Haematological and immunological parameters in patients with systemic sclerosis attending a tertiary care hospital

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.