The Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China.
J Dermatol. 2021 Sep;48(9):1394-1400. doi: 10.1111/1346-8138.15968. Epub 2021 Jun 1.
The neutrophil : lymphocyte ratio (NLR), platelet : lymphocyte ratio (PLR), C-reactive protein : albumin ratio (CAR), and albumin : fibrinogen ratio (AFR) have been considered as useful inflammatory biomarkers. However, their roles in Stevens-Johnson Syndrome (SJS)/toxic epidermal necrolysis (TEN) still remain unclear. This study aimed to test whether NLR, PLR, CAR, and AFR serve as predictive markers of disease severity and systemic inflammation in patients with SJS/TEN. This retrospective study included 40 patients with SJS/TEN and 60 healthy controls. The correlation between these markers and severity-of-illness score for toxic epidermal necrolysis (SCORTEN), ABCD-10, procalcitonin (PCT), C-reactive protein (CRP) were analyzed and compared. Univariable and multivariable analysis were used to assess associations of variables with mortality. The receiver-operator curves (ROC) were used to evaluate the predictive value of variables for mortality in SJS/TEN patients. The results demonstrated that the NLR and PLR of SJS/TEN patients were significantly higher and the AFR was significantly lower when compared with healthy controls (p < 0.05). The NLR and CAR were positively correlated with SCORTEN, ABCD-10, PCT, and CRP. The NLR in SCORTEN of ≥3 group was significantly higher than that in SCORTEN <3 group (p < 0.05) and there were no significant differences between PLR, CAR, and AFR between the two groups. The univariate analysis suggested that NLR of >5.79 was a risk factor for mortality (odds ratio, 10.5; p < 0.05), but the association was no longer statistically significant in multivariable analysis. The ROC showed that NLR had a sensitivity of 85.7% and specificity of 63.6% for predicting death with a cut-off value of 5.79 (p < 0.05) in SJS/TEN patients. In conclusion, among the four markers, NLR and CAR can partially reflect severity and inflammatory status in patients with SJS/TEN. NLR was also a predictor of death.
中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、C 反应蛋白与白蛋白比值（CAR）和白蛋白与纤维蛋白原比值（AFR）已被认为是有用的炎症生物标志物。然而，它们在 Stevens-Johnson 综合征（SJS）/中毒性表皮坏死松解症（TEN）中的作用仍不清楚。本研究旨在检验 NLR、PLR、CAR 和 AFR 是否可作为 SJS/TEN 患者疾病严重程度和全身炎症的预测标志物。这项回顾性研究纳入了 40 例 SJS/TEN 患者和 60 名健康对照者。分析并比较了这些标志物与中毒性表皮坏死松解症评分（SCORTEN）、ABCD-10、降钙素原（PCT）、C 反应蛋白（CRP）之间的相关性。采用单变量和多变量分析评估变量与死亡率的相关性。采用受试者工作特征曲线（ROC）评估变量对 SJS/TEN 患者死亡率的预测价值。结果显示，与健康对照组相比，SJS/TEN 患者的 NLR 和 PLR 显著升高，而 AFR 显著降低（p<0.05）。NLR 和 CAR 与 SCORTEN、ABCD-10、PCT 和 CRP 呈正相关。SCORTEN 评分≥3 组的 NLR 明显高于 SCORTEN<3 组（p<0.05），两组间 PLR、CAR 和 AFR 无显著差异。单变量分析提示，NLR>5.79 是死亡的危险因素（比值比，10.5；p<0.05），但多变量分析时这种相关性不再具有统计学意义。ROC 显示，NLR 预测 SJS/TEN 患者死亡的截断值为 5.79 时，其灵敏度为 85.7%，特异性为 63.6%（p<0.05）。总之，在这 4 个标志物中，NLR 和 CAR 可部分反映 SJS/TEN 患者的严重程度和炎症状态。NLR 也是死亡的预测因子。
