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Clinical Rheumatology

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13-02-2023 | Melanoma | Original Article

Elevated platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with polymyositis/dermatomyositis: a retrospective study

Authors: Meiqi Li, Suyan Yan, Rongrong Dong, Weizhen Xiang, Zhenzhen Ma, Qingrui Yang

Published in: Clinical Rheumatology | Issue 6/2023

Abstract

Objectives

This study aimed to examine the diagnostic and prognostic value of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in patients with polymyositis/dermatomyositis (PM/DM).

Method

Clinical data of 200 patients with PM/DM and 204 healthy controls were retrospectively reviewed. We examined whether the PLR and NLR were associated with PM/DM.

Results

The PLR and NLR were higher in patients with PM/DM than in controls (both P < 0.001). The PLR and NLR were higher in patients with DM than in those with PM (both P < 0.01). The PLR was higher in the anti-melanoma differentiation-associated protein-5 (anti-MDA5) ⁺ PM/DM group than in the anti-MDA5^- PM/DM group (P = 0.002). The NLR in non-survivors was higher than that in survivors (P = 0.01). The NLR was positively correlated with the occurrence of interstitial lung disease (ILD). The PLR and NLR were independent predictors of PM/DM, as well as risk factors (both P < 0.001). Moreover, the NLR had a predictive value for PM/DM-ILD and was closely related to mortality (P = 0.033, P = 0.003, respectively).

Conclusions

Patients with PM/DM have a higher NLR and PLR than healthy controls, especially in those with anti-MDA5⁺. The PLR and NLR are independent risk factors for PM/DM and have some predictive value. The NLR is correlated with ILD and associated with an increased risk of mortality in patients with PM/DM. The NLR and PLR may be simple, economical, and accurate diagnostic and prognostic markers for patients with PM/DM.

Key points

• The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied in numerous inflammatory diseases as potential markers, but their clinical significance in polymyositis/dermatomyositis (PM/DM) remains unclear.

• We examined the changes in the NLR and PLR between patients with PM/DM and healthy controls, as well as their association with mortality, interstitial lung disease, and anti-melanoma differentiation-associated protein-5.

• Patients with PM/DM may benefit from using the NLR and PLR as simple, economical, and accurate diagnostic and prognostic markers.

Available only for authorised users

Lundberg IE, Fujimoto M, Vencovsky J et al (2021) Idiopathic inflammatory myopathies. Nat Rev Dis Primers 7(1):86. https://doi.org/10.1038/s41572-021-00321-xCrossRefPubMed

Gono T, Masui K, Nishina N et al (2021) Risk prediction modeling based on a combination of initial serum biomarker levels in polymyositis/dermatomyositis-associated interstitial lung disease. Arthritis Rheumatol 73(4):677–686. https://doi.org/10.1002/art.41566CrossRefPubMed

Marie I (2012) Morbidity and mortality in adult polymyositis and dermatomyositis. Curr Rheumatol Rep 14(3):275–285. https://doi.org/10.1007/s11926-012-0249-3CrossRefPubMed

Yang X, Hao Y, Zhang X et al (2020) Mortality of Chinese patients with polymyositis and dermatomyositis. Clin Rheumatol 39(5):1569–1579. https://doi.org/10.1007/s10067-019-04910-wCrossRefPubMed

Fathi M, Dastmalchi M, Rasmussen E et al (2004) Interstitial lung disease, a common manifestation of newly diagnosed polymyositis and dermatomyositis. Ann Rheum Dis 63(3):297–301. https://doi.org/10.1136/ard.2003.006122CrossRefPubMedPubMedCentral

Sato S, Hoshino K, Satoh T et al (2009) RNA helicase encoded by melanoma differentiation-associated gene 5 is a major autoantigen in patients with clinically amyopathic dermatomyositis: Association with rapidly progressive interstitial lung disease. Arthritis Rheum 60(7):2193–2200. https://doi.org/10.1002/art.24621CrossRefPubMed

DeWane ME, Waldman R, Lu J (2020) Dermatomyositis: clinical features and pathogenesis. J Am Acad Dermatol 82(2):267–281. https://doi.org/10.1016/j.jaad.2019.06.1309CrossRefPubMed

Chen Z, Cao M, Plana MN et al (2013) Utility of anti-melanoma differentiation-associated gene 5 antibody measurement in identifying patients with dermatomyositis and a high risk for developing rapidly progressive interstitial lung disease: a review of the literature and a meta-analysis. Arthritis Care Res (Hoboken) 65(8):1316–1324. https://doi.org/10.1002/acr.21985CrossRefPubMed

Gono T, Kawaguchi Y, Satoh T et al (2010) Clinical manifestation and prognostic factor in anti-melanoma differentiation-associated gene 5 antibody-associated interstitial lung disease as a complication of dermatomyositis. Rheumatology (Oxford) 49(9):1713–1719. https://doi.org/10.1093/rheumatology/keq149CrossRefPubMed

10.

