Yonsei Med J.  2018 May;59(3):397-405. 10.3349/ymj.2018.59.3.397.

Delta Neutrophil Index Is Associated with Vasculitis Activity and Risk of Relapse in ANCA-Associated Vasculitis

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. sangwonlee@yuhs.ac
  • 2Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Delta neutrophil index (DNI) represents the immature granulocytes count associated with neutrophil-consumption. We investigated whether DNI might be associated with Birmingham vasculitis activity score (BVAS) at diagnosis and could predict relapse during the follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
MATERIALS AND METHODS
We reviewed the medical records of 97 patients having DNI results. Twenty patients had granulomatosis with polyangiitis (GPA), 58 had microscopic polyangiitis (MPA), and 19 had eosinophilic GPA (EGPA). We collected clinical and laboratory data including BVAS, five factor score (FFS), and DNI. The correlation coefficient and cumulative relapse free survival rate were obtained. The optimal cut-off of DNI was extrapolated by calculating the area under the receiver operator characteristic curve.
RESULTS
DNI was significantly related to cross-sectional BVAS. Furthermore, among continuous variables, only DNI could reflect BVAS of GPA and MPA, but not EGPA. Severe AAV was defined as BVAS ≥20 (the highest quartile). At diagnosis, patients having DNI ≥0.65% had a significantly higher risk of severe GPA and MPA than those having not (relative risk 4.255) at diagnosis. During the follow-up, DNI ≥0.65% could predict the higher relapse rate.
CONCLUSION
DNI could reflect BVAS at diagnosis and furthermore, DNI ≥0.65% could not only identify severe AAV at diagnosis, but also predict relapse during the follow-up in patients with GPA and MPA.

Keyword

Delta neutrophil index; granulomatosis with polyangiitis; microscopic polyangiitis; vasculitis activity

MeSH Terms

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis*
Cytoplasm
Diagnosis
Eosinophils
Follow-Up Studies
Granulocytes
Granulomatosis with Polyangiitis
Humans
Medical Records
Microscopic Polyangiitis
Neutrophils*
Recurrence*
Survival Rate
Vasculitis*

Figure

  • Fig. 1 DNI identified severe AAV at diagnosis and predicted relapse of GPA and MPA during the follow-up. (A) Patients having DNI ≥0.65% had severe AAV (BVAS ≥20) more frequently than those having DNI <0.65% (35.3% vs. 11.4%, p=0.011). (B) In Kaplan-Meier survival analysis, patients having DNI ≥0.65% exhibited lower cumulative relapse free survival rate than those having DNI <0.65% (p=0.029). DNI, delta neutrophil index; AAV, antineutrophil cytoplasmic antibody-associated vasculitis; GPA, granulomatosis with polyangiitis; MPA, microscopic polyangiitis; BVAS, Birmingham vasculitis activity score; RR, relative risk.


Cited by  2 articles

Antineutrophil Cytoplasmic Antibody-Associated Vasculitis in Korea: A Narrative Review
Chan-Bum Choi, Yong-Beom Park, Sang-Won Lee
Yonsei Med J. 2019;60(1):10-21.    doi: 10.3349/ymj.2019.60.1.10.

Controlling Nutritional Status Score is Associated with All-Cause Mortality in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis
Sung Soo Ahn, Seung Min Jung, Jason Jungsik Song, Yong-Beom Park, Sang-Won Lee
Yonsei Med J. 2019;60(12):1164-1173.    doi: 10.3349/ymj.2019.60.12.1164.


