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      Evaluation of monocyte to HDL cholesterol ratio and other inflammatory markers in patients with psoriasis ☆☆

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          Abstract

          Background

          Psoriasis is a chronic systemic inflammatory disease frequently associated with serious comorbidities.

          Objectives

          To investigate the systemic inflammatory burden in psoriasis and to assess the correlation between traditional and novel inflammatory markers and the severity of the disease.

          Methods

          This cross-sectional study was conducted on 60 patients with psoriasis vulgaris and 50 healthy volunteers. Data including demographics, Psoriasis Area and Severity Index scores, and laboratory results were analyzed and compared.

          Results

          Compared with the control group, the psoriatic patients had significantly higher high sensitive C-reactive protein, serum amyloid A, erythrocyte sedimentation rate, leukocyte, neutrophil, neutrophil-to-lymphocyte ratio, monocyte to high density lipoprotein (HDL) cholesterol ratio, and aspartate aminotransferase levels, and significantly lower HDL cholesterol levels (p < 0.05). No significant difference was found in procalcitonin, lymphocyte, monocyte, hemoglobin, red blood cell distribution width, platelet, mean platelet volume, platelet distribution width, lymphocyte-to-monocyte ratio, anti-cyclic citrullinated peptide, glucose, alanine aminotransaminase, blood urea nitrogen, creatinine, triglyceride, total cholesterol, and LDL cholesterol levels between the two groups (p > 0.05). The Psoriasis Area and Severity Index score was positively correlated with high-sensitivity C-reactive protein, serum amyloid A, and monocyte to HDL cholesterol ratio, and negatively correlated with lymphocyte-to-monocyte ratio (p < 0.05).

          Study limitations

          This was a single-center study with relatively limited numbers of patients and controls.

          Conclusions

          The data show that high sensitivity C-reactive protein, serum amyloid A, erythrocyte sedimentation rate, neutrophil-to-lymphocyte ratio, and monocyte to HDL cholesterol ratio can be used as markers of systemic inflammation in patients with psoriasis. Moreover, high sensitivity C-reactive protein, serum amyloid A, monocyte to HDL cholesterol ratio and lymphocyte-to-monocyte ratio are closely related to the Psoriasis Area and Severity Index score, and they may be regarded as objective indicators in determining the disease severity.

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          Most cited references36

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          Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill.

