Diagnostic Value of Neutrophil-to-Lymphocyte Ratio, Lymphocyte-to-Monocyte Ratio, and Platelet-to-Lymphocyte Ratio in the Diagnosis of Erythema Nodosum Leprosum: A Retrospective Study

Abstract

Erythema nodosum leprosum (ENL) is an acute immune complex-mediated condition of the dermis, subcutaneous tissue, and other tissues seen in patients with multibacillary (MB) leprosy, causing severe impairment to patients’ quality of life. To date, there is no standard diagnostic criteria for ENL. We aimed to study the diagnostic value and accuracy of Neutrophil-to-Lymphocyte ratio (NLR), Lymphocyte-to-Monocyte ratio (LMR), and Platelet-to-Lymphocyte ratio (PLR) in diagnosing ENL. This is an analytic retrospective study with a cross-sectional design that describes the distribution and clinical characteristics of all newly diagnosed MB patients of Dr. Soetomo General Hospital Surabaya in the years 2018–2020. NLR, LMR, and PLR were calculated for all patients, and a receiver operating characteristic curve (ROC) was generated to identify the cut-off points. Among a total of 182 patients with MB leprosy, 22 cases (12.09%) were reported with ENL. WBC, neutrophils, monocytes, and thrombocytes showed a positive correlation with the incidence of ENL, but not lymphocytes. The NLR cut-off point for the diagnosis of ENL was 4.99 (sensitivity 86.4%, specificity 82.5%, accuracy 82.97), while that of PLR was 237.46 (sensitivity 63.6%, specificity 73.1%, accuracy 71.98%). LMR had poor sensitivity and specificity levels of 50% and 28.7%, with cut-off point of 2.28 and accuracy of 31.32%. These results suggest that NLR and PLR could be potential biomarkers for the diagnosis of ENL.

Whole blood transcriptomics reveals the enrichment of neutrophil activation pathways during erythema nodosum leprosum reaction

“…These genes were CD177, CYSTM1, HP, LRG1, MCEMP1, MMP8, OLFM4, S100A12 , and S100A9 . This was an expected observation based on previous literature reports of neutrophilia during ENL ( 45 – 47 ). Indeed, we also observed higher neutrophil counts in the blood of a subset of ENL patients from the RNAseq cohort with available blood counts by the time they were recruited for the study (LL= 7; ENL = 5) ( Supplementary Figure S1 ).…”

Neutrophil to lymphocyte ratio in odontogenic infection: a systematic review

“…NLR values are expected to be used as diagnostic guidance in predicting patients afflicted with OI who may require a more extended stay in the hospital. NLR has been extensively studied as a test that can be a possible diagnostic tool for predicting mortality, host inflammatory responses, and chemotherapy responses [ 32 – 34 ]. One prospective cohort study identified high NLR as an independent prognostic modality of mortality in critically ill patients during the hospital stay and six months post-treatment [ 35 ].…”

Risk Factors of Acute and Chronic Erythema Nodosum Leprosum in Dr. Soetomo General Academic Hospital Surabaya

“…Leprosy is a chronic granulomatous infection and is one of the neglected diseases caused by Mycobacterium leprae, which infects mucosal tissues and peripheral nerves, causing skin sensation and increased disability during disease progression. 1,2 ENL is a complex syndrome, that caused inflammation of the skin, nerves, and other organs due to an inflammatory immune response to Mycobacterium leprae antigens. Acute ENL was defined as a patient who had a first episode of ENL less than 24 weeks in duration or had a second or subsequent ENL episode, lasting less than 24 weeks and occurring 84 days (i.e., 12 weeks) or more after stopping treatment for ENL.…”