Increased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with organ involvement in ANCA-associated vasculitis: a retrospective study

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Our study aims to determine the role of NLR and PLR in evaluating vasculitis activity and specific organ involvement in antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV). Methods We retrospectively reviewed the medical records of 81 AAV patients. Clinical characteristics, laboratory investigations and Birmingham vasculitis activity score (BVAS) were collected. Correlation analysis was performed between NLR/PLR and BVAS. Receiver operating characteristic (ROC) curve was calculated for differentiating organ involvement. Results Both NLR and PLR were positively correlated with BVAS in AAV patients. AAV patients with pulmonary, cardiac or renal involvement exhibited higher levels of NLR and PLR than those without pulmonary, cardiac or renal involvement. Notably, area under curves (AUC) of NLR and PLR for differentiating cardiac involvement were 0.79 (95% CI: 0.53–0.95) and 0.77 (95% CI: 0.49–0.94), respectively. Conclusions NLR and PLR showed favorable performance in accessing vasculitis activity and specific organ involvement in AAV patients. antineutrophil cytoplasmic autoantibody - associated vasculitis (AAV) neutrophil-to-lymphocyte ratio (NLR) platelet-to-lymphocyte ratio (PLR) organ involvement Figures Figure 1 Figure 2 Background Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders characterized by inflammation and destruction of small blood vessels.( 1 ) The disease phenotypes include granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Due to the involvement of vital organs, patients with AAV have high mortality in clinical practice.( 2 , 3 ) The correct diagnosis of active disease is important for clinical outcome because timely initiation of immunosuppressive therapy can induce remission.( 4 ) However, economic and widely available serum biomarkers are still needed for evaluation of disease activity in AAV. AAV is usually accompanied by the presence of ANCA in the serum. ANCA is a valuable diagnostic marker, but it lacks predictive value for disease activity and the severity of organ involvement.( 5 ) Peripheral white blood cells and their subsets are classic protagonists of systemic inflammation. One of the essential parts in the pathogenesis of AAV is excessive activation of neutrophils which release inflammatory cytokines, lytic enzymes and reactive oxygen species that directly damage vessels.( 6 ) There is also increasing evidence that platelets are indicators of inflammation. Platelets and their secretory proteins have been proved to contribute to inflammatory response and vessel damage in AAV.( 7 ) There are several reports that indicate the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are useful as potential markers for assessing systemic inflammation.( 8 ) NLR and PLR were evaluated in different diseases including cancer, cardiovascular diseases and rheumatic diseases.( 9 , 10 ) Recent studies have also indicated the combination of NLR and PLR was valuable for predicting cardiovascular risk and mortality.( 11 ) The aim of this study was therefore to analyze NLR and PLR as biomarkers for assessment of disease activity and manifestations of disease in AAV. Methods Participants and study design This study included 81 AAV patients who were diagnosed between 2018 and 2020 in the Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital. This study was planned as the retrospective study in accordance to the 1995 Helsinki declaration and was approved by the Ethics Committee at Nanjing Drum Tower Hospital (number: 2024-1036-01). All the recruited patients met the Chapel Hill Consensus Conference Nomenclature for Vasculitis and/or the American College of Rheumatology (ACR) criteria for AAV.( 12 ) All the patients had no concomitant medical conditions to disturb AAV classification, including infections, metabolic diseases, other inflammatory diseases or any kind of malignancy.( 13 ) Demographic, clinical and laboratory data were retrieved from the electronic medical record system in the hospital. Disease activity and organ involvement was determined by the Birmingham Vasculitis Activity Score (BVAS) at the same time.( 14 , 15 ) Blood collection and calculation of BVAS were held at the same time. NLR was calculated as a ratio of neutrophil count over lymphocyte count. PLR was calculated as a ratio of platelet count over lymphocyte count. Statistics Analyzes were performed using SPSS 16.0 software or GraphPad Prism 5. Data were presented as mean ± SEM or median with range or percentage (%). To compare the difference between two groups when the continuous data fitted a normal distribution, an unpaired Student’s t test was used. To compare the differences for nonparametric data between the groups, Mann-Whitney U test was used. The spearman correlation coefficient was used to examine the correlation between two variables. To assess the ability of NLR and PLR to predict organ involvement, receiver operating characteristic (ROC) curves were constructed, and the most discriminating cut-off values were determined. A P -value < 0.05 was considered statistically significant. Results Clinical Characteristic of AAV patients The study included 81 AAV patients (34 males and 47 females) with a median age of 68 years (range from 21 to 87 years). The median disease duration of the patients was 10 months (range from 1 to 276 months). The clinical characteristics (including BVAS) and laboratory investigations of the AAV patients are presented in Table 1 . 18 patients had fever above 38.5℃, 4 patients had cutaneous manifestations, 10 patients had arthritis/arthralgia, 6 patients had eye involvement, and 11 patients had ears, nose and throat (ENT) manifestations. Pulmonary, cardiac, renal and neurological involvement were respectively present in 74, 6, 69 and 15 patients. All the patients received steroids, and 48 patients received immunosuppressants including leflunomide, azathioprine, tripterygium wilfordii, cyclophosphamide, cyclosporine, tacrolimus and or mycophenolate mofetil. 