          R Zahorec (2000)
          For many years, the intensivists are searching for an easily measurable and available parameter which might reflect the intensity of stress and/or systemic inflammation in critically ill patients following shock, multiple trauma, major surgery or sepsis. Recently, some authors have described the onset of significant lymphocytopenia after polytrauma, major surgery, endotoxaemia and sepsis. We investigate whether serial examination of white blood cell counts may reflect and clarify the immune response to stressful events in critically ill patients. We have designed a prospective longitudinal observational study to investigate serial changes in circulating neutrophil and lymphocyte counts following major surgery, unscheduled surgery and sepsis. We have investigated the differential white blood cell counts and the clinical course in 90 oncological ICU patients. We compared three groups: group A consisting of 62 patients who underwent scheduled colorectal surgery, group B consisting of 18 patients who underwent unscheduled surgery for abdominal sepsis, group C consisting of 10 medical ICU patients who were treated for severe sepsis and septic shock. The severity of clinical course was expressed by means of SOFA score (group A 0.3-1-1.3 point, group B 2.2-2.9-2.6 point, group C 7.4-8.3-7.7 point) and APACHE II score (group A 3.7-7.6-8.1 point, group B 8.6-11.1-10.5 point, group C 16.3-15.2-14.3 point). Differential white blood cell counts were investigated on blood cell counter SYSMEX SF 3000 in 4 consecutive periods: 1 day one before surgery, 0 the day of surgery or ICU admittance, 1 day one after surgery (or the 1st ICU day), 2nd day following surgery (or the 2nd ICU day). The measured values of neutrophils and lymphocytes were expressed as relative counts (%) of the whole all white blood cell population. The physiologic response of circulating leukocytes to surgical stress in group A is characterized by the onset of marked neutrophilia (62.5% before surgery up to 84.4% after surgery) and significant lymphocytopenia (28.1% before surgery to 10.3% following surgery). We observed a slow decline in neutrophil counts and an increase in lymphocyte counts since the 1st postoperative day. The patients with abdominal infection (group B) had elevated counts of neutrophils already before surgery (83.2%) and low values of lymphocyte counts (9.5%). A further increase in neutrophil counts (89.9%) and marked lymphopenia (7%) were recorded during the post-surgical period in group B. Critically ill patients with severe sepsis or septic shock (group C) had significantly highest values of neutrophil relative counts (94%-93.1%-92.5%, p < 0.05 against group A) and marked lowest values of lymphocyte counts (3.8%-4%-3.7%, p < 0.05 against group A). The severity of clinical course (according SOFA and APACHE II score) correlated with the divergence of neutrophil and lymphocyte counts in the white blood picture (marked neutrophilia and lymphocytopenia). In the population of 90 ICU oncological patients, we observed rapid serial changes in white blood cell populations, as a response of the immune system to surgical stress, systemic inflammation or sepsis. Preliminary results show the correlation between the severity of clinical course and the grade of neutrophilia and lymphocytopenia. The ratio of neutrophil and lymphocyte counts (in absolute and/or relative % values) is an easily measurable parameter which may express the severity of affliction. We suggest the term: neutrophil-lymphocyte stress factor, as a ratio of neutrophil to lymphocyte counts, which can be routinely used in clinical ICU practice in intervals of 6-12 and 24 hours. The prognostic value of neutrophil-lymphocyte stress factor should be evaluated in further studies. (Tab. 6, Fig. 5, Ref. 12.)
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            Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill

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              Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases.

              Inflammation and lipid accumulation are two basic hallmarks of atherosclerosis as a chronic disease. Inflammation not only is a local response but can also be considered as a systemic process followed by an elevation of inflammatory mediators. Monocytes are a major source of proinflammatory species during atherogenesis. In atherosclerosis, modified low-density lipoproteins (LDLs) are removed by macrophages; these are recruited in the vessel wall, inducing the release of inflammatory cytokines in inflamed tissue. Hence, inflammatory cholesterol ester-loaded plaque is generated. High-density lipoprotein-cholesterol (HDL-C) exhibits antiatherosclerotic effects by neutralizing the proinflammatory and pro-oxidant effects of monocytes via inhibiting the migration of macrophages and LDL oxidation in addition to the efflux of cholesterol from these cells. Furthermore, HDL plays a role in suppressing the activation of monocytes and proliferation-differentiation of monocyte progenitor cells. Thus, accumulation of monocytes and reduction of HDL-C may participate in atherosclerosis and cardiovascular diseases (CVD). Given that the relationship between the high number of monocytes and low HDL-C levels has been reported in inflammatory disorders, this review focused on understanding whether the monocyte-to-HDL ratio could be a convenient marker to predict atherosclerosis development and progression, hallmarks of CV events, instead of the individual monocyte count or HDL-C level.
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                Author and article information

                Contributors
                Journal
                An Bras Dermatol
                An Bras Dermatol
                Anais Brasileiros de Dermatologia
                Sociedade Brasileira de Dermatologia
                0365-0596
                1806-4841
                12 July 2020
                Sep-Oct 2020
                12 July 2020
                : 95
                : 5
                : 575-582
                Affiliations
                [a ]Department of Medical Microbiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
                [b ]Department of Dermatology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
                Author notes
                [* ]Corresponding author. drmcemsirin@ 123456yahoo.com
                Article
                S0365-0596(20)30175-6
                10.1016/j.abd.2020.02.008
                7562997
                32711928
                8265cedd-5bf4-42e0-8dfc-3167ccad6dda
                © 2020 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U.

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 11 October 2019
                : 15 February 2020
                Categories
                Investigation

                biological markers,cholesterol, hdl,c-reactive protein,inflammation,monocytes,psoriasis,serum amyloid a protein

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