Reference

1. Jennette 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; 65:1–11. PMID: 23045170.
Article
2. Millet A, Pederzoli-Ribeil M, Guillevin L, Witko-Sarsat V, Mouthon L. Antineutrophil cytoplasmic antibody-associated vasculitides: is it time to split up the group. Ann Rheum Dis. 2013; 72:1273–1279. PMID: 23606701.
Article
3. Watts R, Lane S, Hanslik T, Hauser T, Hellmich B, Koldingsnes W, et al. Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis. 2007; 66:222–227. PMID: 16901958.
Article
4. Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthritis Rheum. 1990; 33:1101–1107. PMID: 2202308.
Article
5. Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum. 1990; 33:1094–1100. PMID: 2202307.
Article
6. de Lind van Wijngaarden RA, van Rijn L, Hagen EC, Watts RA, Gregorini G, Tervaert JW, et al. Hypotheses on the etiology of antineutrophil cytoplasmic autoantibody associated vasculitis: the cause is hidden, but the result is known. Clin J Am Soc Nephrol. 2008; 3:237–252. PMID: 18077783.
7. Jennette JC, Falk RJ. Pathogenesis of antineutrophil cytoplasmic autoantibody-mediated disease. Nat Rev Rheumatol. 2014; 10:463–473. PMID: 25003769.
Article
8. Jennette JC, Falk RJ, Hu P, Xiao H. Pathogenesis of antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitis. Annu Rev Pathol. 2013; 8:139–160. PMID: 23347350.
Article
9. Honda T, Uehara T, Matsumoto G, Arai S, Sugano M. Neutrophil left shift and white blood cell count as markers of bacterial infection. Clin Chim Acta. 2016; 457:46–53. PMID: 27034055.
Article
10. Field D, Taube E, Heumann S. Performance evaluation of the immature granulocyte parameter on the Sysmex XE-2100 automated hematology analyzer. Lab Hematol. 2006; 12:11–14. PMID: 16513542.
Article
11. Nigro KG, O'Riordan M, Molloy EJ, Walsh MC, Sandhaus LM. Performance of an automated immature granulocyte count as a predictor of neonatal sepsis. Am J Clin Pathol. 2005; 123:618–624. PMID: 15743752.
Article
12. Nahm CH, Choi JW, Lee J. Delta neutrophil index in automated immature granulocyte counts for assessing disease severity of patients with sepsis. Ann Clin Lab Sci. 2008; 38:241–246. PMID: 18715852.
13. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36:309–332. PMID: 18538699.
Article
14. Pyo JY, Park JS, Park YB, Lee SK, Ha YJ, Lee SW. Delta neutrophil index as a marker for differential diagnosis between flare and infection in febrile systemic lupus erythematosus patients. Lupus. 2013; 22:1102–1109. PMID: 23934401.
Article
15. Park HJ, Ha YJ, Pyo JY, Park YB, Lee SK, Lee SW. Delta neutrophil index as an early marker for differential diagnosis of adult-onset Still’s disease and sepsis. Yonsei Med J. 2014; 55:753–759. PMID: 24719144.
Article
16. Pyo JY, Ha YJ, Song JJ, Park YB, Lee SK, Lee SW. Delta neutrophil index contributes to the differential diagnosis between acute gout attack and cellulitis within 24 hours after hospitalization. Rheumatology (Oxford). 2017; 56:795–801. PMID: 28115599.
Article
17. Csernok E, Moosig F. Current and emerging techniques for ANCA detection in vasculitis. Nat Rev Rheumatol. 2014; 10:494–501. PMID: 24890776.
Article
18. Mukhtyar 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; 68:1827–1832. PMID: 19054820.
Article
19. Stone JH, Hoffman GS, Merkel PA, Min YI, Uhlfelder ML, Hellmann DB, et al. A disease-specific activity index for Wegener's granulomatosis: modification of the Birmingham Vasculitis Activity Score. International Network for the Study of the Systemic Vasculitides (INSSYS). Arthritis Rheum. 2001; 44:912–920. PMID: 11318006.
