THE ROLE OF NEUTROPHIL-LYMPHOCYTE AND PLATELET-LYMPHOCYTE RATIO AS A PREDICTOR OF RELAPSE IN LUPUS NEPHRITIS

8 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-1185, Poster Board= SAT-136

Introduction:

Lupus nephritis is a major organ involvement in systemic lupus erythematosus. Periodical renal function test and urinalysis monitoring is the current standard practise in detecting early flare. Recently, there is increasing interest in using neutrophil-lymphocyte and platelet-lymphocyte ratios in detecting active lupus nephritis.

Methods:

A retrospective observational study involving patients with lupus nephritis under Nephrology clinic, Hospital Canselor Tuanku Muhriz follow up. Patients with flare of lupus nephritis from 1st January 2014 to 31st December 2023 were recruited by convenient sampling. Their laboratory investigations during flare episode were compared with those during remissive disease 3-6 months prior to the flare.

Results:

A total of 76 patients were enrolled with a mean age of 42.0±11.6 years with predominantly female (85.5%) and Chinese (50.0%) ethnicity. Both active and remissive lupus nephritis groups had medians (IQR) urine protein-creatinine index of 0.17 (0.13) and 0.04 (0.04) g/mmol whilst their medians (IQR) serum albumin were 33 (7) and 36 (4) g/L respectively. There were no significant differences of serum haemoglobin, white blood cell, platelet, and serum creatinine levels in both groups. The neutrophil-lymphocyte and platelet-lymphocyte ratios as well as their temporal trends showed significant differences with median (IQR) of neutrophil-lymphocyte ratio 2.60 (3.15) vs 2.14 (1.20), platelet-lymphocyte ratio 171.13 (148.70) vs 153.90 (74.92), delta neutrophil-lymphocyte ratio 0.62 (1.86) vs -0.14 (1.28), and delta platelet-lymphocyte ratio  21.48 (101.02) vs 0.46 (58.78) with respective p-value of <0.001, 0.001, <0.001, and <0.001 accordingly.

Parameters

N = 76

Age (years)

42.0 ± 11.6

Sex, n (%)

  Male

  Female

 

11 (14.5)

65 (85.5)

Race, n (%)

  Malay

  Chinese

  Indian

  Others

 

34 (44.7)

38 (50.0)

3 (3.9)

1 (1.3)

Comorbidities, n (%)

  Hypertension

  Diabetes mellitus

  Dyslipidaemia

  Cardiovascular disease

  Chronic liver disease

  Haematological disease

 

18 (23.7)

7 (9.2)

8 (10.5)

2 (2.6)

4 (5.3)

4 (5.3)

Baseline immunosuppressant, n (%)

  Steroids

  Second-line

  Hydroxychloroquine

 

69 (90.8)

39 (51.3)

46 (60.5)

Management of flare/relapse, n (%)

  Steroids only

  Dose adjustment of second-line immunosuppressant

  Add-on second-line immunosuppressant

    Mycophenolic acid

    Calcineurin inhibitor

    Azathioprine

    Intravenous cyclophosphamide

 

27 (35.5)

19 (25.0)

30 (39.5)

19 (63.3)

4 (13.3)

3 (10.0)

4 (13.3)

Serum creatinine, µmol/L

71.9 (24.2)

Urine PCI, g/mmol

0.17 (0.13)

Serum albumin, g/L

33 (7)

 

Parameters

Flare

Quiescence

p-value

NLR

2.60 (3.15)

2.14 (1.20)

<0.001α

PLR

171.13 (148.70)

153.90 (74.92)

0.001α

Delta NLR

0.62 (1.86)

-0.14 (1.24)

<0.001α

Delta PLR

21.48 (101.02)

0.46 (58.78)

<0.001α

Haemoglobin, g/dL

11.91 ± 2.01

11.96 ± 1.52

0.751β

White blood cell, x109/L

6.7 (3.4)

6.3 (3.4)

0.117α

Platelet, x109/L

274.3 ± 88.1

275.4 ± 83.7

0.864β

Serum creatinine, µmol/L

71.9 (24.2)

70.2 (21.3)

0.969α

Urine PCI, g/mmol

0.17 (0.13)

0.04 (0.04)

<0.001α

Serum albumin, g/L

33 (7)

36 (4)

<0.001α

Conclusions:

Both of the neutrophil-lymphocyte and platelet-lymphocyte ratios were significantly higher in active lupus nephritis compared to remissive state. Thus, the increasing trend of these parameters may predict early flare of lupus nephritis.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.