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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 5, September/October 2018
296
AFRICA
The neutrophil-to-lymphocyte ratio and mean platelet
volume can be associated with severity of valvular
involvement in patients with acute rheumatic carditis
Serkan F Çelik, Elif Çelik
Abstract
Objectives:
The aim of the study was to investigate the associ-
ation between the severity of acute rheumatic carditis (ARC)
and the neutrophil–lymphocyte ratio (NLR) and mean plate-
let volume (MPV).
Methods:
Paediatric patients diagnosed with ARC between
2010 and 2016 and age- and gender-matched controls were
retrospectively analysed. At the time of diagnosis, we reviewed
the demographic features obtained: echocardiographic data,
complete blood count reports, acute-phase reactants, includ-
ing C-reactive protein, and erythrocyte sedimentation rate
values. The patient group was further divided into two
subgroups according to the degree of valvular regurgitation,
which included those with severe and those with mild-to-
moderate valvular regurgitation.
Results:
The number of cases with ARC and age- and gender-
matched controls were 120 and 50, respectively. The mean age
of the patients was 12.25 ± 2.89 (range: 7–18) years. NLR,
MPV, anti-streptolysin-O, C-reactive protein (CRP), erythro-
cyte sedimentation rate (ESR), haemoglobin level, and white
blood cell (WBC) and neutrophil count were significantly
higher in patients with acute carditis compared with the
controls (
p
<
0.001). NLR was found to have a significantly
positive correlation with CRP (
r
=
0.177,
p
=
0.001), ESR
(
r
=
0.81,
p
=
0.03) and WBC count (
r
=
0.47,
p
=
0.001).
Moreover, we found a positive correlation between NLR and
severity of valvular regurgitation (
r
=
0.34,
p
<
0.001), and a
negative correlation between MPV and severity of valvular
regurgitation (
r
=
–0.38,
p
<
0.05) in our patients. In multiple
linear regression analysis, severe valvular regurgitation was
associated with NLR (0.51; 95% CI: 0.32–0.68;
p
=
0.006) and
MPV (–0.78; 95% CI: –0.72 to –0.98;
p
=
0.008).
Conclusion:
NLR and MPV are novel inflammatory markers
and simple, rapid and easily accessible prognostic parameters
that can be associated with severity of valvular involvement
in patients with ARC.
Keywords:
neutrophil-to-lymphocyte ratio, mean platelet volume,
acute rheumatic carditis
Submitted 11/10/17, accepted 19/6/18
Published online 10/9/18
Cardiovasc J Afr
2018;
29
: 296–300
www.cvja.co.zaDOI: 10.5830/CVJA-2018-031
Acute rheumatic fever (ARF) results from the body’s auto-
immune response to a throat infection caused by
Streptococcus
pyogenes
, also known as group A Streptococcus bacteria. The
most serious manifestation is carditis (
>
50% of patients) because
it can lead to chronic rheumatic heart disease, whereas all other
clinical features resolve fully, often within weeks. The most
commonly affected valves in rheumatic heart disease are the
mitral and aortic valves.
1
The pathogenic mechanisms of ARF are not completely
understood.
2
Activation of the innate immune system begins
with a pharyngeal infection that leads to the presentation of
S
pyogenes
antigens to the T and B cells. CD4+ T cells are activated
and results in the production of specific IgG and IgM antibodies
by the B cells.
3
Tissue injury ensues through an immune-mediated
mechanism that is initiated via molecular mimicry.
4
Structural
similarity between the infectious agent and human proteins leads
to cross-activation of antibodies and/or T cells directed against
the human proteins.
3
Leukocytes are the main mediators of inflammation, and
changes in their populations reflect the response of the immune
system to systemic inflammation.
5
In general, neutrophils are
considered a marker of ongoing non-specific inflammation, while
lymphocytes are a marker of the immune regulatory response.
6
The neutrophil-to-lymphocyte ratio (NLR) therefore represents
the balance between inflammation and immune regulation.
It has been shown to predict mortality and major adverse
cardiac events in acute coronary syndromes,
7
degenerative aortic
stenosis,
8
acute rejection after heart transplantation,
9
and acute
myocardial infarction.
Also, platelet activation has a very important role in
inflammation; it has been observed to secrete mediators such
as chemokines and cytokines.
10
Mean platelet volume (MPV)
is a marker of platelet activation that is associated with serious
inflammation.
11
In previously reported studies, MPV values
were shown to be significantly lower in rheumatoid arthritis
and inflammatory bowel disease patients with active disease,
compared to controls.
12,13
Furthermore, lower MPV values have
been shown in patients with acute rheumatic carditis (ARC).
14
However, there is no study evaluating the correlation between
valve involvement and MPV, NLR and other full blood count
parameters during the ARC period.
The aims of this study were to compare full blood count
parameters in children with ARC with healthy children, and to
Division of Paediatric Cardiology, Department of
Paediatrics, Adnan Menderes University Hospital, Aydın,
Turkey
Serkan F Çelik, MD,
docser2003@yahoo.comDepartment of Paediatrics, Adnan Menderes University
Hospital, Aydın, Turkey
Elif Çelik, MD