Internal Medicine Department, University of Algiers 1, Faculty of Medical Sciences, Benyoucef Benkhedda, Bab El Oued University Hospital Center, Bab El Oued city, Algiers, Algeria.
Biochemistry, Hemotology and Genetics Laboratory of Research, Bab El Oued University Hospital Center, Bab El Oued City, Algiers Algeria.
Medicine (Baltimore). 2022 Aug 12;101(32):e29970. doi: 10.1097/MD.0000000000029970.
This study was performed to investigate the role of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of adult onset Still disease (AOSD) and its performance to improve the sensitivity of the classifications criteria (Yamaguchi and Fautrel Classifications). We conducted a multicenter prospective nationwide case-control study in Internal medicine, Rheumatology and Infectious disease departments, to include successively patients with suspected AOSD (2 or more major criteria of Yamaguchi or Fautrel classifications). All clinical and biological features were collected in a consensual and standardized clinical assessment at baseline and during follow-up. A receiving operating characteristic (ROC) curve was used to reassess the cutoff value of NLR. After determination of the cutoff value for NLR by ROC curve, 2 composite sets (Yamaguchi classification + NLR as a major criterion and Fautrel classification + NLR as a major criterion) were performed and evaluated. One hundred sixty patients were included, 80 patients with AOSD and 60 controls with different diagnoses. Twenty patients with incomplete data were excluded. The cutoff value for NLR equals 4 (area under the curve, AUC: 0.82). The NLR was ≥ 4 in 93.7% (75/80) of AOSD patients with a sensitivity of 93.8% and specificity of 61.7%. The association of NLR as a major criterion with the classification of Yamaguchi or Fautrel improved their sensitivity, respectively for Fautrel (76.3% to 92.5%, P = .004) and Yamaguchi (78.8% to 90%, P = .05). This study validates the NLR as a good simple biomarker of AOSD with a cutoff value of 4 and high sensitivity (93.8%). The addition of NLR (NLR ≥ 4) as a major criterion to the classifications (Yamaguchi and Fautrel) improved significantly their sensitivity and accuracy.
本研究旨在探讨中性粒细胞与淋巴细胞比值（NLR）在成人Still 病（AOSD）诊断中的作用及其对提高分类标准（Yamaguchi 和 Fautrel 分类）敏感性的作用。我们在内科、风湿病学和传染病科进行了一项多中心前瞻性全国性病例对照研究，纳入了符合 Yamaguchi 或 Fautrel 分类标准 2 项或更多主要标准的疑似 AOSD 患者。在基线和随访期间，通过一致和标准化的临床评估收集所有临床和生物学特征。采用接收者操作特征（ROC）曲线重新评估 NLR 的临界值。通过 ROC 曲线确定 NLR 的临界值后，进行了 2 项复合组（Yamaguchi 分类+NLR 作为主要标准和 Fautrel 分类+NLR 作为主要标准）并进行了评估。共纳入 160 例患者，其中 AOSD 患者 80 例，其他诊断患者 60 例。20 例患者因数据不完整被排除。NLR 的临界值等于 4（曲线下面积，AUC：0.82）。93.7%（75/80）的 AOSD 患者 NLR≥4，其敏感性为 93.8%，特异性为 61.7%。将 NLR 作为主要标准与 Yamaguchi 或 Fautrel 分类相结合，分别提高了 Fautrel（76.3%至 92.5%，P=0.004）和 Yamaguchi（78.8%至 90%，P=0.05）分类的敏感性。本研究验证了 NLR 作为一种具有 4 截断值和高敏感性（93.8%）的 AOSD 良好的简单生物标志物。将 NLR（NLR≥4）作为主要标准添加到分类（Yamaguchi 和 Fautrel）中，显著提高了它们的敏感性和准确性。
