Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
The Significance of Hematological Parameters in Predicting Disease Activity in Chronic Spontaneous Urticaria and Their Changes with Omalizumab: A Retrospective Cohort Study
Kronik Spontan Ürtikerde Hastalık Aktivitesini Öngörmede Hematolojik Parametrelerin Önemi ve Omalizumab ile Değişimleri: Retrospektif Bir Kohort Çalışması
Cansu ALTINÖZ GÜNEYa , Akın AKTAŞa
aAnkara Yıldırım Beyazıt University Faculty of Medicine, Department of Dermatology, Ankara, Türkiye
Turkiye Klinikleri J Dermatol. 2024;34(2):59-67
doi: 10.5336/dermato.2023-100276
Article Language: EN
Full Text
ABSTRACT
 Objective: To investigate the change of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-tomonocyte ratio (LMR), neutrophil-to-monocyte ratio (NMR), mean platelet volume (MPV), the red blood cell distribution width (RDW), C-reactive protein (CRP), and total immunoglobulin E (IgE) with omalizumab treatment in patients with chronic spontaneous urticaria (CSU). Additionally, to evaluate the relationship between complete blood cell count (CBC)-derived biomarkers and urticaria activity score (UAS7), as well as their relationship with CRP and total IgE, known indicators of disease activity in CSU. Material and Methods: CBC, CRP, total IgE and UAS7 values of 101 patients before and at the 12th week of treatment were analyzed retrospectively. Results: Before the omalizumab treatment, a significant difference was found between the mild+moderate and severe urticaria groups for the NLR (p=0.023) and NMR (p=0.019). At the 12th week of treatment; a significant increase was observed in MPV (p=0.010), LMR (p=0.031), and total IgE (p<0.001) while NLR (p<0.001), PLR (p=0.013), NMR (p<0.001) and CRP (p<0.001) significantly decreased. There was no significant correlation between CBC-derived biomarkers and UAS7 before and after the treatment. Of the CBC-derived biomarkers, only RDW and MPV showed a weak correlation with CRP. Besides, solely NMR had a weak negative correlation with total IgE just for post-treatment. Conclusion: NLR and NMR may reflect the severity of CSU. The inflammatory biomarkers showed a significant change during omalizumab treatment. Omalizumab inhibits inflammation as well as having anti-IgE effect. The lack of correlation between the biomarkers and UAS7 may be attributed to the involvement of different complex inflammatory pathways in the pathogenesis of urticaria.

Keywords: Chronic spontaneous urticaria; omalizumab; CBC-derived biomarkers; C-reactive protein; total immunoglobulin E
ÖZET
 Amaç: Kronik spontan ürtikerli (KSÜ) hastalarda omalizumab tedavisi ile nötrofil-lenfosit oranı [neutrophil-to-lymphocyte ratio (NLR)], trombosit-lenfosit oranı [platelet-to-lymphocyte ratio (PLR)], lenfosit-monosit oranı [lymphocyte-to-monocyte ratio (LMR)], nötrofil-monosit oranı [neutrophil-to-monocyte ratio (NMR)], ortalama trombosit hacmi [mean platelet volume (MPV)], eritrosit dağılım genişliği [red blood cell distribution width (RDW)], C-reaktif protein (CRP) ve total immünglobulin E'deki (IgE) değişimleri incelemektir. Ayrıca, tam kan sayımı kaynaklı biyobelirteçlerin hastalık aktivite skoru [urticaria activity score (UAS7)] ile olan ilişkisini ve KSÜ'de hastalık aktivitesini yansıttığı bilinen CRP ve total IgE değerleri ile olan ilişkilerini değerlendirmektir. Gereç ve Yöntemler: Yüz bir hastanın tedavi öncesi ve tedavinin 12. haftasındaki tam kan sayımı, CRP, total IgE ve UAS7 değerleri retrospektif olarak incelendi. Bulgular: Omalizumab tedavisi öncesi hafif+orta ve şiddetli ürtiker grupları arasında NLR (p=0,023) ve NMR (p=0,019) açısından anlamlı fark bulundu. Tedavinin 12. haftasında; MPV (p=0,010), LMR (p=0,031) ve total IgE'de (p<0,001) anlamlı artış gözlenirken, NLR (p<0,001), PLR (p=0,013), NMR (p<0,001) ve CRP (p<0,001) anlamlı derecede azaldı. Tedaviden önce ve sonra, tam kan sayımı biyobelirteçleri ile UAS7 arasında anlamlı bir korelasyon yoktu. Tam kan sayımı biyobelirteçlerinden yalnızca RDW ve MPV, CRP ile zayıf bir korelasyon gösterdi. Ayrıca sadece tedavi sonrası için NMR'nin toplam IgE ile zayıf bir negatif korelasyonu vardı. Sonuç: NLR ve NMR KSÜ'nün şiddetini yansıtabilir. Omalizumab tedavisi ile inflamatuar biyobelirteçlerin anlamlı değişimi, omalizumabın anti-IgE etkisinin yanı sıra antiinflamatuar etkisini de göstermektedir. Biyobelirteçler ile UAS7 arasındaki korelasyon eksikliğinin, ürtiker patogenezinde rol alan farklı kompleks inflamatuar yolaklar ile ilişkili olabileceği düşünülmüştür.

Anahtar Kelimeler: Kronik spontan ürtiker; omalizumab; tam kan sayımı kaynaklı biyobelirteçler; C-reaktif protein; total immünglobulin E
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