Koga T, Fujikawa K, Horai Y et al (2012) The diagnostic utility of anti-melanoma differentiation-associated gene 5 antibody testing for predicting the prognosis of Japanese patients with DM. Rheumatology (Oxford) 51(7):1278–1284. https://doi.org/10.1093/rheumatology/ker518CrossRefPubMed

11.

Li Y, Gao X, Li Y et al (2020) Predictors and mortality of rapidly progressive interstitial lung disease in patients with idiopathic inflammatory myopathy: a series of 474 patients. Front Med (Lausanne) 7:363. https://doi.org/10.3389/fmed.2020.00363CrossRefPubMed

12.

Li L, Xia Y, Chen C et al (2015) Neutrophil-lymphocyte ratio in systemic lupus erythematosus disease: a retrospective study. Int J Clin Exp Med 8(7):11026–11031PubMedPubMedCentral

13.

Chen Q, Chen DY, Xu XZ et al (2019) Platelet/lymphocyte, lymphocyte/monocyte, and neutrophil/lymphocyte ratios as biomarkers in patients with rheumatoid arthritis and rheumatoid arthritis-associated interstitial lung disease. Med Sci Monit 25:6474–6481. https://doi.org/10.12659/msm.916583CrossRefPubMedPubMedCentral

14.

Shadmanfar S, Masoumi M, Davatchi F et al (2021) Correlation of clinical signs and symptoms of Behçet's disease with platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). Immunol Res 69(4):363–371. https://doi.org/10.1007/s12026-021-09194-4CrossRefPubMed

15.

Wang H, Hu Y, Geng Y et al (2017) The relationship between neutrophil to lymphocyte ratio and artery stiffness in subtypes of hypertension. J Clin Hypertens (Greenwich) 19(8):780–785. https://doi.org/10.1111/jch.13002CrossRefPubMed

16.

Haybar H, Pezeshki SMS, Saki N (2019) Evaluation of complete blood count parameters in cardiovascular diseases: an early indicator of prognosis? Exp Mol Pathol 110:104267. https://doi.org/10.1016/j.yexmp.2019.104267CrossRefPubMed

17.

Tas M, Yavuz A, Ak M et al (2019) Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in discriminating precancerous pathologies from cervical cancer. J Oncol 2019:2476082. https://doi.org/10.1155/2019/2476082CrossRefPubMedPubMedCentral

18.

Kemal Y, Yucel I, Ekiz K et al (2014) Elevated serum neutrophil to lymphocyte and platelet to lymphocyte ratios could be useful in lung cancer diagnosis. Asian Pac J Cancer Prev 15(6):2651–2654. https://doi.org/10.7314/apjcp.2014.15.6.2651CrossRefPubMed

19.

Lee S, Oh SY, Kim SH et al (2013) Prognostic significance of neutrophil lymphocyte ratio and platelet lymphocyte ratio in advanced gastric cancer patients treated with FOLFOX chemotherapy. BMC Cancer 13:350. https://doi.org/10.1186/1471-2407-13-350CrossRefPubMedPubMedCentral

20.

Liu X, Shen Y, Wang H et al (2016) Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: a prospective observational study. Mediators Inflamm 2016:8191254. https://doi.org/10.1155/2016/8191254CrossRefPubMedPubMedCentral

21.

Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (first of two parts). N Engl J Med 292(7):344–347. https://doi.org/10.1056/nejm197502132920706CrossRefPubMed

22.

Bohan A, Peter JB (1975) Polymyositis and dermatomyositis (second of two parts). N Engl J Med 292(8):403–407. https://doi.org/10.1056/nejm197502202920807CrossRefPubMed

23.

Zhu D, Qiao J, Tang S et al (2021) Elevated carcinoembryonic antigen predicts rapidly progressive interstitial lung disease in clinically amyopathic dermatomyositis. Rheumatology (Oxford) 60(8):3896–3903. https://doi.org/10.1093/rheumatology/keaa819CrossRefPubMed

24.

Ishikawa Y, Iwata S, Hanami K et al (2018) Relevance of interferon-gamma in pathogenesis of life-threatening rapidly progressive interstitial lung disease in patients with dermatomyositis. Arthritis Res Ther 20(1):240. https://doi.org/10.1186/s13075-018-1737-2CrossRefPubMedPubMedCentral

25.

Katipoğlu Z, Mirza E, Oltulu R et al (2020) May monocyte/HDL cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) Be an Indicator of Inflammation and Oxidative Stress in Patients with Keratoconus? Ocul Immunol Inflamm 28(4):632–636. https://doi.org/10.1080/09273948.2019.1611876CrossRefPubMed

26.

Suszek D, Górak A, Majdan M (2020) Differential approach to peripheral blood cell ratios in patients with systemic lupus erythematosus and various manifestations. Rheumatol Int 40(10):1625–1629. https://doi.org/10.1007/s00296-020-04669-3CrossRefPubMedPubMedCentral

27.

Yang W, Wang X, Zhang W et al (2017) Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are 2 new inflammatory markers associated with pulmonary involvement and disease activity in patients with dermatomyositis. Clin Chim Acta 465:11–16. https://doi.org/10.1016/j.cca.2016.12.007CrossRefPubMed

28.