20. Gayraud M, Guillevin L, le Toumelin P, Cohen P, Lhote F, Casassus P, et al. Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum. 2001; 44:666–675. PMID: 11263782.
Article
21. Guillevin L, Pagnoux C, Seror R, Mahr A, Mouthon L, Le Toumelin P. French Vasculitis Study Group (FVSG). assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore). 2011; 90:19–27. PMID: 21200183.
22. Mukhtyar C, Hellmich B, Jayne D, Flossmann O, Luqmani R. Remission in antineutrophil cytoplasmic antibody-associated systemic vasculitis. Clin Exp Rheumatol. 2006; 24(6 Suppl 43):S-93-8.
23. Mukhtyar C, Flossmann O, Hellmich B, Bacon P, Cid M, Cohen-Tervaert JW, et al. Outcomes from studies of antineutrophil cytoplasm antibody associated vasculitis: a systematic review by the European League Against Rheumatism systemic vasculitis task force. Ann Rheum Dis. 2008; 67:1004–1010. PMID: 17911225.
Article
24. Oh YJ, Ahn SS, Park ES, Jung SM, Song JJ, Park YB, et al. Chest and renal involvements, Birmingham vascular activity score more than 13.5 and five factor score (1996) more than 1 at diagnosis are significant predictors of relapse of microscopic polyangiitis. Clin Exp Rheumatol. 2017; 35(Suppl 103):47–54.
25. Yoo J, Kim HJ, Ahn SS, Jung SM, Song JJ, Park YB, et al. Clinical and prognostic features of Korean patients with MPO-ANCA, PR3-ANCA and ANCA-negative vasculitis. Clin Exp Rheumatol. 2017; 35(Suppl 103):111–118. PMID: 28339364.
26. Nakazawa D, Tomaru U, Suzuki A, Masuda S, Hasegawa R, Kobayashi T, et al. Abnormal conformation and impaired degradation of propylthiouracil-induced neutrophil extracellular traps: implications of disordered neutrophil extracellular traps in a rat model of myeloperoxidase antineutrophil cytoplasmic antibodyassociated vasculitis. Arthritis Rheum. 2012; 64:3779–3787. PMID: 22777766.
27. Schreiber A, Kettritz R. The neutrophil in antineutrophil cytoplasmic autoantibody-associated vasculitis. J Leukoc Biol. 2013; 94:623–631. PMID: 23381471.
Article
28. Kettritz R. How anti-neutrophil cytoplasmic autoantibodies activate neutrophils. Clin Exp Immunol. 2012; 169:220–228. PMID: 22861361.
Article
29. Ooi JD, Chang J, Hickey MJ, Borza DB, Fugger L, Holdsworth SR, et al. The immunodominant myeloperoxidase T-cell epitope induces local cell-mediated injury in antimyeloperoxidase glomerulonephritis. Proc Natl Acad Sci U S A. 2012; 109:E2615–E2624. PMID: 22955884.
Article
30. Furuta S, Jayne DR. Antineutrophil cytoplasm antibody-associated vasculitis: recent developments. Kidney Int. 2013; 84:244–249. PMID: 23423257.
Article
31. Xiao H, Dairaghi DJ, Powers JP, Ertl LS, Baumgart T, Wang Y, et al. C5a receptor (CD88) blockade protects against MPO-ANCA GN. J Am Soc Nephrol. 2014; 25:225–231. PMID: 24179165.
Article
32. Charles Jennette J, Xiao H, Hu P. Complement in ANCA-associated vasculitis. Semin Nephrol. 2013; 33:557–564. PMID: 24161040.
Article
33. Sanders JS, Abdulahad WH, Stegeman CA, Kallenberg CG. Pathogenesis of antineutrophil cytoplasmic autoantibody-associated vasculitis and potential targets for biologic treatment. Nephron Clin Pract. 2014; 128:216–223. PMID: 25401277.
Article
34. Oh YJ, Ahn SS, Park ES, Jung SM, Song JJ, Park YB, et al. Birmingham vasculitis activity score at diagnosis is a significant predictor of relapse of polyarteritis nodosa. Rheumatol Int. 2017; 37:685–694. PMID: 28341881.
Article
Full Text Links
  • YMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr