Haematological and immunological parameters in patients with systemic sclerosis attending a tertiary care hospital
Date
2019
Authors
Vinod, Vaishak
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
To describe the frequency of full blood count and serological abnormalities at diagnosis of systemic sclerosis (SSc) and correlates with acute phase reactants, specific clinical features and mortality.
Patients and Methods
A retrospective case record review of SSc patients attending a tertiary rheumatology clinic from over a 17 year period. Parameters of the full blood count, inflammatory indices, serological markers and acute phase reactants were the focus of the study.
Results
Of the 135 patients, the majority were black females (92.6%) with diffuse cutaneous SSc (DcSSc). Anaemia was the commonest haematological abnormality (35%) followed by lymphopenia (29.4%) and thrombocytosis (16.9%).
Haematological abnormalities at diagnosis and associations with clinical manifestations and mortality in patients with systemic sclerosis
HAEMATOLOGICAL
PARAMETER
CLINICAL MANIFESTATIONS
PRESENT
ABSENT
OR (95% CI)
p-value
PERICARDIAL EFFUSION
Mean (SD) Hb (g/dL)
11.5 (1.8)
12.8 (1.7)
-
<0.01
Anaemia (%)
14/20 (70.0)
31/109 (28.4)
5.87 (2.07-16.66)
<0.01
Mean (SD) RDW (%)
16.7 (2.5)
15.8 (1.9)
-
0.14
RDW >17 (%)
6/12 (50)
6/69 (8.7)
6.30 (1.69-23.43)
<0.01
PULMONARY HYPERTENSION
Mean (SD) RDW (%)
16.8 (2.4)
15.5 (1.7)
-
<0.01
RDW >17 (%)
10/28 (35.7)
6/57 (10.5)
4.72 (1.50-14.85)
0.01
CARDIAC INVOLVEMENT
Mean (SD) NLR (g/dL)
3.7 (3.1)
2.5 (1.8)
-
0.02
High NLR
25/50 (50)
15/52 (28.8)
2.47 (1.09-5.58)
0.04
DIGITAL LESIONS
Mean (SD) NLR (g/dL)
3.6 (3.0)
2.5 (1.9)
-
0.03
High NLR
24/53 (45.2)
16/49 (32.7)
1.71 (0.76-3.82)
0.14
MORTALITY
Mean (SD) NLR (g/dL)
3.8 (3.2)
2.6 (2.2)
-
0.04
High NLR
18/33 (54.5)
22/69 (31.9)
2.56 (1.09-6.00)
0.03
RDW - red cell distribution width; NLR – neutrophil lymphocyte ratio; Hb - haemoglobin
A red cell distribution width (RDW) >17% was associated with cardiopulmonary disease. Similiary, patients with cardiac disease and digital lesions had a higher mean neutrophil lymphocyte ratio (NLR). Furthermore, a NLR ≥ 3, was a predictor for mortality.
Conclusion
Red cell parameters such as anaemia and an increased RDW were common and associated mainly with cardiopulmonary disease and a high NLR with mortality.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine, Johannesburg, 2019
Keywords
Citation
Vinod, Vaishak, Haematological and immunological parameters in patients with systemic sclerosis attending a tertiary care hospital, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/29864>