Alexandrakis MG, Passam FH, Moschandrea IA et al (2003) Levels of serum cytokines and acute phase proteins in patients with essential and cancer-related thrombocytosis. Am J Clin Oncol 26(2):135–140. https://doi.org/10.1097/00000421-200304000-00007CrossRefPubMed

29.

Ohsugi Y (2007) Recent advances in immunopathophysiology of interleukin-6: an innovative therapeutic drug, tocilizumab (recombinant humanized anti-human interleukin-6 receptor antibody), unveils the mysterious etiology of immune-mediated inflammatory diseases. Biol Pharm Bull 30(11):2001–2006. https://doi.org/10.1248/bpb.30.2001CrossRefPubMed

30.

Imai T, Koike K, Kubo T et al (1991) Interleukin-6 supports human megakaryocytic proliferation and differentiation in vitro. Blood 78(8):1969–1974CrossRefPubMed

31.

Dan K, Gomi S, Inokuchi K et al (1995) Effects of interleukin-1 and tumor necrosis factor on megakaryocytopoiesis: mechanism of reactive thrombocytosis. Acta Haematol 93(2-4):67–72. https://doi.org/10.1159/000204114CrossRefPubMed

32.

Klinger MH, Jelkmann W (2002) Role of blood platelets in infection and inflammation. J Interferon Cytokine Res 22(9):913–922. https://doi.org/10.1089/10799900260286623CrossRefPubMed

33.

Wang DX, Lu X, Zu N et al (2012) Clinical significance of peripheral blood lymphocyte subsets in patients with polymyositis and dermatomyositis. Clin Rheumatol 31(12):1691–1697. https://doi.org/10.1007/s10067-012-2075-4CrossRefPubMed

34.

Iannone F, Cauli A, Yanni G et al (1996) T-lymphocyte immunophenotyping in polymyositis and dermatomyositis. Br J Rheumatol 35(9):839–845. https://doi.org/10.1093/rheumatology/35.9.839CrossRefPubMed

35.

Menges T, Engel J, Welters I et al (1999) Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications. Crit Care Med 27(4):733–740. https://doi.org/10.1097/00003246-199904000-00026CrossRefPubMed

36.

Özpelit E, Akdeniz B, Özpelit ME et al (2015) Prognostic value of neutrophil-to-lymphocyte ratio in pulmonary arterial hypertension. J Int Med Res 43(5):661–671. https://doi.org/10.1177/0300060515589394CrossRefPubMed

37.

Gao MZ, Huang YL, Wu XD et al (2018) Red blood cell distribution width and neutrophil to lymphocyte ratio are correlated with disease activity of dermatomyositis and polymyositis. J Clin Lab Anal 32(1). https://doi.org/10.1002/jcla.22209

38.

Summers C, Rankin SM, Condliffe AM et al (2010) Neutrophil kinetics in health and disease. Trends Immunol 31(8):318–324. https://doi.org/10.1016/j.it.2010.05.006CrossRefPubMedPubMedCentral

39.

Colotta F, Re F, Polentarutti N et al (1992) Modulation of granulocyte survival and programmed cell death by cytokines and bacterial products. Blood 80(8):2012–2020CrossRefPubMed

40.

Kim MH, Granick JL, Kwok C et al (2011) Neutrophil survival and c-kit(+)-progenitor proliferation in Staphylococcus aureus-infected skin wounds promote resolution. Blood 117(12):3343–3352. https://doi.org/10.1182/blood-2010-07-296970CrossRefPubMedPubMedCentral

41.

Feng JF, Huang Y, Chen QX (2014) Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Oncol 12:58. https://doi.org/10.1186/1477-7819-12-58CrossRefPubMedPubMedCentral

42.

Ha YJ, Hur J, Go DJ et al (2018) Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: a retrospective observational study. PLoS One 13(1):e0190411. https://doi.org/10.1371/journal.pone.0190411CrossRefPubMedPubMedCentral

43.

Li Y, Li Y, Wu J et al (2020) Predictors of poor outcome of Anti-MDA5-associated rapidly progressive interstitial lung disease in a chinese cohort with dermatomyositis. J Immunol Res 2020:2024869. https://doi.org/10.1155/2020/2024869CrossRefPubMedPubMedCentral

44.

Peng JM, Du B, Wang Q et al (2016) Dermatomyositis and polymyositis in the intensive care unit: a single-center retrospective cohort study of 102 patients. PLoS One 11(4):e0154441. https://doi.org/10.1371/journal.pone.0154441CrossRefPubMedPubMedCentral

Title: Elevated platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with polymyositis/dermatomyositis: a retrospective study
Authors: Meiqi Li
Suyan Yan
Rongrong Dong
Weizhen Xiang
Zhenzhen Ma
Qingrui Yang
Publication date: 13-02-2023
Publisher: Springer International Publishing
Keywords: Melanoma
Melanoma
Polymyositis
Polymyositis
Dermatomyositis
Published in: Clinical Rheumatology / Issue 6/2023
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-023-06542-7

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