Department of Pulmonary Disease, University of Health Sciences Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Pulmonary Disease, Acıbadem Hospital Chest Diseases, Istanbul, Turkey.
Postgrad Med. 2022 Aug;134(6):603-608. doi: 10.1080/00325481.2022.2082805. Epub 2022 Jun 6.
To evaluate the utility of neutrophil-lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis.
A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cutoff value via ROC analysis.
Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34-4.31) vs. 2.29 (1.67-3.23), p = 0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p = 0.001). ROC analysis revealed an NLR cutoff value of ≥2.39 (AUC (95% CI): 0.70 (0.62-0.79), p < 0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥2.39 (74.0 vs. 47.0%, p = 0.002).
Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.
评估中性粒细胞与淋巴细胞比值（NLR）在初诊时预测疾病晚期和区分结节病活动期与稳定期的价值。
本回顾性横断面研究共纳入 465 例经活检证实的结节病患者（年龄：47 岁，70.5%为女性）。记录患者的人口统计学资料、结节病分期、临床状态（活动期和稳定期）、抗炎治疗、全血细胞计数和炎症标志物，包括红细胞沉降率（ESR）、C 反应蛋白（CRP）、中性粒细胞与淋巴细胞比值（NLR）和血小板/平均血小板体积（MPV）比值。根据结节病分期和临床状态对患者进行亚组分组，比较 NLR 值，同时绘制受试者工作特征（ROC）曲线，通过 ROC 分析计算曲线下面积（AUC）和截断值，以确定 NLR 在识别疾病活动中的作用。
总体而言，36 例（7.8%）患者为活动期，427 例（92.2%）患者为稳定期。与稳定期相比，活动期患者的 NLR 值中位数明显更高（3.31（2.34-4.31）vs. 2.29（1.67-3.23），p=0.005）。0 期、I 期、II 期、III 期和 IV 期的结节病患者 NLR 值明显更高（p=0.001）。ROC 分析显示，NLR 截断值≥2.39（AUC（95%CI）：0.70（0.62-0.79），p<0.001）可区分活动期和稳定期，敏感性为 72.0%，特异性为 52.0%。与稳定期相比，活动期患者 NLR 值≥2.39 的比例显著更高（74.0% vs. 47.0%，p=0.002）。
本研究结果表明，入院时 NLR 值可用于预测晚期疾病风险，并区分结节病的活动期和稳定期，这可能具有潜在价值。通过简单、易得且低成本的检测方法测量 NLR，似乎是监测疾病活动和进展的有价值标志物。