11 patients (13.6%) had c-ANCA positivity, and 56 patients (69.1%) had p-ANCA positivity. Table 1 Clinical characteristics and laboratory investigations of the ANCA-associated vasculitis (AAV) patients. Parameter AAV patients (n = 81) Clinical characteristics Male (%) 34 (42.0%) Age 68 (21–87) Duration (months) 10 (1-276) Fever > 38.5℃ 18 (22.2%) Cutaneous 4 (4.9%) Arthritis/arthralgia 10 (12.3%) Eye 6 (7.4%) ENT 11 (13.6%) Pulmonary 74 (91.4%) Cardiac 6 (7.4%) Renal 69 (85.2%) Neurological 15 (18.5%) BVAS 18.30 ± 0.67 Immunosuppressants 48 (59.3%) Laboratory investigations WBC (×10 9 /L) 9.29 ± 0.46 Neutrophils (×10 9 /L) 7.18 ± 0.41 Lymphocytes (×10 9 /L) 1.40 ± 0.08 Esinophils (×10 9 /L) 0.27 ± 0.09 Haemoglobin (g/L) 101.8 ± 2.59 Platelets (×10 9 /L) 259.4 ± 11.24 NLR 6.78 ± 0.65 PLR 235.6 ± 16.33 ALT (U/L) 22.03 ± 2.26 AST (U/L) 19.38 ± 1.84 Albumin (g/L) 33.68 ± 0.45 Creatinine (µmoI/L) 146.7 ± 15.46 Haematuria ( > + or > 10RBC/Hp) 50 (61.7%) Protenuria ( > + or > 0.2g/24h) 50 (61.7%) ESR (mm/h) 51.06 ± 3.88 CRP (mg/L) 32.80 ± 4.00 C3 (g/L) 1.11 ± 0.03 C4 (g/L) 0.26 ± 0.01 c-ANCA positivity 11 (13.6%) p-ANCA positivity 56 (69.1%) Data were presented as mean ± SEM or median with range or percentage (%). ANCA: anti-neutrophil cytoplasmic antibody; ENT: ears, nose and throat; BVAS: Birmingham Vasculitis Activity Score; WBC: white blood cell; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; C3: Complement 3; C4: Complement 4. Correlations of NLR/PLR with disease activity in AAV patients The correlations of NLR/PLR with disease activity (as showed by BVAS) were analyzed in AAV patients. We found that NLR was positively correlated with BVAS (r = 0.35, P = 0.001; Fig. 1 A). PLR was also positively correlated with BVAS in AAV patients (r = 0.31, P = 0.005; Fig. 1 B). NLR and PLR were compared according to the presence and absence of clinical manifestations, immunosuppressants received and ANCA positivity, and the corresponding data are shown in Table 2 and Table 3 . NLR and PLR did not significantly correlate with cutaneous manifestations, arthritis/arthralgia, eye involvement, ENT manifestations or immunosuppressants received. There were also no significant correlations between NLR/PLR and ANCA positivity. NLR was significantly increased in AAV patients with pulmonary involvement (7.00 ± 0.70) compared to the patients without pulmonary involvement (4.38 ± 0.89, P = 0.04). AAV patients with cardiac involvement (16.30 ± 4.71) had higher levels of NLR than the patients without cardiac involvement (6.02 ± 0.52, P = 0.02). The levels of NLR were also higher in AAV patients with renal involvement (7.19 ± 0.74) than the patients without renal involvement (4.41 ± 0.94, P = 0.03). Patients with pulmonary (244.6 ± 17.41), cardiac (401.6 ± 77.75) or renal (251.6 ± 18.20) involvement also exhibited higher levels of PLR than those without pulmonary (141.0 ± 22.81, P = 0.003), cardiac (222.3 ± 15.70, P = 0.03) or renal (143.7 ± 20.32, P = 0.0004) involvement respectively. Table 2 The neutrophil-to-lymphocyte ratio (NLR) according to the presence and absence of clinical parameters. Clinical parameters AAV patients (n = 81) Presence Absence P Fever > 38.5℃ 6.67 ± 0.95 6.81 ± 0.80 0.91 Cutaneous 11.34 ± 3.88 6.54 ± 0.65 0.31 Arthritis/arthralgia 9.63 ± 3.02 6.38 ± 0.61 0.32 Eye 9.98 ± 3.72 6.52 ± 0.64 0.40 ENT 7.95 ± 2.32 6.59 ± 0.67 0.58 Pulmonary 7.00 ± 0.70 4.38 ± 0.89 0.04 Cardiac 16.30 ± 4.71 6.02 ± 0.52 0.02 Renal 7.19 ± 0.74 4.41 ± 0.94 0.03 Neurological 5.11 ± 0.52 7.16 ± 0.79 0.66 Immunosuppressants 6.78 ± 0.98 6.77 ± 0.74 0.24 c-ANCA positivity 9.08 ± 2.49 6.41 ± 0.64 0.32 p-ANCA positivity 6.76 ± 0.75 6.82 ± 1.31 0.97 Data were presented as mean ± SEM. Table 3 The platelet-to-lymphocyte ratio (PLR) according to the presence and absence of clinical parameters. Clinical parameters AAV patients (n = 81) Presence Absence P Fever > 38.5℃ 278.4 ± 26.91 223.4 ± 19.35 0.11 Cutaneous 306.2 ± 154.2 231.9 ± 15.58 0.66 Arthritis/arthralgia 273.5 ± 63.86 230.3 ± 16.44 0.53 Eye 293.4 ± 74.46 231.0 ± 16.65 0.45 ENT 239.8 ± 48.01 235.0 ± 17.47 0.93 Pulmonary 244.6 ± 17.41 141.0 ± 22.81 0.003 Cardiac 401.6 ± 77.75 222.3 ± 15.70 0.03 Renal 251.6 ± 18.20 143.7 ± 20.32 0.0004 Neurological 182.8 ± 18.46 247.6 ± 19.34 0.30 Immunosuppressants 208.1 ± 18.90 275.6 ± 28.07 0.05 c-ANCA positivity 298.6 ± 63.85 225.7 ± 15.95 0.29 p-ANCA positivity 236.0 ± 16.82 234.6 ± 37.76 0.97 Data were presented as mean ± SEM. Relationship between NLR, PLR and organ involvement in AAV patients ROC curves were applied to define the optimal cut-off value for the prediction of specific organ involvement in AAV (Fig. 2 ). A cut-off level of 8.22 for NLR had 83% sensitivity and 80% specificity for cardiac involvement (area under curves, 0.79; 95% CI, 0.53–0.95; Table 4 ). A cut-off level of 282.6 for PLR had 83% sensitivity and 79% specificity to predict cardiac involvement (area under curves, 0.77; 95% CI, 0.49–0.94; Table 4 ). Table 4 Sensitivity and specificity of NLR and PLR cut-off values differentiating organ involvement in AAV. Cut-off value AUC (95% CI) Sensitivity Specificity Pulmonary involvement NLR 6.75 0.62 (0.44–0.80) 0.37 0.86 PLR 150.7 0.73 (0.57–0.88) 0.73 0.71 Cardiac involvement NLR 8.22 0.79 (0.53–0.95) 0.83 0.80 PLR 282.6 0.77 (0.49–0.94) 0.83 0.79 Renal involvement NLR 2.56 0.67 (0.48–0.84) 0.87 0.50 PLR 97.1 0.75 (0.61–0.90) 0.93 0.50 AUC: area under curves. Discussion In recent years the understanding of AAV pathogenesis have increased, resulting in improvements in diagnosis and management of these diseases. However, there is still unmet need of reliable biomarkers for disease activity and specific organ involvement to guide precise therapy. Systemic inflammation is usually accompanied by alterations in the count and composition of peripheral blood cells. NLR and PLR have emerged as markers to determine severity of inflammation in many diseases.( 16 , 17 ) In this study we found that NLR and PLR were both positively correlated with BVAS in AAV patients. These results indicated that NLR and PLR may serve as biomarkers for disease activity in AAV patients. Remarkably, AAV patients with pulmonary, cardiac or renal involvement had higher levels of NLR and PLR. Therefore, we suggest that NLR and PLR might also be good markers for assessing specific organ involvement in AAV patients. The primary pathogenic mechanism of AAV is neutrophil-mediated vessel damage.