Background/Purpose: Neutrophil/lymphocyte ratio (NLR) has recently been extensively studied as a prognostic indicator in various malignancies, as well as an indicator of severity in cardiovascular disorders, including coronary arterial disease and hypertention.  Its prognostic value in vasculitic disorders remains to be investigated. Aim of the study was to investigate NLR and its association with renal outcome in patients with granulomatosis with polyangiitis.

Methods: We studied 41 patients (mean±SD age 50±14 and M/F 23/17) with granulomatosis with polyangiitis. Data were obtained retrospectively from medical records. 17 patients had renal involvement of the vasculitis. Baseline C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), neutrophil and lympocyte counts were recorded. NLRs were calculated using the formula (neutrophil count/lymphocyte count). Serum creatinine levels at baseline and at 6-month follow-up were also recorded. Non-parametric tests were used for analyses.

Results: Median NLR of the entire group at baseline was high (4,5 [IQ range 5,8]).  NLR at baseline correlated significantly with ESR and CRP levels (r=0,402, p<0,001 and r=0,481,  p<0,001, respectively).  Patients with NLR greater than 8.3 (the highest quartile) had significantly higher creatinine at baseline, as well as at 6 month follow-up (Mann-Whitney test p=0.002 and p=0.05, respectively). Patients with vasculitic renal involvement had higher NLR at baseline compared to those with non-renal vasculitis (5,0 [IQ range 10,9] vs 2,9 [IQ range 7,7], p=0,05). In the subgroup with renal involvement, baseline NLR correlated significantly with baseline creatinine levels (r=0,52, p=0,026). Moreover, in this subgroup, those with NLR at the highest quartile had significantly higher baseline, as well as 6-month follow-up creatinine (p=0,011 and 0,037, respectively) compared to those with renal involvment but lower NLR.

Conclusion: Results suggest that NLR at baseline correlates with renal function and those with a higher NLR at baseline have worse kidney outcome at 6 month follow-up. Further studies are needed to elucidate the function of neutrophils in the pathogenesis of tissue damage in a lymphocyte-mediated disease, such as granulomatosis with polyangiitis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/neutrophillymphocyte-ratio-could-it-be-a-prognostic-indicator-for-renal-outcome-in-patients-with-granulomatosis-with-polyangiitis/