Hematological Inflammatory Markers in Patients with Pemphigus Vulgaris

Abstract

<b><i>Background:</i></b> Emerging evidence indicates that several hematological markers can be used to evaluate treatment response, prediction, and early relapse detection in different inflammatory conditions. This study aimed to investigate the correlation between the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet-to-neutrophil ratio, mean platelet volume, and disease activity in patients with pemphigus vulgaris. <b><i>Methods:</i></b> Fifty-six patients (20 men, 36 women; mean age 54 ± 14 years) diagnosed with pemphigus vulgaris were included in this retrospective study. Patients were divided into those treated and not treated with rituximab (groups 1 and 2), and into those who did and did not develop relapse (groups 3 and 4). The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet-to-neutrophil ratio and mean platelet volume were evaluated at the time of diagnosis, remission, and relapse. The relationship between each marker and disease stage was analyzed using the Wilcoxon rank-sum test for pairwise comparisons. <b><i>Results:</i></b> The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio showed a positive correlation with disease activity, while the platelet-to-neutrophil ratio and mean platelet volume showed a negative correlation. The neutrophil-to-lymphocyte ratio significantly decreased in remission (<i>p</i> < 0.001) and significantly increased in relapse (<i>p</i> < 0.01). The platelet-to-lymphocyte ratio significantly decreased in remission (<i>p</i> < 0.001) and showed no significant change in relapse. The platelet-to-neutrophil ratio significantly increased in remission (<i>p</i> < 0.001) and significantly decreased at relapse (<i>p</i> < 0.001). The mean platelet volume significantly increased in remission (<i>p</i> < 0.001) and decreased non-significantly at relapse. A more significant decrease in the neutrophil-to-lymphocyte ratio in remission was found in patients not treated with rituximab. No significant differences were observed between patients who developed relapse and those who did not. <b><i>Conclusion:</i></b> Our results suggest that the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet-to-neutrophil ratio, and mean platelet volume can be useful markers for monitoring treatment response, while the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio can also assist in detecting early relapse.

Factors Associated with Candidiasis in Pemphigus Vulgaris Patients: Results from a Retrospective Study in Two Second-Care Level Hospitals in Mexico

“…The median age of the patients participating in the study was 47 years, which is within the range reported in the literature [16]. A female predominance was observed in this study, as in previous epidemiologic studies of PV [17].…”

“…Two markers of systemic inflammation, the NLR and the PLR, which are correlated with the activity and severity of PV, were found to be elevated in patients with candidiasis, and elevated levels of these markers were, in turn, associated with a high risk of developing candidiasis [ 16 ]. The elevated levels of the NLR presented in this study may be attributed to an activated immune response to PV activity or relapse, as well as to a bacterial infection resulting in increased neutrophils and decreased lymphocytes, the latter being further decreased in inflammatory conditions and with megadoses of corticosteroids [ 16 , 29 ].…”

Assessment of Immune Cell Activation in Pemphigus

“…Lyakhovitsky and colleagues [ 29 ] in a recent paper also confirmed the validity of neutrophil and lymphocyte counts in pemphigus patients. Admittedly, their study was based on assessing the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, platelet-to-neutrophil ratio and mean platelet volume, without addressing the activation of these cells during the course of the disease.…”

Role of Hematological Indices as Predictors of Systemic Inflammation in Dermatology

“…This was based on their observation of the NLR and PLR correlating positively, and the MPV and PNR correlating negatively with the disease activity, with the NLR showing a more significant correlation in patients not treated with rituximab. [ 37 ] Lin and Li observed NLR and PLR (together with monocyte count and antibodies against Dsg 1 and Dsg 3) correlating positively with the pemphigus vulgaris disease activity with the NLR, low albumin-to-globulin ratio, and high anti-Dsg1 antibody levels being associated with pemphigus area disease index scores. The authors believe these findings could be more comprehensive and objective reflectors of the pemphigus vulgaris disease severity.…”