( 18 ) Neutrophils are the main source of autoantigens such as MPO and PR3. ANCA may bind to those autoantigens on the cell surface, resulting in neutrophil activation. Activated neutrophils then bind to vascular endothelium and release reactive oxygen species, proteases or neutrophil extracellular traps to induce vessel injury. Platelets also play an important role in the pathogenesis of vascular injury in AAV. Platelets participate in inflammatory processes as well as endothelial disruption of vessels. In experimental model of acute lung injury, platelets could activate neutrophils or interact with endothelium directly to increase vascular permeability.( 19 ) Lymphocytes are the responders of adaptive immune system, and their count may be affected by inflammation, virus infection and stress. Strikingly, NLR or PLR, in which two kinds of immune cells are integrated, is considered a more reliable marker than the count of single immune cells. Previous studies have showed that NLR could estimate vasculitis activity and poor prognosis in GPA, one of the vasculitis syndromes.( 20 ) As refer to PLR, it has also been reported that PLR was correlated with disease activity of several autoimmune diseases including dermatomyositis, psoriasis, and rheumatoid arthritis.( 21 ) In our study, we did the analysis in AAV patients, and the results showed NLR and PLR could reflect disease activity and involvement of lung, heart and kidney. Lung and kidney involvement are the most common clinical features and also the most important predictors of mortality in AAV.( 22 ) Above 75% of AAV patients have renal involvement.( 23 ) Previous studies have showed that the levels of PLR were higher in patients with chronic renal failure and were associated with increased mortality among those patients( 24 ). It has also been reported that systemic lupus erythematosus patients with nephritis had higher PLR levels than those without nephritis.( 25 ) With regard to the cardiac involvement, pericarditis, myocarditis, congestive cardiac failure or myocardial infarct may occur in AAV. Notably, our study revealed that NLR and PLR were useful predictors especially for cardiac involvement. NLR was previously found to be predictive of cardiovascular risk in patients with immune checkpoint inhibitor-associated atherosclerosis.( 26 ) In Kawasaki disease, another vasculitis syndrome, patients with aneurysms had higher NLR than patients without coronary artery abnormalities.( 27 ) PLR could also predict cardiovascular mortality among patients suffering from acute decompensated heart failure.( 28 ) Our study now provides novel data that NLR and PLR measurements may be effective and rapid means to screen AAV patients with cardiac involvement. However, prospective trials will be needed to demonstrate the efficacy of these measurements. Our study is a single-institution retrospective investigation, multi-center and long-term prospective studies on a larger sample are also recommended to validate the value of immune cell count ratios and apply them to risk prediction and therapeutic intervention in AAV Conclusions Thus, NLR and PLR are effective indicators of disease activity and specific organ involvements in AAV. NLR and PLR could be applied when there is a clinical suspicion of cardiac involvement in AAV. Abbreviations AAV antineutrophil cytoplasmic autoantibody-associated vasculitis NLR neutrophil-to-lymphocyte ratio PLR platelet-to-lymphocyte ratio BVAS Birmingham vasculitis activity score ROC Receiver operating characteristic AUC area under curves GPA granulomatosis with polyangiitis MPA microscopic polyangiitis EGPA eosinophilic granulomatosis with polyangiitis ACR American College of Rheumatology ENT ears, nose and throat Declarations Acknowledgements Not applicable. Author contributions Xin Zhang, Shengnan Zhao: conception and design, data analysis, drafting; Yantong Zhu, Liupan Zhang: interpretation of data, revising; Wei Kong, Yue Sun: conception and design, data analysis, drafting and revising. All authors read and approved the final manuscript. Funding This work was funded by grants from National Natural Science Foundation of China (grant numbers: 81971522, 81871282 and 81601365). Data availiability The data that support the findings of this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was planned as the retrospective study in accordance to the 1995 Helsinki declaration and was approved by the Ethics Committee at Nanjing Drum Tower Hospital (number: 2024-1036-01). Patient consent for publication Not applicable. Competing interests The authors declared no conflicts of interest with respect to the authorship and/or publication of this article. References Geetha D, Jefferson JA. ANCA-Associated Vasculitis: Core Curriculum 2020. Am J Kidney Dis. 2020;75(1):124-37. Mohammad AJ. An update on the epidemiology of ANCA-associated vasculitis. Rheumatology (Oxford). 2020;59(Suppl 3):iii42-iii50. Sebastiani M, Manfredi A, Vacchi C, Cassone G, Faverio P, Cavazza A, et al. Epidemiology and management of interstitial lung disease in ANCA-associated vasculitis. 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Value of neutrophil-lymphocyte ratio in predicting outcomes in Kawasaki disease. The American journal of cardiology. 2015;116(2):301-6. Heidarpour M, Bashiri S, Vakhshoori M, Heshmat-Ghahdarijani K, Khanizadeh F, Ferdowsian S, et al. The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure. BMC cardiovascular disorders. 2021;21(1):454. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5762721","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":398334260,"identity":"28dfc4f4-bfe9-49ed-a67a-793b88881ba3","order_by":0,"name":"Xin Zhang","email":"","orcid":"","institution":"Nanjing Drum Tower Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Zhang","suffix":""},{"id":398334261,"identity":"57f1e36f-f99b-45fb-b141-2748abf3d1be","order_by":1,"name":"Shengnan Zhao","email":"","orcid":"","institution":"Nanjing Drum Tower Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shengnan","middleName":"","lastName":"Zhao","suffix":""},{"id":398334268,"identity":"0a88cddf-c0d7-4321-861d-77a8c10c6016","order_by":2,"name":"Yantong Zhu","email":"","orcid":"","institution":"Nanjing Drum Tower Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yantong","middleName":"","lastName":"Zhu","suffix":""},{"id":398334270,"identity":"30a17911-d6a3-418c-a330-2f7635964255","order_by":3,"name":"Liupan Zhang","email":"","orcid":"","institution":"Nanjing Drum Tower Hospital","correspondingAuthor":false,"prefix":"","firstName":"Liupan","middleName":"","lastName":"Zhang","suffix":""},{"id":398334271,"identity":"0dfbfb05-0121-4e33-8c82-1129bd77a18f","order_by":4,"name":"Wei