Comparison of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio , and red blood cell distribution width during the attack phase of familial Mediterranean fever with the silent phase of the disease in patients referred to the emergency department
Abstract
Objective: As patients with acute-phase familial Mediterranean fever (FMF) require prompt diagnosis for optimal management, we are conducting a study to compare inflammatory markers during the attack and silent phases in individuals referred to the emergency department. Methods: This case-control study involved 184 FMF patients under 16 years old, with data collected at Bo Ali Hospital's emergency department in Ardabil city throughout 2022. Patients in the attack phase were assessed by emergency medicine specialists, while those in the silent phase were recruited from the rheumatology clinic. Hematological parameters were obtained from venous blood samples, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and red blood cell distribution width (RDW) were calculated. Statistical analyses included 1-Sample Kolmogorov-Smirnov, ANOVA, Tukey's-b post hoc, Independent Samples T-test, Kruskal-Wallis, and Pearson Chi-squared tests. Results: In the attack group, the NLR correlated with increased leukocytes (r=0.652, P<0.001) and RDW (r=0.310, P=0.003). The non-attack group showed a correlation between the NLR and higher leukocytes (r=0.384, P<0.001) and ESR (r=0.214, P=0.04). Additionally, the attack group exhibited a correlation between the PLR and higher leukocytes (r=0.711, P=0.009), and ESR (r=0.285, P=0.014) while no correlation was found in the non-attack group. Conclusion: Our study revealed that RDW levels were significantly higher in FMF patients, indicating clinical inflammation. During FMF attacks, NLR and PLR ratios were notably elevated, making them key markers for systemic inflammation in these patients.
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16. Inal A, Yilmaz M, Guneser Kendirli S, Altintas DU, Bingol Karakoc G. The clinical and genetical features of 124 children with familial Mediterranean fever: experience of a single tertiary center. Rheumatol Int. 2009;29(11):1279-85.
17. Medlej-Hashim M, Loiselet J, Lefranc G, Mégarbané A. [Familial Mediterranean fever (FMF): from diagnosis to treatment]. Sante (Montrouge, France). 2004;14(4):261-6.
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19. Özdemir ED, Özdemir H. Evaluate the correlations of maternal systemic ınflammatory markers such as neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with gestation age. Tropical Journal of Obstetrics and Gynaecology. 2020;37(1):62-6.
20. Pek E, Beyazit F, Nilay Korkmaz S. Predictive value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with vaginitis. Pak J Med Sci. 2021;37(1):250-5.
21. Abbasi Moghaddam A, Saremi Z, Atabati E, Sharifzadeh G. Hematologic parameters and disease activity in patients with primary Sjögren's syndrome. The Egyptian Rheumatologist. 2022;44(4):329-32.
22. Kosekli MA. Mean platelet volume and platelet to lymphocyte count ratio are associated with hepatitis B-related liver fibrosis. Eur J Gastroenterol Hepatol. 2022;34(3):324-7.
23. Kayaİslamoğlu ZG, Demirbaş A. Evaluation of complete blood cell and inflammatory parameters in patients with alopecia areata: Their association with disease severity. Journal of Cosmetic J Cosmet Dermatol. 2020;19(5):1239-45.
24. Albayrak H. Neutrophil-to-lymphocyte ratio, neutrophil-to-monocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index in psoriasis patients: response to treatment with biological drugs. J Clin Med. 2023;12(17):5452.
25. Aktaş G, Duman TT, Atak B, Kurtkulağı Ö, Bilgin S, Başaran E, et al. Irritable bowel syndrome is associated with novel inflammatory markers derived from hemogram parameters. Fam Med Prim Care Rev. 2020;22(2):107-10
26. Tezcan ME, Acer Kasman S, Şen N, Osken S, Yılmaz-Oner S. Importance of hematological markers in familial Mediterranean fever in terms of disease severity and amyloidosis. Rheumatol Int. 2023;43(7):1313-21.
27. Marzouk H, Mostafa N, Khalifa I, Badawi N, Mohamed Fathy Sabry NI. Red cell distribution width (RDW) as a marker of subclinical inflammation in children with familial Mediterranean fever. Curr Rheumatol Rev. 2020;16(4):298-303.
28. Keles A, Iskender D, Celik OY, Dagdeviren G, Iskender C, Caglar A, et al. Neutrophil-to-lymphocyte ratios in pregnant women with familial mediterranean fever. Bratisl Lek Listy. 2021;122(4):251-5.
