Can Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Tumor Necrosis Factor Alpha Predict Lupus Nephritis Flares?

Abstract

Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune multisystem disease with an array of variable presentations in which the kidney is the most affected organ and influences the overall outcome of the patients. Methodology: The study is a case control study conducted on 90 SLE patients diagnosed according to ACR criteria grouped into three subgroups. It aims at evaluating the role of serum tumor necrosis factor alpha (TNFα), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in diagnosing renal flares and predicting the prognosis in lupus nephritis patients. Results: A highly significant difference was observed between both the SLE starting dialysis group, the SLE nephritis ( LN ) group, and the control group regarding neutrophil to lymphocyte ratio and TNFα (p<0.001 & ˂ 0.001, respectively). The median serum Neutrophil/Lymphocyte and TNFα were statistically significantly higher in the SLE starting dialysis patient group than the LN patients and the control group. A cut-off value of ≤ 200 for serum TNFα level and of ≤ 4.8 for Neutrophil/lymphocyte ratio sufficiently differentiated between the LN patients and the SLE patients starting dialysis. TNFα cut-off value showed sensitivity of 76.67%, specificity of 96.67%, positive predictive value of 95.8% and negative predictive value of 80.6 %. Neutrophil/Lymphocyte cut-off showed sensitivity of 70.00%, specificity of 70.00%, positive predictive value of 70.00% and negative predictive value of 70.00 %. Conclusion: NLR and TNFα serum levels appear to be useful biomarkers for disease flares and tissue injury in LN patients. Both can identify disease activities, relapses and remissions in lupus nephritis patients.