Kong","email":"","orcid":"","institution":"Nanjing Drum Tower Hospital","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Kong","suffix":""},{"id":398334272,"identity":"c3789228-adaa-4065-a026-9bb486f97c5b","order_by":5,"name":"Yue Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYDADxvbGxocfSNPSc7jZWII0ayTS2wR4iFEoPyP3mDRPBUMe88yHbQwSDHZyug0EtBjcyEuT5jnDUMw4O7HtQQFDsrHZAUJaJHLMpHnbGBIbZye2G0gwHEjcRkiL/AyQln9ALTMPtknwEKOF4QZISwNQywxGIrUYnHljbDnnGFBLTyIwkA2I8It8e47hjTc1DIkb248/fPihwk6OoBYgYAFG4H8GwwawpYSVgwAzOJnIE6d4FIyCUTAKRiIAACkRP4kRwmrXAAAAAElFTkSuQmCC","orcid":"","institution":"Nanjing Drum Tower Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yue","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2025-01-04 09:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5762721/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5762721/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73316558,"identity":"c70689ed-912d-41f0-8986-00d172178476","added_by":"auto","created_at":"2025-01-08 20:07:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":169243,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation of NLR or PLR with disease activity in AAV patients.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5762721/v1/2251f5c65d0d4a2dd3ad2b6b.jpg"},{"id":73316562,"identity":"c56d7355-6193-4a11-8f0d-fb3c47f5d13e","added_by":"auto","created_at":"2025-01-08 20:07:30","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":160635,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of NLR and PLR for differentiating pulmonary (A), cardiac (B) or renal (C) involvement in AAV patients.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5762721/v1/7dcd52ce56723b394b400bc3.jpg"},{"id":82799200,"identity":"901ac041-6dfb-4f88-8bc5-b4f7b735c054","added_by":"auto","created_at":"2025-05-15 10:53:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1047123,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5762721/v1/d3bfd82a-ff7c-470f-8e13-c2338ae899de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Increased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with organ involvement in ANCA-associated vasculitis: a retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eAnti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders characterized by inflammation and destruction of small blood vessels.(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The disease phenotypes include granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Due to the involvement of vital organs, patients with AAV have high mortality in clinical practice.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The correct diagnosis of active disease is important for clinical outcome because timely initiation of immunosuppressive therapy can induce remission.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) However, economic and widely available serum biomarkers are still needed for evaluation of disease activity in AAV.\u003c/p\u003e \u003cp\u003eAAV is usually accompanied by the presence of ANCA in the serum. ANCA is a valuable diagnostic marker, but it lacks predictive value for disease activity and the severity of organ involvement.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Peripheral white blood cells and their subsets are classic protagonists of systemic inflammation. One of the essential parts in the pathogenesis of AAV is excessive activation of neutrophils which release inflammatory cytokines, lytic enzymes and reactive oxygen species that directly damage vessels.(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) There is also increasing evidence that platelets are indicators of inflammation. Platelets and their secretory proteins have been proved to contribute to inflammatory response and vessel damage in AAV.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThere are several reports that indicate the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are useful as potential markers for assessing systemic inflammation.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) NLR and PLR were evaluated in different diseases including cancer, cardiovascular diseases and rheumatic diseases.(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Recent studies have also indicated the combination of NLR and PLR was valuable for predicting cardiovascular risk and mortality.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) The aim of this study was therefore to analyze NLR and PLR as biomarkers for assessment of disease activity and manifestations of disease in AAV.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and study design\u003c/h2\u003e \u003cp\u003eThis study included 81 AAV patients who were diagnosed between 2018 and 2020 in the Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital. This study was planned as the retrospective study in accordance to the 1995 Helsinki declaration and was approved by the Ethics Committee at Nanjing Drum Tower Hospital (number: 2024-1036-01). All the recruited patients met the Chapel Hill Consensus Conference Nomenclature for Vasculitis and/or the American College of Rheumatology (ACR) criteria for AAV.(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) All the patients had no concomitant medical conditions to disturb AAV classification, including infections, metabolic diseases, other inflammatory diseases or any kind of malignancy.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eDemographic, clinical and laboratory data were retrieved from the electronic medical record system in the hospital. Disease activity and organ involvement was determined by the Birmingham Vasculitis Activity Score (BVAS) at the same time.(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) Blood collection and calculation of BVAS were held at the same time. NLR was calculated as a ratio of neutrophil count over lymphocyte count. PLR was calculated as a ratio of platelet count over lymphocyte count.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eAnalyzes were performed using SPSS 16.0 software or GraphPad Prism 5. Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM or median with range or percentage (%). To compare the difference between two groups when the continuous data fitted a normal distribution, an unpaired Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e test was used. To compare the differences for nonparametric data between the groups, Mann-Whitney U test was used. The spearman correlation coefficient was used to examine the correlation between two variables. To assess the ability of NLR and PLR to predict organ involvement, receiver operating characteristic (ROC) curves were constructed, and the most discriminating cut-off values were determined. A \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eClinical Characteristic of AAV patients\u003c/h2\u003e \u003cp\u003eThe study included 81 AAV patients (34 males and 47 females) with a median age of 68 years (range from 21 to 87 years). The median disease duration of the patients was 10 months (range from 1 to 276 months). The clinical characteristics (including BVAS) and laboratory investigations of the AAV patients are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. 18 patients had fever above 38.5℃, 4 patients had cutaneous manifestations, 10 patients had arthritis/arthralgia, 6 patients had eye involvement, and 11 patients had ears, nose and throat (ENT) manifestations. Pulmonary, cardiac, renal and neurological involvement were respectively present in 74, 6, 69 and 15 patients. All the patients received steroids, and 48 patients received immunosuppressants including leflunomide, azathioprine, tripterygium wilfordii, cyclophosphamide, cyclosporine, tacrolimus and or mycophenolate mofetil. 11 patients (13.6%) had c-ANCA positivity, and 56 patients (69.1%) had p-ANCA positivity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics and laboratory investigations of the ANCA-associated vasculitis (AAV) patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAAV patients (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"13\" rowspan=\"14\"\u003e \u003cp\u003eClinical characteristics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (42.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (21\u0026ndash;87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (1-276)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFever\u0026thinsp;\u0026gt;\u0026thinsp;38.5℃\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCutaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArthritis/arthralgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eENT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (91.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRenal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (85.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBVAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmunosuppressants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (59.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"19\" rowspan=\"20\"\u003e \u003cp\u003eLaboratory investigations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWBC (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutrophils (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLymphocytes (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEsinophils (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHaemoglobin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlatelets (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235.6\u0026thinsp;\u0026plusmn;\u0026thinsp;16.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlbumin (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCreatinine (\u0026micro;moI/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHaematuria (\u0026thinsp;\u0026gt;\u0026thinsp;+\u0026thinsp;or \u0026gt;\u0026thinsp;10RBC/Hp)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (61.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtenuria (\u0026thinsp;\u0026gt;\u0026thinsp;+\u0026thinsp;or \u0026gt;\u0026thinsp;0.2g/24h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (61.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eESR (mm/h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCRP (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC3 (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eC4 (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ec-ANCA positivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep-ANCA positivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (69.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eData were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM or median with range or percentage (%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eANCA: anti-neutrophil cytoplasmic antibody; ENT: ears, nose and throat; BVAS: Birmingham Vasculitis Activity Score; WBC: white blood cell; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; C3: Complement 3; C4: Complement 4.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCorrelations of NLR/PLR with disease activity in AAV patients\u003c/h3\u003e\n\u003cp\u003eThe correlations of NLR/PLR with disease activity (as showed by BVAS) were analyzed in AAV patients. We found that NLR was positively correlated with BVAS (r\u0026thinsp;=\u0026thinsp;0.35, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). PLR was also positively correlated with BVAS in AAV patients (r\u0026thinsp;=\u0026thinsp;0.31, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNLR and PLR were compared according to the presence and absence of clinical manifestations, immunosuppressants received and ANCA positivity, and the corresponding data are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. NLR and PLR did not significantly correlate with cutaneous manifestations, arthritis/arthralgia, eye involvement, ENT manifestations or immunosuppressants received. There were also no significant correlations between NLR/PLR and ANCA positivity. NLR was significantly increased in AAV patients with pulmonary involvement (7.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70) compared to the patients without pulmonary involvement (4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04). AAV patients with cardiac involvement (16.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71) had higher levels of NLR than the patients without cardiac involvement (6.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). The levels of NLR were also higher in AAV patients with renal involvement (7.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74) than the patients without renal involvement (4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03). Patients with pulmonary (244.6\u0026thinsp;\u0026plusmn;\u0026thinsp;17.41), cardiac (401.6\u0026thinsp;\u0026plusmn;\u0026thinsp;77.75) or renal (251.6\u0026thinsp;\u0026plusmn;\u0026thinsp;18.20) involvement also exhibited higher levels of PLR than those without pulmonary (141.