J Rheum Dis.  2018 Jul;25(3):169-178. 10.4078/jrd.2018.25.3.169.

Association between the Neutrophil-to-lymphocyte Ratio, and Platelet-to-lymphocyte Ratio and Rheumatoid Arthritis and their Correlations with the Disease Activity: A Meta-analysis

• Lee YH

• KMID: 2415605
• DOI: http://doi.org/10.4078/jrd.2018.25.3.169

Abstract

OBJECTIVE
This study examined the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and rheumatoid arthritis (RA), to establish a correlation among the NLR, PLR, and MPV and RA activity.
METHODS
Medline, Embase, and Cochrane were searched, and a meta-analysis was performed to compare the NLR, PLR, and MPV between RA patients and healthy controls. The correlation coefficients between NLR, PLR, and MPV and the Disease Activity Score 28 (DAS28) in the RA patients were examined.
RESULTS
Sixteen studies were included in this meta-analysis. NLR was significantly higher in the RA group (standardized mean difference [SMD], 0.800; 95% confidence interval [CI], 0.542~1.058; p < 0.001). Stratification according to ethnicity revealed a significantly elevated NLR in the RA group in Asian and Turkish populations (SMD, 95% CI: 0.994, 0.418~1.519, p=0.001 and 0.695, 0.443~0.948, p < 0.001, respectively). Subgroup analysis revealed a significantly high NLR in RA, independent of the data type and adjustment for age and/or sex. PLR was also significantly higher in the RA group (SMD, 0.708; 95% CI, 0.401~0.995; p < 0.001), regardless of ethnicity, data type, and adjustment for age and/or sex. In addition, NLR and PLR were positively associated with the RA activity based on the DAS28 (correlation coefficient, 95% CI: 0.277, 0.190~0.359, p < 0.001 and 0.318, 0.197~0.430, p < 0.001, respectively). However, MPV showed no correlation with the RA activity (correlation coefficient, −0.095; 95% CI, −0.435 to 0.269; p=0.615).
CONCLUSION
Meta-analysis showed that the NLR and PLR were significantly higher in the RA patients and positively but weakly correlated with the RA activity.

Keyword

Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio; Mean platelet volume; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid*
Asian Continental Ancestry Group
Humans
Mean Platelet Volume

Figure

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  Supplementary Figure 1. Sensitivity analysis. NLR: neutrophil-to-lymphocyte ratio, PLR: platelet-to-lymphocyte ratio, MPV: mean platelet volume, Std diff: standard difference, CI: confidence interval, RA: rheumatoid arthritis.

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  Supplementary Figure 2. Funnel plot of publication bias. NLR: neutrophil-to-lymphocyte ratio, PLR: platelet-to-lymphocyte ratio, MPV: mean platelet volume, Std diff: standard difference, Std Err: standard error.

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  Figure 1. Flow diagram of the study selection process. SLE: systemic lupus erythematosus.

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  Figure 2. Meta-analysis of the relationship of (A) NLR, (B) PLR, and (C) MPV to RA and the correlation coefficients between (D) NLR, (E) PLR, and (F) MPV and DAS28. NLR: neutrophil-to-lymphocyte ratio, PLR: plate-let-to-lymphocyte ratio, MPV: mean platelet volume, RA: rheumatoid arthritis, DAS28: Disease Activity Score 28, Std diff: standard difference, CI: confidence interval.

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