Abstract
Henoch–Schönlein purpura (HSP) is the most common systemic vasculitis of childhood. Gastrointestinal (GI) bleeding is one of the major complications of HSP. The blood neutrophil-to-lymphocyte ratio (NLR) is identified as a potentially useful marker of clinical outcome in inflammatory diseases. NLR may be a useful biomarker of GI bleeding in children with HSP, which has a neutrophil-dominated inflammation. The aim of this study was to evaluate NLR in patients with HSP and to investigate the relationship with GI bleeding. The study consisted of 63 HSP patients and 38 age- and sex-matched healthy children. C-reactive protein, white blood cell count, platelet count, mean platelet volume (MPV), hemoglobin level, and NLR were evaluated. Logistic regression analysis and receiver operating characteristic (ROC) analysis were used to determine the variables associated with GI bleeding. NLR and MPV were the only two indicators associated with GI bleeding in HSP in logistic regression analysis. The area under the ROC curve analysis indicated that NLR could be a more efficient potential predictor of GI bleeding in HSP when compared to MPV. This study suggested that higher NLR might predict GI bleeding in HSP.
Similar content being viewed by others
References
Batu ED, Özen S (2012) Pediatric vasculitis. Curr Rheumatol Rep 14:121–129
Trapani S, Micheli A, Grisolia F, Resti M, Chiappini E, Falcini F, De Martino M (2005) Henoch–Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthr Rheum 35:143–153
Ozen S, Bakkaloglu A, Dusunsel R, Soylemezoglu O, Ozaltin F, Poyrazoglu H, Kasapcopur O, Ozkaya O, Yalcinkaya F, Balat A, Kural N, Donmez O, Alpay H, Anarat A, Mir S, Gur-Guven A, Sonmez F, Gok F, Turkish Pediatric Vasculitis Study Group (2007) Childhood vasculitides in Turkey: a nationwide survey. Clin Rheumatol 26:196–200
Calvino MC, Llorca J, Garcia-Porrua C, Fernández-Iglesias JL, Rodriguez-Ledo P, González-Gay MA (2001) Henoch–Schonlein purpura in children from northwestern Spain. A 20–year epidemiologic and clinical study. Medicine 80:279–290
Saulsbury FT (1999) Henoch–Schonlein purpura in children. Report of 100 patients and review of the literature. Medicine 78:395–409
Cull DL, Rosario V, Lally KP, Ratner I, Mahour GH (1990) Surgical implications of Henoch–Schonlein purpura. J Pediatr Surg 25:741–743
Lin SJ, Huang JL, Hsieh KH (1998) Clinical and laboratory correlation of acute Henoch–Schonlein purpura in children. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 39:94–98
Saulsbury FT, Kesler RW (1983) Thrombocytosis in Henoch–Schonlein purpura. Clin Pediatr 22:185–187
Makay B, Türkyilmaz Z, Duman M, Unsal E (2009) Mean platelet volume in Henoch–Schönlein purpura: relationship to gastrointestinal bleeding. Clin Rheumatol 28:1225–1228
O’Brien CE, Price ET (2013) The blood neutrophil to lymphocyte ratio correlates with clinical status in children with cystic fibrosis: a retrospective study. PLoS ONE 8(10):e77420. doi:10.1371/journal.pone.0077420
Kim JY, Park T, Jeong SH, Jeong CY, Ju YT, Lee YJ, Hong SC, Ha WS, Choi SK, Jung EJ (2013) Prognostic importance of baseline neutrophil to lymphocyte ratio in patients with advanced papillary thyroid carcinomas. Endocrine. doi:10.1007/s12020-013-0089-6
Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS (2008) Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 102:653–657
Nunez JE, Nunez E, Bodi V, Miñana G, Mainar L, Santas E, Merlos P, Rumiz E, Darmofal H, Heatta AM, Llàcer A (2008) Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 101:747–752
Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ (2005) Neutrophil lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 91:181–184
Uslu AU, Deveci K, Korkmaz S, Aydin B, Senel S, Sancakdar E, Sencan M (2013) Is neutrophil/lymphocyte ratio associated with subclinical inflammation and amyloidosis in patients with familial Mediterranean fever? Biomed Res Int. doi:10.1155/2013/185317
Ozen S, Ruperto N, Dillon MJ, Bagga A, Barron K, Davin JC, Kawasaki T, Lindsley C, Petty RE, Prieur AM, Ravelli A, Woo P (2006) EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 65:936–941
Besbas N, Saatci U, Ruacan S, Ozen S, Sungur A, Bakkaloglu A, Elnahas AM (1997) The role of cytokines in Henoch–Schonlein purpura. Scand J Rheumatol 26:456–460
Ha TS (2005) The role of tumor necrosis factor-alpha in Henoch–Schonlein purpura. Pediatr Nephrol 20:149–153
Wyllie DH, Bowler IC, Peto TE (2004) Relation between lymphopenia and bacteraemia in UK adults with medical emergencies. J Clin Pathol 57:950–955
Menges T, Engel J, Welters I, Wagner RM, Little S, Ruwoldt R, Wollbrueck M, Hempelmann G (1999) Changes in blood lymphocyte populations after multiple trauma. Crit Care Med 27:733–740
Hotchkiss RS, Swanson PE, Freeman BD, Tinsley KW, Cobb JP, Matuschak GM, Buchman TG, Karl IE (1999) Apoptotic cell death in patients with sepsis, shock, and multiple organ dysfunction. Crit Care Med 27:1230–1251
Ronkainen J, Koskimies O, Ala-Houhala M, Antikainen M, Merenmies J, Rajantie J, Ormälä T, Turtinen J, Nuutinen M (2006) Early prednisone therapy in Henoch–Schönlein purpura: a randomized, double-blind, placebo-controlled trial. J Pediatr 149:241–247
Weiss PF, Klink AJ, Localio R, Hall M, Hexem K, Burnham JM, Keren R, Feudtner C (2010) Corticosteroids may improve clinical outcomes during hospitalization for Henoch–Schönlein purpura. Pediatrics 126:674–681
Chartapisak W, Opastirakul S, Hodson E, Willis N, Craig J (2009) Interventions for preventing and treating kidney disease in Henoch–Schönlein purpura (HSP). Cochrane Datab Syst Rev 2009:005128
Jauhola O, Ronkainen J, Koskimies O, Ala-Houhala M, Arikoski P, Hölttä T, Jahnukainen T, Rajantie J, Örmälä T, Nuutinen M (2012) Outcome of Henoch–Schönlein purpura 8 years after treatment with a placebo or prednisone at disease onset. Pediatr Nephrol 27:933–999
Conflict of interest
None of the authors have conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Makay, B., Gücenmez, Ö.A., Duman, M. et al. The relationship of neutrophil-to-lymphocyte ratio with gastrointestinal bleeding in Henoch–Schonlein purpura. Rheumatol Int 34, 1323–1327 (2014). https://doi.org/10.1007/s00296-014-2986-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-014-2986-2