Higher blood neutrophil count, lymphocyte ratio predict more severe systemic sclerosis
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Higher blood neutrophil count and neutrophil-to-lymphocyte ratio predict more severe disease and increased mortality in patients with systemic sclerosis, according to data published in Arthritis Care and Research.
“We observed a neutrophil gene expression signature in patients with systemic sclerosis in our previous peripheral blood global gene expression studies,” Shervin Assassi, MD, MS, of the University of Texas Health Science Center, told Healio. “This neutrophil gene expression signature showed a correlation with the neutrophil count. Building on these findings, we examined whether a neutrophil count or neutrophil/lymphocyte ratio has prognostic value in systemic sclerosis.”
To investigate the relationship between blood neutrophil count, and neutrophil-to-lymphocyte ratio (NLR), and disease severity and mortality in patients with SSc, Assassi and colleagues evaluated data from the GENISOS cohort and Scleroderma Lung Study II. All 477 patients in the GENISOS cohort met the criteria for SSc set forth by the American College of Rheumatology and EULAR. Of the included patients, 377 had baseline neutrophil and lymphocyte counts available. Skin thickness was assessed using a modified Rodnan Skin Score (mRSS) at baseline and follow-up visits. Forced vital capacity was measured using pulmonary function tests.
Forced vital capacity, expressed as percentage of predicted forced vital capacity, was used as a surrogate measure for SSc-related interstitial lung disease and overall disease severity. All pulmonary function tests were reviewed by two pulmonologists. Vital data for participants were obtained through medical records and inquiries through the National Death Index, the CDC and the Social Security Death Index.
According to the researchers, higher baseline neutrophil was associated with higher baseline mRSS (P < .001) and lower forced vital capacity percentages (P = .035). There were no noted associations between baseline lymphocyte counts and forced vital capacity or mRSS scores.
Higher baseline neutrophil counts (P = .002) and NLR (P < .001) were associated with higher rates of mortality in a univariable analysis. Additionally, older age at enrollment and African American race were both associated with higher mortality, the authors wrote.
“The role of neutrophils in systemic sclerosis pathogenesis is not well-studied,” Assassi said. “Our study indicates that higher neutrophil count and neutrophil-lymphocyte ratio is a marker for more severe disease in systemic sclerosis because they showed predictive significance for more severe skin and lung involvement, as well as mortality. The present study underscores the importance of future research on the role of neutrophils in systemic sclerosis pathogenesis, as well as its role as prognostic biomarker for more severe disease course.”
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