribution width (RDW), mean platelet volume (MPV) as biomarkers of disease severity and clinical manifestations in systemic sclerosis (SSc).Patients and methodsThis study included 35 SSc patients, together with 45 controls. Disease severity was assessed by Medsger severity score (MSS). NLR, PLR, MPV, RDW were measured by COULTER LH 750 assay analyzer.ResultsThe mean age of SSc patients and controls was 42.8 ± 12.6 and 40.8 ± 9.7 years respectively. MPV, RDW, NLR, PLR were significantly higher in patients compared to controls (p = 0.03, < 0.001, <0.001, 0.02). NLR, PLR were significantly higher in patients presenting with myositis (p = 0.002, 0.004), and proximal muscle weakness on MSS (p = 0.009, 0.02). NLR was significantly higher in patients with severe peripheral vascular ischemia (p = 0.02). RDW was significantly higher in patients with higher general MSS (p = 0.03) NLR, PLR were significantly positively correlated with severity of muscle weakness (p = 0.001, 0.004), RDW was significantly associated with general MSS (p = 0.002). NLR and PLR were the valuable predictors of muscle involvement (p = 0.003, 0.005) and severity of muscle weakness (p = 0.001, 0.003).ConclusionMPV, RDW, NLR, PLR were significantly higher in SSc patients suggesting their role as biomarkers reflecting the enduring inflammatory process in SSc. Increased NLR and PLR were related to muscular involvement, and severity of muscular weakness. Increased NLR predicted severity of peripheral vascular ischemia and elevated RDW predicted general severity, MPV did not predict severity or disease manifestations of SSc.     

Sexual dysfunction and physical performance in female systemic lupus erythematosus patients

Aim of the workTo investigate the sexual dysfunction in systemic lupus erythematosus (SLE) patients and its relation to physical fitness and other disease parameters.Patients and methodsThe study included 47 SLE females and 47 matched healthy controls. SLE disease activity index (SLEDAI) and systemic lupus international collaborative clinics damage index (SLICC DI) were assessed. Physical performance of the patients was assessed by the grip ability test (GAT), gait velocity test, Jebsen hand function test, fatigue severity scale (FSS) and the modified health assessment questionnaire (mHAQ). Sexual dysfunction of the patients was assessed by the sexual function index (FSFI). Depressive disorders of the patients were assessed by Beck depression inventory.ResultsThe mean age of the patients was 28.7 ± 7.2 years and disease duration 4.4 ± 2.9 years. GAT was significantly lower (43.65 vs 70.00; p = 0.001), and FSS higher (6.5 vs 1; p = 0.001) in patients compared to control. The total FSFI was significantly lower (23.41 vs 29.60; p = 0.001) and all domains scores were significantly lower except the pain domain (p = 0.001). Beck depression inventory score was higher in patients (13.29 vs 12.74; p = 0.365). SLE females with prescribed corticosteroids and azathioprine had significantly lower FSFI as compared to those without while FSFI score was higher in those receiving hydroxychloroquine. The FSFI significantly correlated with C4 level (r = 0.328, p = 0.024 and inversely with, SLEDAI (r = ?0.07, p = 0.001), FSS (r = ?0.54, p = 0.001), mHAQ (?0.37, p = 0.01) and with Beck depression inventory (r = ?0.57, p = 0.001).ConclusionMarried female patients with SLE revealed a higher degree of sexual dysfunction of all domains except pain.     

Usefulness of neutrophil-to-lymphocyte ratio as a biomarker for diagnosing infections in patients with systemic lupus erythematosus