29. Vampertzi O, Papadopoulou-Legbelou K, Triantafyllou A, Douma S, Papadopoulou-Alataki E. Familial Mediterranean fever and atherosclerosis in childhood and adolescence. Rheumatol Int. 2020;40(1):1-8.
30. Beser DM, Oluklu D, Uyan Hendem D, Yıldırım M, Tanacan A, Sahin D. Fetal thymic-thoracic ratio in pregnancies with familial Mediterranean fever. Eur J Obstet Gynecol Reprod Biol. 2023;282:105-9.
2. Kehribar DY, Özgen M. The importance of Mediterranean fever gene in familial Mediterranean fever. Eur J Rheumatol. 2020;7(4):173-6.
3. Nobakht H, Zamani F, Ajdarkosh H, Mohamadzadeh Z, Fereshtehnejad S, Nassaji M. Adult-onset familial Mediterranean fever in northwestern Iran; clinical feature and treatment outcome. Middle East J Dig Dis. 2011;3(1):50-5.
4. Balcı-Peynircioğlu B, Kaya-Akça Ü, Arıcı ZS, Avcı E, Akkaya-Ulum ZY, Karadağ Ö, et al. Comorbidities in familial Mediterranean fever: analysis of 2000 genetically confirmed patients. Rheumatology. 2020;59(6):1372-80.
5. Süzen A. The role of platelet indices, red cell distribution width and the ratios of neutrophil to lymphocyte, platelet to lymphocyte and lymphocyte to C-reactive protein as markers for the diagnosis of acute appendicitis in children. Bezmiâlem Science. 2022;10(2):135-8.
6. Avcı O, Gündoğdu O. The relationship between platelet/lymphocyte and neutrophil/lymphocyte ratios and mortality in intensive care patients with Crimean-congo hemorrhagic fever. Erciyes Med J. 2020;42(4):425-30
7. Qi X, Dong Y, Lin X, Xin W. Value of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and red blood cell distribution width in evaluating the prognosis of children with severe pneumonia. Evid Based Complement Alternat Med. 2021;2021:18186.
8. Fei Y, Wang X, Zhang H, Huang M, Chen X, Zhang C. Reference intervals of systemic immune-inflammation index, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume to platelet ratio, mean platelet volume and red blood cell distribution width-standard deviation in healthy Han adults in Wuhan region in central China. Scand J Clin Lab Invest. 2020;80(6):500-7.
9. Tezol O, Bozlu G, Sagcan F, Citak C. Value of neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio and red blood cell distribution width in distinguishing between reactive lymphadenopathy and lymphoma in children. Bratisl Lek Listy. 2020;121(4):287-92.
10. Omma A, Ssndikci SC, Enecik ME, Küçükşahin O, Çolak S, Karaaslan Y. Can the red cell distribution width be a predictor of colchicine resistance in familial Mediterraneanfever? Ortadogu Medical Journal/Ortadogu Tip Dergisi. 2016;8(3):145.
11. Akyol Onder EN, Ertan P. Fibrinogen-to-albumin ratio in familial Mediterranean fever: association with subclinical inflammation. Klin Padiatr. 2021;233(06):292-8.
12. Öztürk K, Coşkuner T, Baglan E, Sönmez HE, Otar Yener G, Çakmak F, et al. Real-life data from the largest pediatric familial Mediterranean fever cohort. Front Pediatr. 2022;9:805919.
13. Hotta Y, Kawasaki T, Kotani T, Okada H, Ikeda K, Yamane S, et al. Familial Mediterranean fever without fever. Intern Med. 2020;59(10):1267-70.
14. Park YH, Remmers EF, Lee W, Ombrello AK, Chung LK, Shilei Z, et al. Ancient familial Mediterranean fever mutations in human pyrin and resistance to Yersinia pestis. Nat Immunol. 2020;21(8):857-67.
15. KeleşoğluDinçer AB, AydemirGülöksüz EG, Sezer S, Yılmaz R, Turgay TM, Ateş A, et al. Neutrophil/lymphocyte ratio but not platelet/lymphocyte ratio and mean platelet volume can be an indicator of subclinical inflammation in patients with familial Mediterranean fever. The Egyptian Rheumatologist. 2022;44(3):215-8.
