AB0429 NEUTROPHIL TO LYMPHOCYTE RATIO INDEPENDENTLY PREDICTS CUTANEOUS MANIFESTATIONS IN PATIENTS WITH SJÖGREN’S SYNDROME
Authors: A. Mihai, D. Mardale, D. Opris-Belinski, R. Ionescu, C. Jurcut
Journal: Annals of the Rheumatic Diseases (2020)

Background: Various cutaneous manifestations are described in patients with Sjogren’s syndrome (SS). However, the predictors for its occurrence are not fully investigated. Recently, data regarding the role of hematological parameters ratios in patients with rheumatic diseases were reported. However, routine hematological parameters and the derived ratios were not studied in SS patients. Objectives: The aim of this study was to evaluate the predictors for cutaneous manifestations in a large cohort of patients with SS followed in a tertiary center. Methods: We included 114 patients with SS (mean age: 53.1±12.1; 94.7% female). We divided the patients in group A – patients with cutaneous manifestations and group B – without cutaneous manifestations. The complete laboratory workup [including the calculation of neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV) to platelet ratio, platelet distribution width (PDW) to platelet ratio], clinical manifestations and treatment were reviewed and the EULAR Sjögren’s syndrome disease activity index (ESSDAI) was calculated for each patients. Results: Cutaneous manifestations were diagnosed in 11 patients (9.6%). The age of the patients, the levels of anti-SSA, complement, inflammatory markers (ESR, CRP), immunoglobulins and vitamin D levels, the ultrasonographic score of salivary glands and the ESSDAI value were similar in both groups. The patients with cutaneous manifestations were more frequently treated with hydroxychloroquine (9/11 vs 49/103, p=0.03) but the mean doses were similar in both groups. The values of anti-SSB were marginally higher in patients with cutaneous manifestations (102.3±83.1 vs 53.6±79.9, p=0.07). The lymphocyte, neutrophil count, MPV and PDW were similar in both groups, while platelet count was lower in patients with cutaneous manifestations (224090.9±59528.9 vs 264339.8±60669.0, p=0.03). The MPV/Plt ratio tended to be higher in patients with cutaneous manifestations (0.051±0.017 vs. 0.043±0.013, p=0.07), but the values of PDW/Plt ratio (0.064±0.022 vs 0.051±0.018, p=0.03) and of NLR (3.82±2.30 vs 2.35±0.92, p=0.001) were found to be significantly higher in these patients. In multivariate analysis, only the NLR remains independently associated with cutaneous manifestations (p=0.001). Using the ROC curve analysis, a cutoff of 2.70 for NLR had a 63% sensitivity and 69% specificity for cutaneous manifestations. Conclusion: The hematological parameters related to platelets appear to be modified in patients with SS and cutaneous manifestations. However, only neutrophil to lymphocite ratio is independently associated with cutaneous involvement in these patients. Disclosure of Interests: Ancuta MIHAI: None declared, DENISE MARDALE: None declared, Daniela Opris-Belinski Speakers bureau: as declared, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Ciprian Jurcut: None declared