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have been investigated as disease activity markers for systemic lupus erythematosus (SLE). Hence, we investigated the clinical significance of these parameters in diagnosing infection in patients with SLE. In total, 120 patients with SLE, who were admitted to hospital due to disease flares or infection, were recruited for the study. Of the 120 patients, 60 had a concurrent infection (SLE with infection), while the remaining 60 patients were admitted with a flare without any evidence of infection (SLE with flare). NLR was higher in the patients with SLE with infection, compared to patients with SLE with flare (14.2 ± 15.4 versus 3.3 ± 2.2, p < 0.001). Additionally, PLR was higher in the SLE with infection group than in the SLE with flare group (357.7 ± 350.1 versus 231.7 ± 152.9, p = 0.012), but not MLR. In the SLE with infection group, C-reactive protein (CRP) levels positively correlated with NLR and PLR. NLR with a cut-off value of 5.70 and an area under the curve (AUC) of 0.872 indicated good sensitivity (75%) and specificity (90%), for the diagnosis of SLE with infection. CRP with a cut-off value of 1.28 mg/dL (AUC 0.942) showed the sensitivity (93.3%) and specificity (91.7%). NLR with a cut-off value of 5.70 and CRP with a cut-off value of 1.28 mg/dL showed the increased specificity (98.3%) than only CRP, but not significant. NLR could be a good additive marker for diagnosing infection in patients with SLE.     

Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension

Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with worse outcome in various diseases. Non-dipping blood pressure pattern is associated with higher cardiovascular mortality. The aim of this study was to explore the association between NLR and PLR in patients with dipper versus non-dipper hypertension.

Methods: The study included 166 patients with hypertension. Eighty-three patients (40 male, mean age: 49.1?±?10.5 years) had dipper hypertension, while 83 patients (41 male, mean age: 52.3?±?12.7 years) had non-dipper hypertension.

Results: Baseline demographic characteristics were similar in both groups. Patients with non-dipper hypertension had significantly higher NLR compared to dipper hypertension (2.3?±?0.9 versus 1.8?±?0.5, p?p?=?0.001). In univariate analysis, hyperlipidemia, smoking, presence of diabetes, PLR more than 107 and NLR more than 1.89 were among predictors of dipper and non-dipper status. In logistic regression analyses, only hyperlipidemia (odds ratio: 2.96, CI: 1.22–7.13) and PLR more than 107 (odds ratio: 2.62, CI: 1.13–6.06) were independent predictors of dipper and non-dipper status. A PLR of 107 or higher predicted non-dipper status with a sensitivity of 66.3% and specificity of 68.7%.

Conclusion: We demonstrated that patients with non-dipper hypertension had significantly higher NLR and PLR compared to dipper hypertension, which has not been reported previously. Moreover PLR more than 107 but not NLR was independent predictor of non-dipper status.     

Pre‐treatment neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are prognostic of progression in early stage classical Hodgkin lymphoma

To determine whether pre‐treatment neutrophil/lymphocyte (NLR) or platelet/lymphocyte ratios (PLR) are predictive for progression in early‐stage classical Hodgkin lymphoma (cHL), we derived NLR and PLR values for 338 stage I/II cHL patients and appropriate cut‐off point values to define progression. Two‐year freedom from progression (FFP) for patients with NLR ≥6·4 was 82·2% vs. 95·7% with NLR <6·4 (P < 0·001). Similarly, 2‐year FFP was 84·3% for patients with PLR ≥266·2 vs. 96·1% with PLR <266·2 (P = 0·003). On univariate analysis, both NLR and PLR were significantly associated with worse FFP (P = 0·001). On multivariate analysis, PLR remained a significant, independent prognostic factor (P < 0·001).     

The association of vitamin D deficiency with hemogram-derived inflammatory biomarkers in children

Background and aimsOne of the extraosseous effects of vitamin D is that it is a potent modulator of inflammatory processes. Many studies have demonstrated the inverse association between vitamin D and inflammation. Therefore, we hypothesize that vitamin D deficiency may affect the inflammatory markers derived from hemogram parameters [neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), platelet distribution width (PDW), red blood cell distribution width (RDW)] in healthy children.Methods and resultsWe conducted a retrospective study on healthy children. From 2015 to 2020, 16,321 children with simultaneous vitamin D and hemogram measurements were identified from electronic records. Participants were divided into 2 groups according to whether they had vitamin D deficiency or not. The relationship between vitamin D status and the levels of inflammatory markers was analyzed. All inflammatory markers showed statistically significant differences between vitamin D status (p < 0.001 for all). Vitamin D levels were significantly negatively correlated with NLR (r = ?0.285), PLR (r = ?0.257), PDW (r = ?0.181), and positively correlated with LMR (r = 0.218), and RDW (r = 0.057). In logistic regression analysis, age (OR = 1.15, 95% CI: 1.14–1.16), gender (OR = 1.66, 95% CI: 1.54–1.78), LMR (OR = 0.96, 95% CI: 0.95–0.98), PLR (OR = 1.003, 95% CI: 1.001–1.004), and RDW (OR = 1.10, 95%CI: 1.07–1.13) were found to be independent predictors for vitamin D deficiency.ConclusionsStatistically significant differences were detected between vitamin D status and inflammatory parameters. However, the difference between the median values of vitamin D groups was very small and the degree of correlation was very weak. Therefore, the clinical significance of the difference should be questioned.     

