Background/Purpose: The need for readily available markers of SLE activity has led to the evaluation of laboratory parameters, such as the neutrophil to lymphocyte ratio (NLR). Our goal was to ascertain the association of NLR with SLE activity and damage, and further evaluate its association with disease specific health-related quality of life (HRQoL) and depression.

Methods: This cross-sectional study included data from 134 patients from the Cyprus SLE registry. All patients fulfilled the SLICC classification criteria 2012. The following data were captured: NLR, demographic parameters, patient self-rated health (poor/fair vs. good/excellent), SELENA-SLEDAI index (score ≥4 was defined as active disease), SLICC/ACR damage index (DI) (damage defined as score ≥1). HRQoL was assessed by the Lupus QoL, a disease specific measure that includes 8 domains (physical health, pain, planning, intimacy, burden to others, emotional health, body image, and fatigue). Each domain score ranges from 0 to 100, with higher scores indicating better QoL. Depression was evaluated by the patient health questionnaire (PHQ-9) and higher scores suggest the presence of impaired depressive symptoms. Scores ≥15 are consistent with severe or moderately severe depression. Patients were separated in two groups using an NLR cutoff of 2.73, which corresponds to the 90th percentile of healthy individuals. Mean ± SD and median (q1, q3) were reported for normally and not normally distributed variables and compared using the student’s t-test and Wilcoxon test, respectively. Categorical variables were compared using the χ2 test of independence. Unadjusted and adjusted logistic regression models were used, adjusting for age, sex, and BMI and odds ratios (OR) with the corresponding 95% CIs and p-values were reported. All tests performed were two-tailed, using an alpha level of significance of 0.05

Results: Out of the 134 SLE patients, 47 (35%) had NLR ≥2.73 and among them the mean age was 47 years old and 85% were females. Compared to the NLR< 2.73 group, SLE patients with NLR ≥2.73 were more likely to report poor/fair self-rated health (53.2% vs. 28.7%, p=0.005) and higher activity based on the SELENA-SLEDAI-index (median 4 vs. 2, p=0.002). There was no statistically significant difference between the groups in SLICC/ACR DI (p=0.054) or presence of damage (p=0.057). Several LupusQoL domains such as physical health (p=0.012), planning (p=0.010), and body image (p=0.028), were significantly lower in the high NLR group (Table 1). While no significant difference was found in the presence of depression (PHQ ≥10) (p=0.143) or overall PHQ-9 score (p=0.082), there were significantly more patients with moderately severe or severe depression (PHQ ≥15) in the high NLR group (23.9% vs. 5.8%, p=0.002). Adjusted logistic regression models revealed a significant association between high NLR and moderately severe or severe depression (OR=7.21), poor/fair self-reported health (OR=2.79), high disease activity (SLEDAI≥4) (OR=2.23) and the presence of damage (SLIC/ACR DI ≥1) (OR=2.51).

Conclusion: High NLR in SLE patients is associated with active disease, damage, severe depression, and worse HRQoL and self-rated health.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/investigating-the-neutrophil-to-lymphocyte-ratio-as-a-marker-of-sle-disease-activity-health-related-quality-of-life-and-depression/