Clinical Significance of the Neutrophil-to-Lymphocyte Ratio in IgA Vasculitis

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Background: Some patients with immunoglobulin A (IgA) vasculitis develop severe disease, with severe abdominal symptoms that necessitate prolonged fasting. Moreover, no biomarkers that can predict severe disease have been clearly established.

Methods: We analyzed the data of 65 children with IgA vasculitis who were admitted to our department between 2010 and 2015. Seven patients with severe abdominal symptoms who required fasting for at least one week were classified into the fasting group, and the remaining 58 patients were classified into the non-fasting group. The clinicopathological factors were compared between the two groups.

Results: Significant differences in peripheral blood neutrophil-to-lymphocyte ratio (NLR), plasma D-dimer levels, and coagulation factor XIII activity at admission were observed between the two groups. Logistic regression analysis revealed that the NLR showed the highest odds ratio for severe abdominal symptoms (odds ratio, OR: 1.67; 95% confidence interval, CI: 1.14-2.45). The results of receiver operating characteristic (ROC) curve analysis revealed an area under the curve (AUC) of 0.89 for the NLR, and an optimum cutoff value of 2.8 was associated with a sensitivity of 100% and specificity of 72.5%.

Conclusion: The NLR at diagnosis is a useful marker for predicting the severity of abdominal symptoms in patients with IgA vasculitis.