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.81, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), cardiac (222.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.70, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.03) or renal (143.7\u0026thinsp;\u0026plusmn;\u0026thinsp;20.32, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0004) involvement respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe neutrophil-to-lymphocyte ratio (NLR) according to the presence and absence of clinical parameters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAAV patients (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbsence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u0026thinsp;\u0026gt;\u0026thinsp;38.5℃\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCutaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArthritis/arthralgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eENT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunosuppressants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec-ANCA positivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-ANCA positivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe platelet-to-lymphocyte ratio (PLR) according to the presence and absence of clinical parameters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAAV patients (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbsence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u0026thinsp;\u0026gt;\u0026thinsp;38.5℃\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e278.4\u0026thinsp;\u0026plusmn;\u0026thinsp;26.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223.4\u0026thinsp;\u0026plusmn;\u0026thinsp;19.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCutaneous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e306.2\u0026thinsp;\u0026plusmn;\u0026thinsp;154.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231.9\u0026thinsp;\u0026plusmn;\u0026thinsp;15.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArthritis/arthralgia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e273.5\u0026thinsp;\u0026plusmn;\u0026thinsp;63.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e230.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEye\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e293.4\u0026thinsp;\u0026plusmn;\u0026thinsp;74.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231.0\u0026thinsp;\u0026plusmn;\u0026thinsp;16.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eENT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e239.8\u0026thinsp;\u0026plusmn;\u0026thinsp;48.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e244.6\u0026thinsp;\u0026plusmn;\u0026thinsp;17.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141.0\u0026thinsp;\u0026plusmn;\u0026thinsp;22.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e401.6\u0026thinsp;\u0026plusmn;\u0026thinsp;77.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e222.3\u0026thinsp;\u0026plusmn;\u0026thinsp;15.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e251.6\u0026thinsp;\u0026plusmn;\u0026thinsp;18.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143.7\u0026thinsp;\u0026plusmn;\u0026thinsp;20.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurological\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e182.8\u0026thinsp;\u0026plusmn;\u0026thinsp;18.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247.6\u0026thinsp;\u0026plusmn;\u0026thinsp;19.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunosuppressants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e208.1\u0026thinsp;\u0026plusmn;\u0026thinsp;18.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e275.6\u0026thinsp;\u0026plusmn;\u0026thinsp;28.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec-ANCA positivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e298.6\u0026thinsp;\u0026plusmn;\u0026thinsp;63.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225.7\u0026thinsp;\u0026plusmn;\u0026thinsp;15.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep-ANCA positivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e236.0\u0026thinsp;\u0026plusmn;\u0026thinsp;16.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e234.6\u0026thinsp;\u0026plusmn;\u0026thinsp;37.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eData were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SEM.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRelationship between NLR, PLR and organ involvement in AAV patients\u003c/h2\u003e \u003cp\u003eROC curves were applied to define the optimal cut-off value for the prediction of specific organ involvement in AAV (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A cut-off level of 8.22 for NLR had 83% sensitivity and 80% specificity for cardiac involvement (area under curves, 0.79; 95% CI, 0.53\u0026ndash;0.95; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). A cut-off level of 282.6 for PLR had 83% sensitivity and 79% specificity to predict cardiac involvement (area under curves, 0.77; 95% CI, 0.49\u0026ndash;0.94; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity and specificity of NLR and PLR cut-off values differentiating organ involvement in AAV.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCut-off value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAUC (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.62 (0.44\u0026ndash;0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73 (0.57\u0026ndash;0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79 (0.53\u0026ndash;0.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e282.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77 (0.49\u0026ndash;0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal involvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.67 (0.48\u0026ndash;0.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75 (0.61\u0026ndash;0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAUC: area under curves.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn recent years the understanding of AAV pathogenesis have increased, resulting in improvements in diagnosis and management of these diseases. However, there is still unmet need of reliable biomarkers for disease activity and specific organ involvement to guide precise therapy. Systemic inflammation is usually accompanied by alterations in the count and composition of peripheral blood cells. NLR and PLR have emerged as markers to determine severity of inflammation in many diseases.