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The neutrophil-to-lymphocyte ratio could be a good diagnostic marker and predictor of relapse in patients with adult-onset Still's disease: A STROBE-compliant retrospective observational analysis.

Abstract The neutrophil-to-lymphocyte ratio (NLR) is the proportion of absolute neutrophil count to lymphocytes on routine complete blood count (CBC) tests, and has been studied as a simple marker of the systemic inflammatory response. This study was performed to investigate whether the NLR could be used as a tool to diagnose and predict prognosis in cases of adult-onset Still's disease (AOSD).We retrospectively reviewed 164 patients with suspected AOSD. Among 164 patients with suspected AOSD, 37 patients received another diagnosis (such as viral infection) and were compared with the 127 patients who received a diagnosis of AOSD. Laboratory tests including CBCs, ferritin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and the NLR were evaluated.AOSD patients showed higher neutrophil counts, lower lymphocyte counts, higher NLRs, and higher levels of ferritin, ESR, and CRP than non-AOSD patients (all P < .001). In receiver operating characteristic (ROC) curve analysis of the NLR for diagnosis of AOSD, the area under the curve (AUC) was highest at 0.967 (95% CI = 0.940-0.993) with a cutoff value of 3.08. The cutoff value showed the greatest sensitivity (91.7%), specificity (68.4%), and AUC value (0.967) as a diagnostic tool for AOSD. The NLR and treatment appeared to be significant prognostic factors for relapse, but only age showed a significant relationship with death. Furthermore, the NLR was significantly higher in patients with macrophage activation syndrome than in hemophagocytic lymphohistiocytosis (HLH) patients (P = .007). In ROC analysis, the NLR with a cutoff value of 5.86 showed a sensitivity of 89.4%, specificity of 87.8%, and AUC of 0.794.The NLR can be used as a diagnostic tool and predictor of relapse in AOSD, and for differential diagnosis of HLH.
PMID
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Authors

Mayor MeshTerms

Lymphocytes

Neutrophils

Keywords
Journal Title medicine
Publication Year Start




PMID- 28723775
OWN - NLM
STAT- MEDLINE
DA  - 20170720
DCOM- 20170728
LR  - 20170728
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 29
DP  - 2017 Jul
TI  - The neutrophil-to-lymphocyte ratio could be a good diagnostic marker and
      predictor of relapse in patients with adult-onset Still's disease: A
      STROBE-compliant retrospective observational analysis.
PG  - e7546
LID - 10.1097/MD.0000000000007546 [doi]
AB  - The neutrophil-to-lymphocyte ratio (NLR) is the proportion of absolute neutrophil
      count to lymphocytes on routine complete blood count (CBC) tests, and has been
      studied as a simple marker of the systemic inflammatory response. This study was 
      performed to investigate whether the NLR could be used as a tool to diagnose and 
      predict prognosis in cases of adult-onset Still's disease (AOSD).We
      retrospectively reviewed 164 patients with suspected AOSD. Among 164 patients
      with suspected AOSD, 37 patients received another diagnosis (such as viral
      infection) and were compared with the 127 patients who received a diagnosis of
      AOSD. Laboratory tests including CBCs, ferritin, erythrocyte sedimentation rate
      (ESR), C-reactive protein (CRP) level, and the NLR were evaluated.AOSD patients
      showed higher neutrophil counts, lower lymphocyte counts, higher NLRs, and higher
      levels of ferritin, ESR, and CRP than non-AOSD patients (all P &lt; .001). In
      receiver operating characteristic (ROC) curve analysis of the NLR for diagnosis
      of AOSD, the area under the curve (AUC) was highest at 0.967 (95% CI =
      0.940-0.993) with a cutoff value of 3.08. The cutoff value showed the greatest
      sensitivity (91.7%), specificity (68.4%), and AUC value (0.967) as a diagnostic
      tool for AOSD. The NLR and treatment appeared to be significant prognostic
      factors for relapse, but only age showed a significant relationship with death.
      Furthermore, the NLR was significantly higher in patients with macrophage
      activation syndrome than in hemophagocytic lymphohistiocytosis (HLH) patients (P 
      = .007). In ROC analysis, the NLR with a cutoff value of 5.86 showed a
      sensitivity of 89.4%, specificity of 87.8%, and AUC of 0.794.The NLR can be used 
      as a diagnostic tool and predictor of relapse in AOSD, and for differential
      diagnosis of HLH.
FAU - Seo, Ji-Yeoun
AU  - Seo JY
AD  - Department of Rheumatology, Ajou University School of Medicine, Worldcup-ro,
      Yeongtong-gu, Suwon, Korea.
FAU - Suh, Chang-Hee
AU  - Suh CH
FAU - Jung, Ju-Yang
AU  - Jung JY
FAU - Kim, Ar-Reum
AU  - Kim AR
FAU - Yang, Ji Won
AU  - Yang JW
FAU - Kim, Hyoun-Ah
AU  - Kim HA
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Area Under Curve
MH  - Blood Sedimentation
MH  - Diagnosis, Differential
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Leukocyte Count
MH  - Logistic Models
MH  - Lupus Erythematosus, Systemic/blood
MH  - *Lymphocytes
MH  - Macrophage Activation Syndrome/blood
MH  - Male
MH  - Multivariate Analysis
MH  - *Neutrophils
MH  - Prognosis
MH  - ROC Curve
MH  - Recurrence
MH  - Retrospective Studies
MH  - Still's Disease, Adult-Onset/*blood/drug therapy/immunology/mortality
EDAT- 2017/07/21 06:00
MHDA- 2017/07/29 06:00
CRDT- 2017/07/21 06:00
AID - 10.1097/MD.0000000000007546 [doi]
AID - 00005792-201707210-00040 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jul;96(29):e7546. doi: 10.1097/MD.0000000000007546.