Clinical significance of interferon lambda-3 (IFNλ3)/interleukin 28B (IL28B) in systemic lupus erythematosus patients

BackgroundInappropriate and excessive activation of type I interferon (IFN) system is a key feature of systemic lupus erythematosus (SLE), and its targeting has led to important achievements in the development of novel drugs for SLE.Aim of the workTo evaluate the serum levels of interferon lambda IFNλ3 (IL28B) in Egyptian patients with SLE and investigate its potential relation with different clinical and laboratory parameters.Patients and methodsThe study included 40 SLE patients and 40 controls. The SLE disease activity index (SLEDAI) was assessed. The measurement of serum levels of IFNλ3 was performed in all participants using enzyme linked immunosorbent assay (ELISA).ResultsThe mean age of the patients was 26.8 ± 7.8 years with disease duration 5.1 ± 4.5 years and they were 35 females and 5 males. The serum levels of IFNλ3 were significantly higher in SLE patients (9.7 ± 12.47 pg/mL) compared to the control (5.13 ± 1.63 pg/mL)(p = 0.02). Significant correlations were observed between serum IFNλ3 and serositis (r = 0.35,p = 0.03), C3 consumption (r ?0.33, p = 0.04) and SLEDAI (r 0.34, p = 0.03). On multivariate regression analysis, serositis and SLEDAI (but not C3) were significant independent predictors of IFNλ3 levels (β = 0.08, p = 0.037 and β = 0.06, p = 0.014 respectively).ConclusionThe results support a possible role of IFNλ3/IL28B in the immunopathogenesis of SLE. The significant association of serum IFNλ3 with disease activity highlights the utility of IFNλ3 as a novel biomarker for monitoring disease activity and predicting severity in SLE. Further studies on IFNλ3 in SLE could be promising in the development of personalized therapy for lupus patients.     

Programmed death 1 (PD-1) serum level and gene expression in recent onset systemic lupus erythematosus patients

Aim of the workTo investigate the potential association of protein programmed death 1 (PD-1) serum level and its gene expression inrecent onset systemic lupus erythematosus (SLE) patients and study its association with the disease activity.Patients and methodsThe study included 80 recently diagnosed SLE patients and 80 healthy controls. SLE disease activity index (SLEDAI) was assessed. The serum level of soluble (sPD-1) was assessed by enzyme linked immunosorbent assay (ELISA) and its gene expression level was evaluated by real time-polymerase chain reaction (RT-PCR).ResultsThey were 68 females and 12 males (F: M 5.7:1) with age 30.8 ± 8.7 years and disease duration of 3.2 ± 1.7 months. The sPD-1 and PD-1 gene expression level (folds) were significantly elevated in patients (1280.6 ± 1448.1 pg/ml and 0.3 ± 0.06 folds) than controls (109.1 ± 11.9 pg/ml and 0.03 ± 0.008 folds) (p < 0.001). A significant correlation was found between sPD-1 and hematuria, pyuria, fever and C3 level (p = 0.01, p = 0.001, p = 0.02, and p = 0.03 respectively), and between PD-1gene expression and psychosis and fever (p = 0.03, p = 0.014). No significant correlation was found between SLEDAI and PD-1 gene expression or sPD-1 level (p = 0.1, p = 0.23 respectively). No significant correlation was found between sPD-1 and PD-1 gene expression levels and the autoantibodies.ConclusionPD-1 gene expression as well as the serum level of sPD-1 are elevated significantly in recent onset SLE patients denoting that they may have a role in the pathogenesis of the disease while there was no relation to the disease activity. This biomarker may be potentially promising for the development of a novel lupus immunotherapy by targeting the PD-1 pathway.