Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Department of Medicine, Surgery, and Pharmacy, University of Sassari, Sassari, Italy.
Clin Exp Med. 2024 Jul 25;24(1):170. doi: 10.1007/s10238-024-01438-5.
The wide range of clinical and serological manifestations in systemic lupus erythematosus (SLE) and the lack of accepted diagnostic criteria warrant the identification of novel, more accurate biomarkers. Hematological indices derived from full blood cell counts, particularly the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have shown promise in SLE; however, a critical appraisal of their diagnostic accuracy is lacking. We sought to address this issue by conducting a systematic review and meta-analysis of the diagnostic accuracy of the NLR and PLR in SLE. The electronic databases PubMed, Scopus, and Web of Science were systematically searched from inception to 15 March 2024 for studies reporting the sensitivity and specificity of the NLR and PLR, obtained by receiver operating characteristic (ROC) curve analysis, for the presence of SLE, disease severity, organ involvement (lupus nephritis, pericarditis, and pleural disease), and complications (infections). The risk of bias was assessed using the JBI Critical Appraisal Checklist (PROSPERO registration number: CRD42024531446). The NLR exhibited good accuracy for the diagnosis of SLE (eight studies; area under the curve, AUC = 0.81, 95% CI 0.78-0.85) and lupus nephritis (nine studies; AUC = 0.81, 95% CI 0.77-0.84), but not for severe disease (nine studies; AUC = 0.69, 95% CI 0.65-0.73) or infections (six studies; AUC = 0.73, 95% CI 0.69-0.77). The PLR exhibited good accuracy for the diagnosis of severe disease (six studies; AUC = 0.85, 95% CI 0.81-0.87). There were an insufficient number of studies to assess the accuracy of the PLR for the diagnosis of SLE, lupus nephritis, or infections. No study investigated the NLR and PLR in SLE patients with pericarditis or pleural disease. Therefore, the NLR and the PLR have a relatively high diagnostic accuracy for the presence of SLE and lupus nephritis (NLR) and severe disease (PLR). Further studies are warranted to determine whether the NLR and PLR, in combination with clinical evaluation and other serological biomarkers, can enhance the diagnosis and management of SLE.
系统性红斑狼疮（SLE）的临床表现和血清学表现广泛，且缺乏公认的诊断标准，因此需要确定新的、更准确的生物标志物。源自全血细胞计数的血液学指标，特别是中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR），在 SLE 中显示出了一定的应用前景；然而，其诊断准确性的关键性评估仍有所欠缺。因此，我们通过对 NLR 和 PLR 在 SLE 中的诊断准确性进行系统评价和荟萃分析来解决这一问题。我们系统地检索了电子数据库 PubMed、Scopus 和 Web of Science，从建库至 2024 年 3 月 15 日，以获取通过接收者操作特征（ROC）曲线分析报告 NLR 和 PLR 的敏感性和特异性的研究，这些研究的纳入标准为：存在 SLE、疾病严重程度、器官受累（狼疮肾炎、心包炎和胸腔疾病）和并发症（感染）。使用 JBI 批判性评估清单（PROSPERO 注册号：CRD42024531446）评估偏倚风险。NLR 对 SLE（8 项研究；曲线下面积 AUC=0.81，95%置信区间 0.78-0.85）和狼疮肾炎（9 项研究；AUC=0.81，95%置信区间 0.77-0.84）的诊断具有良好的准确性，但对严重疾病（9 项研究；AUC=0.69，95%置信区间 0.65-0.73）或感染（6 项研究；AUC=0.73，95%置信区间 0.69-0.77）的诊断准确性不佳。PLR 对严重疾病（6 项研究；AUC=0.85，95%置信区间 0.81-0.87）的诊断具有良好的准确性。用于评估 PLR 对 SLE、狼疮肾炎或感染的诊断准确性的研究数量不足。没有研究调查 NLR 和 PLR 在患有心包炎或胸腔疾病的 SLE 患者中的应用。因此，NLR 和 PLR 对 SLE 和狼疮肾炎（NLR）以及严重疾病（PLR）的存在具有相对较高的诊断准确性。需要进一步的研究来确定 NLR 和 PLR 是否可以与临床评估和其他血清学标志物结合使用，从而提高 SLE 的诊断和管理水平。