(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this study we found that NLR and PLR were both positively correlated with BVAS in AAV patients. These results indicated that NLR and PLR may serve as biomarkers for disease activity in AAV patients. Remarkably, AAV patients with pulmonary, cardiac or renal involvement had higher levels of NLR and PLR. Therefore, we suggest that NLR and PLR might also be good markers for assessing specific organ involvement in AAV patients.\u003c/p\u003e \u003cp\u003eThe primary pathogenic mechanism of AAV is neutrophil-mediated vessel damage.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) Neutrophils are the main source of autoantigens such as MPO and PR3. ANCA may bind to those autoantigens on the cell surface, resulting in neutrophil activation. Activated neutrophils then bind to vascular endothelium and release reactive oxygen species, proteases or neutrophil extracellular traps to induce vessel injury. Platelets also play an important role in the pathogenesis of vascular injury in AAV. Platelets participate in inflammatory processes as well as endothelial disruption of vessels. In experimental model of acute lung injury, platelets could activate neutrophils or interact with endothelium directly to increase vascular permeability.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Lymphocytes are the responders of adaptive immune system, and their count may be affected by inflammation, virus infection and stress. Strikingly, NLR or PLR, in which two kinds of immune cells are integrated, is considered a more reliable marker than the count of single immune cells.\u003c/p\u003e \u003cp\u003ePrevious studies have showed that NLR could estimate vasculitis activity and poor prognosis in GPA, one of the vasculitis syndromes.(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) As refer to PLR, it has also been reported that PLR was correlated with disease activity of several autoimmune diseases including dermatomyositis, psoriasis, and rheumatoid arthritis.(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) In our study, we did the analysis in AAV patients, and the results showed NLR and PLR could reflect disease activity and involvement of lung, heart and kidney. Lung and kidney involvement are the most common clinical features and also the most important predictors of mortality in AAV.(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) Above 75% of AAV patients have renal involvement.(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) Previous studies have showed that the levels of PLR were higher in patients with chronic renal failure and were associated with increased mortality among those patients(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). It has also been reported that systemic lupus erythematosus patients with nephritis had higher PLR levels than those without nephritis.(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWith regard to the cardiac involvement, pericarditis, myocarditis, congestive cardiac failure or myocardial infarct may occur in AAV. Notably, our study revealed that NLR and PLR were useful predictors especially for cardiac involvement. NLR was previously found to be predictive of cardiovascular risk in patients with immune checkpoint inhibitor-associated atherosclerosis.(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) In Kawasaki disease, another vasculitis syndrome, patients with aneurysms had higher NLR than patients without coronary artery abnormalities.(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) PLR could also predict cardiovascular mortality among patients suffering from acute decompensated heart failure.(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) Our study now provides novel data that NLR and PLR measurements may be effective and rapid means to screen AAV patients with cardiac involvement. However, prospective trials will be needed to demonstrate the efficacy of these measurements. Our study is a single-institution retrospective investigation, multi-center and long-term prospective studies on a larger sample are also recommended to validate the value of immune cell count ratios and apply them to risk prediction and therapeutic intervention in AAV\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThus, NLR and PLR are effective indicators of disease activity and specific organ involvements in AAV. NLR and PLR could be applied when there is a clinical suspicion of cardiac involvement in AAV.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAAV antineutrophil cytoplasmic autoantibody-associated vasculitis\u003c/p\u003e\n\u003cp\u003eNLR neutrophil-to-lymphocyte ratio\u003c/p\u003e\n\u003cp\u003ePLR platelet-to-lymphocyte ratio\u003c/p\u003e\n\u003cp\u003eBVAS Birmingham vasculitis activity score\u003c/p\u003e\n\u003cp\u003eROC Receiver operating characteristic\u003c/p\u003e\n\u003cp\u003eAUC area under curves\u003c/p\u003e\n\u003cp\u003eGPA granulomatosis with polyangiitis\u003c/p\u003e\n\u003cp\u003eMPA microscopic polyangiitis\u003c/p\u003e\n\u003cp\u003eEGPA eosinophilic granulomatosis with polyangiitis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eACR American College of Rheumatology\u003c/p\u003e\n\u003cp\u003eENT ears, nose and throat\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXin Zhang, Shengnan Zhao: conception and design, data analysis, drafting; Yantong Zhu, Liupan Zhang: interpretation of data, revising; Wei Kong, Yue Sun: conception and design, data analysis, drafting and revising. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by grants from National Natural Science Foundation of China (grant numbers: 81971522, 81871282 and 81601365).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availiability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was planned as the retrospective study in accordance to the 1995 Helsinki declaration and was approved by the Ethics Committee at Nanjing Drum Tower Hospital\u0026nbsp;(number: 2024-1036-01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no conflicts of interest with respect to the authorship and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGeetha D, Jefferson JA. 