Assessment of Platelet to Lymphocyte ratio and Neutrophil to Lymphocyte ratio as potential biomarkers in patients with rheumatoid arthritis at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
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Date
2019-11
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Addis Ababa University
Abstract
Background: Rheumatoid Arthritis (RA) is a chronic, systemic autoimmune disease involving
inflammation of synovial joints. The interest in the study of platelet to lymphocyte ratio (PLR)
and neutrophil to lymphocyte ratio( NLR) has grown recently because they have been found to
be predictive of the prognosis of patients with diverse inflammatory and ischemic conditions and
these ratios are easily calculated from hematology analyzer printout. However, in Ethiopia no
published study is available in this regard.
Objective: This study aimed to assess platelet to lymphocyte ratio (PLR) and neutrophil to
lymphocyte ratio (NLR) as potential biomarkers in patients with rheumatoid arthritis at St. Paul's
Hospital Millennium Medical College, Addis Ababa, Ethiopia from April-July, 2019.
Method: This comparative cross-sectional study enrolled 61 newly diagnosed adult rheumatoid
arthritis patients and 61 sex and age matched healthy controls. Blood sample was collected from
all study participants using convenient sampling technique. CBC was measured using Mindray
BC5300 hematology analyzer and BD sedintainer was used for ESR measurement, while RF
and CRP were done based on latex agglutination method. Data analysis was done using SPSS
version 20. Level of significance between groups was analyzed using independent student t-test
and Mann-Whitney U test. Receiver operating characteristic (ROC) curves was used to evaluate
the performance of PLR and NLR. P values less than 0.05 was taken as statistically significant.
Result: The median PLR and NLR were significantly increased in RA patients compared with
healthy controls 195(IQR, 150-242) vs 125(105-150), P<0.05; 2.4(1.85-3.5) vs. 1.6(1.3-1.9),
P<0.05 respectively). ROC curves analysis showed that PLR had area under the curve(AUC) of
0.859 with 85.2% sensitivity and 66% specificity as a marker of rheumatoid arthritis and NLR
had AUC of 0.80 with sensitivity and specificity of 78.3% and 68% respectively.
Conclusion: There was a statistically significant increment in the level of Platelet to lymphocyte
ratio and Neutrophil to lymphocyte ratio among new RA patients compared with healthy
controls. In addition ROC curves analysis revealed a good diagnostic performance. Therefore,
PLR and NLR can be added to routine diagnostic parameters as indicators in the assessment of
rheumatoid arthritis patients. So, further studies with larger numbers of RA cases is needed to
better understand the role of PLR and NLR in patients with RA.
Description
This is to certify that the thesis prepared by Senait Abate, entitled: Assessment of Platelet to
Lymphocyte ratio and Neutrophil to Lymphocyte ratio as potential biomarkers in patients with
rheumatoid arthritis at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
submitted in partial fulfillment of the requirements for Master of Science degree in Clinical
Laboratory Sciences (Hematology and Immunohematology) complies with the regulations of the
University and meets the accepted standards with respect to originality and quality.
Keywords
Rheumatoid arthritis, Platelet to lymphocyte ratio, Neutrophil to lymphocyte ratio.