The neutrophil-to-lymphocyte ratio could be a good diagnostic marker and predictor of relapse in patients with adult-onset Still's disease

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.

Cytomegalovirus Infection May Trigger Adult-Onset Still's Disease Onset or Relapses

“…First CMV DNA was positively correlated with the count of leukocytes in AOSD patients. Neutrophils, the first line of innate immune defense against infection, are the primary effector cells in the pathogenesis of AOSD (30). Recent data demonstrate a profound survival response and delayed apoptosis in neutrophils exposed to CMV by secreting pro-survival secretome (31), further supporting the hypothesis that CMV infection may trigger inflammatory response of neutrophils.…”

Neutrophil‐to‐C3 ratio and neutrophil‐to‐lymphocyte ratio were associated with disease activity in patients with systemic lupus erythematosus

“…Neutrophil‐to‐lymphocyte ratio (NLR), calculated as neutrophil counts divided by lymphocyte counts, is considered as a marker for general immune responses to various stress stimuli . It was considered as a good diagnostic marker with autoimmune diseases, such as adult‐onset Still's disease . It was associated with disease activity in patients with systemic lupus erythematosus .…”

Adult-onset Still’s disease with macrophage activation syndrome diagnosed and treated based on cytokine profiling: a case-based review

“…In addition, one other research paper was related to the remission of AOSD. Seo et al report that the neutrophil-to-lymphocyte (NLR) ratio is a useful marker for predicting the onset of MAS in AOSD [17]. The NLR, with a cutoff value of 5.86, showed a sensitivity of 89.4%, specificity of 87.8%, and area under the curve of 0.794.…”