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The association of neutrophil-to-lymphocyte ratio with all-cause mortality in Chinese patients with MPO-ANCA associated vasculitis. Clin Exp Med. 2020;20(3):401-8.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;i\u0026ccedil;ek G, A\u0026ccedil;ıkgoz SK, Bozbay M, Altay S, Uğur M, Uluganyan M, et al. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio combination can predict prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology. 2015;66(5):441-7.\u003c/li\u003e\n\u003cli\u003eJennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1-11.\u003c/li\u003e\n\u003cli\u003eNoel N, Andr\u0026eacute; C, Bengoufa D, Dehoulle C, Mahler M, Limal N, et al. Performance evaluation of three assays for the detection of PR3-ANCA in granulomatosis with polyangiitis in daily practice. Autoimmun Rev. 2013;12(12):1118-22.\u003c/li\u003e\n\u003cli\u003eMukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S, et al. Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis. 2009;68(12):1827-32.\u003c/li\u003e\n\u003cli\u003eGuillevin L, Pagnoux C, Seror R, Mahr A, Mouthon L, Toumelin PL. The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine. 2011;90(1):19-27.\u003c/li\u003e\n\u003cli\u003eTedesco M, Gallieni M, Pellegata F, Cozzolino M, Alberici F. Update on ANCA-associated vasculitis: from biomarkers to therapy. J Nephrol. 2019;32(6):871-82.\u003c/li\u003e\n\u003cli\u003eAhn SS, Jung SM, Song JJ, Park YB, Lee SW. Neutrophil to lymphocyte ratio at diagnosis can estimate vasculitis activity and poor prognosis in patients with ANCA-associated vasculitis: a retrospective study. BMC Nephrol. 2018;19(1):187.\u003c/li\u003e\n\u003cli\u003eAlmaani S, Fussner LA, Brodsky S, Meara AS, Jayne D. ANCA-Associated Vasculitis: An Update. Journal of clinical medicine. 2021;10(7).\u003c/li\u003e\n\u003cli\u003eCaudrillier A, Kessenbrock K, Gilliss BM, Nguyen JX, Marques MB, Monestier M, et al. Platelets induce neutrophil extracellular traps in transfusion-related acute lung injury. J Clin Invest. 2012;122(7):2661-71.\u003c/li\u003e\n\u003cli\u003eAbaza NM, El-Latif EMA, Gheita TA. Clinical Significance of Neutrophil/lymphocyte Ratio in Patients With Granulomatosis With Polyangiitis. Reumatologia clinica. 2019;15(6):363-7.\u003c/li\u003e\n\u003cli\u003eFu H, Qin B, Hu Z, Ma N, Yang M, Wei T, et al. Neutrophil- and platelet-to-lymphocyte ratios are correlated with disease activity in rheumatoid arthritis. Clinical laboratory. 2015;61(3-4):269-73.\u003c/li\u003e\n\u003cli\u003eMercuzot C, Letertre S, Daien CI, Zerkowski L, Guilpain P, Terrier B, et al. Comorbidities and health-related quality of life in Patients with Antineutrophil Cytoplasmic Antibody (ANCA) - associated vasculitis. Autoimmun Rev. 2021;20(1):102708.\u003c/li\u003e\n\u003cli\u003eMiyabe Y, Karasawa K, Takabe T, Ogura S, Sugiura N, Kyoda M, et al. Long-term follow-up characteristics of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) receiving chronic hemodialysis at a single center. Clinical and experimental nephrology. 2020;24(2):136-42.\u003c/li\u003e\n\u003cli\u003eAhbap E, Sakaci T, Kara E, Sahutoglu T, Koc Y, Basturk T, et al. Neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio in evaluation of inflammation in end-stage renal disease. Clinical nephrology. 2016;85(4):199-208.\u003c/li\u003e\n\u003cli\u003eQin B, Ma N, Tang Q, Wei T, Yang M, Fu H, et al. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients. Mod Rheumatol. 2016;26(3):372-6.\u003c/li\u003e\n\u003cli\u003eAdamstein NH, Ridker PM. The neutrophil-lymphocyte ratio: considerations for clinical application. European heart journal. 2021;42(22):2216-7.\u003c/li\u003e\n\u003cli\u003eHa KS, Lee J, Jang GY, Lee J, Lee KC, Son CS, et al. Value of neutrophil-lymphocyte ratio in predicting outcomes in Kawasaki disease. The American journal of cardiology. 2015;116(2):301-6.\u003c/li\u003e\n\u003cli\u003eHeidarpour M, Bashiri S, Vakhshoori M, Heshmat-Ghahdarijani K, Khanizadeh F, Ferdowsian S, et al. The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure. BMC cardiovascular disorders. 2021;21(1):454.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"antineutrophil cytoplasmic autoantibody - associated vasculitis (AAV), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), organ involvement","lastPublishedDoi":"10.21203/rs.3.rs-5762721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5762721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNeutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been used to estimate disease activity in many diseases. Our study aims to determine the role of NLR and PLR in evaluating vasculitis activity and specific organ involvement in antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e We retrospectively reviewed the medical records of 81 AAV patients. Clinical characteristics, laboratory investigations and Birmingham vasculitis activity score (BVAS) were collected. Correlation analysis was performed between NLR/PLR and BVAS. Receiver operating characteristic (ROC) curve was calculated for differentiating organ involvement.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBoth NLR and PLR were positively correlated with BVAS in AAV patients. AAV patients with pulmonary, cardiac or renal involvement exhibited higher levels of NLR and PLR than those without pulmonary, cardiac or renal involvement. Notably, area under curves (AUC) of NLR and PLR for differentiating cardiac involvement were 0.79 (95% CI: 0.53\u0026ndash;0.95) and 0.77 (95% CI: 0.49\u0026ndash;0.94), respectively.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNLR and PLR showed favorable performance in accessing vasculitis activity and specific organ involvement in AAV patients.\u003c/p\u003e","manuscriptTitle":"Increased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with organ involvement in ANCA-associated vasculitis: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-08 20:07:25","doi":"10.21203/rs.3.rs-5762721/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1b8a2d1d-b92f-42a1-a754-8b4702c28f13","owner":[],"postedDate":"January 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-15T10:53:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-08 20:07:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5762721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5762721","identity":"rs-5762721","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}