16. Inal A, Yilmaz M, Guneser Kendirli S, Altintas DU, Bingol Karakoc G. The clinical and genetical features of 124 children with familial Mediterranean fever: experience of a single tertiary center. Rheumatol Int. 2009;29(11):1279-85.
17. Medlej-Hashim M, Loiselet J, Lefranc G, Mégarbané A. [Familial Mediterranean fever (FMF): from diagnosis to treatment]. Sante (Montrouge, France). 2004;14(4):261-6.
18. Güngörer V, Yorulmaz A, Vatansev H, Arslan S. The effect of neutrophil-lymphocyte ratio and thrombocyte index on inflammation in patients with periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome. Indian Journal of Rheumatology. 2020;15(1):11-6.
19. Özdemir ED, Özdemir H. Evaluate the correlations of maternal systemic ınflammatory markers such as neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with gestation age. Tropical Journal of Obstetrics and Gynaecology. 2020;37(1):62-6.
20. Pek E, Beyazit F, Nilay Korkmaz S. Predictive value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with vaginitis. Pak J Med Sci. 2021;37(1):250-5.
21. Abbasi Moghaddam A, Saremi Z, Atabati E, Sharifzadeh G. Hematologic parameters and disease activity in patients with primary Sjögren's syndrome. The Egyptian Rheumatologist. 2022;44(4):329-32.
22. Kosekli MA. Mean platelet volume and platelet to lymphocyte count ratio are associated with hepatitis B-related liver fibrosis. Eur J Gastroenterol Hepatol. 2022;34(3):324-7.
23. Kayaİslamoğlu ZG, Demirbaş A. Evaluation of complete blood cell and inflammatory parameters in patients with alopecia areata: Their association with disease severity. Journal of Cosmetic J Cosmet Dermatol. 2020;19(5):1239-45.
24. Albayrak H. Neutrophil-to-lymphocyte ratio, neutrophil-to-monocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index in psoriasis patients: response to treatment with biological drugs. J Clin Med. 2023;12(17):5452.
25. Aktaş G, Duman TT, Atak B, Kurtkulağı Ö, Bilgin S, Başaran E, et al. Irritable bowel syndrome is associated with novel inflammatory markers derived from hemogram parameters. Fam Med Prim Care Rev. 2020;22(2):107-10
26. Tezcan ME, Acer Kasman S, Şen N, Osken S, Yılmaz-Oner S. Importance of hematological markers in familial Mediterranean fever in terms of disease severity and amyloidosis. Rheumatol Int. 2023;43(7):1313-21.
27. Marzouk H, Mostafa N, Khalifa I, Badawi N, Mohamed Fathy Sabry NI. Red cell distribution width (RDW) as a marker of subclinical inflammation in children with familial Mediterranean fever. Curr Rheumatol Rev. 2020;16(4):298-303.
28. Keles A, Iskender D, Celik OY, Dagdeviren G, Iskender C, Caglar A, et al. Neutrophil-to-lymphocyte ratios in pregnant women with familial mediterranean fever. Bratisl Lek Listy. 2021;122(4):251-5.
29. Vampertzi O, Papadopoulou-Legbelou K, Triantafyllou A, Douma S, Papadopoulou-Alataki E. Familial Mediterranean fever and atherosclerosis in childhood and adolescence. Rheumatol Int. 2020;40(1):1-8.
30. Beser DM, Oluklu D, Uyan Hendem D, Yıldırım M, Tanacan A, Sahin D. Fetal thymic-thoracic ratio in pregnancies with familial Mediterranean fever. Eur J Obstet Gynecol Reprod Biol. 2023;282:105-9.
| Files | ||
| Issue | Vol 8 No 3 (2024): Summer (July) | |
| Section | Original article | |
| DOI | 10.18502/fem.v8i3.16332 | |
| Keywords | ||
| Attack Phase Familial Mediterranean Fever Lymphocyte Neutrophil Platelet | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sandoghchian Shotorbani B, Ajri-Khamesloo F, Alizadeh F, Mahboobi L. Comparison of neutrophil/lymphocyte ratio, platelet/lymphocyte ratio , and red blood cell distribution width during the attack phase of familial Mediterranean fever with the silent phase of the disease in patients referred to the emergency department. Front Emerg Med. 2024;8(3):e25.
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