Relationship of hematological and biochemical parameters with WOMAC index to severity of osteoarthritis: A retrospective study

Aim: Our aim was to investigate whether any hematologic changes that could be detected easily in whole blood counts together with the Western Ontario and McMaster Universities Osteoarthritis score (WOMAC) had diagnostic value for predicting knee osteoarthritis severity. Methods: A retrospective study including a total of 208 knee osteoarthritis patients (112 patients early and 106 patients late osteoarthritis) was carried out. Cut-off values for age, C-reactive protein, neutrophil leukocyte ratio and WOMAC index for osteoarthritis were calculated. A multivariate logistic regression model was used to identify the independent factors of late osteoarthritis. Results: Compared with late osteoarthritis with early osteoarthritis, late osteoarthritis had significantly higher C-reactive protein, neutrophil leukocyte ratio and WOMAC index (p=0.019, p=0.028 and p=0.001, respectively). Area Under Curve was found to be 0.922, 0.533, 0.558 and 0.824 for age, C-reactive protein, neutrophil leukocyte ratio and WOMAC index, respectively. Multilogistic regression analysis was performed with C-reactive protein, neutrophil leukocyte ratio and WOMAC index to determine independent risk factors associated with late osteoarthritis. Odds ratios for neutrophil lymphocyte ratio, C-reactive protein and WOMAC index were found to be 1.317 (95% CI = 1.030-1.682, p = 0.034), 1.055 (95% CI = 1.004-1.108, p = 0.028) and 1.078 (95% CI = 1.056-1.100, p=0.001), respectively. Age, neutrophil leukocyte ratio, C-reactive protein and WOMAC index were statistically significant in predicting late osteoarthritis. Conclusions: Our study suggests that increased neutrophil leukocyte ratio, C-reactive protein and WOMAC index are associated with independent risk factors for late osteoarthritis

Hematolojik ve biyokimyasal parametreler ile WOMAC indeksinin osteoartrit şiddeti ile olan ilişkisi: Retrospektif bir çalışma

Amaç: Amacımız, Western Ontario ve McMaster Üniversiteleri Osteoartrit skoru (WOMAC) ile birlikte kolayca saptanabilecek tam kanda herhangi bir hematolojik değişikliğin diz osteoartriti şiddetini öngörmede tanısal değere sahip olup olmadığını araştırmaktır. Yöntemler: 208 diz osteoartrit hastasını (112 hasta erken ve 106 hasta geç osteoartrit) içeren retrospektif bir çalışma planlandı. Yaş, CRP, nötrofil lökosit oranı ve WOMAC index için cut-off değerleri hesaplandı. Geç osteoartrit için bağımsız faktörlerini tanımlamak için çok değişkenli lojistik regresyon modeli kullanıldı. Bulgular: Erken ve geç osteoartrit karşılaştırıldığında, C-reaktif protein, nötrofil lökost oranı ve WOMAC indeksi anlamlı olarak geç osteoartrit olan grupta daha yüksekti (sırası ile; p=0,019, p=0,028 ve p=0,001). Yaş, C-reaktif protein, nötrofil lökosit oranı ve WOMAC index Area Under Curve değerleri sırasıyla 0,922, 0,533, 0,558 ve 0,824 olarak bulundu. Geç osteoartrit ile ilişkili bağımsız risk faktörlerini belirlemek amacı ile yapılan regresyon analizinde, nötrofil lökosit oranı için odds oranı 1.317 (95% CI = 1.030-1.682, p=0.034 ), C-reaktif protein için odds oranı 1.055 (95% CI = 1.004-1.108, p= 0.028) ve WOMAC index için odds oranı 1.078 (95% CI = 1.056-1.100, p=0.001) idi. Geç osteoartrit öngörüsünde yaş, nötrofil lökosit oranı, C-reaktif protein and WOMAC index istatistiksel olarak anlamlı idi. Sonuç: Nötrofil lökosit oranı, C-reaktif protein düzeyleri ve WOMAC indeksinin, geç osteoartrit için bağımsız risk faktörleri ile ilişkili olduğu düşünülmektedir.

PDF

___

Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28:5-15.

Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis, Lancet. 2005;365: 965–73.

Berenbaum F. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!), Osteoarthr Cartil. 2013;21:16–21.

Pelletier JP, Martel-Pelletier J, Abramson SB. Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum. 2001;44:1237–47.

Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017; 58:1-13.

Velissaris D, Pantzaris ND, Bountouris P, Gogos C. Correlation between neutrophil-to-lymphocyte ratio and severity scores in septic patients upon hospital admission. A series of 50 patients. Rom J Intern Med. 2018; Feb 9. doi: 10.2478/rjim-2018-0005.

Curbelo J, Luquero Bueno S, Galván-Román JM, Ortega-Gómez M, Rajas O, Fernández-Jiménez G, et al. Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio. PLoS One. 2017; 12:e0173947.

Eo WK, Kim KH, Park EJ, Kim HY, Kim HB, Koh SB, Namkung J. Diagnostic accuracy of inflammatory markers for distinguishing malignant and benign ovarian masses. J Cancer. 2018;9:1165-72.

Yang Z, Zhang Z, Lin F, Ren Y, Liu D, Zhong R, Liang Y. Comparisons of neutrophil, monocyte-, eosinophil-, and basophillymphocyte ratios among various systemic autoimmune rheumatic diseases. APMIS. 2017;125:863-871.

Ballou SP, Lozanski G. Induction of inflammatory cytokine release from cultured human monocytes by C-reactive protein. Cytokine. 1992; 4:361e8.

Sowers M, Jannausch M, Stein E, Jamadar D, Hochberg M, Lachance L. C-reactive protein as a biomarker of emergent osteoarthritis. Osteoarthritis Cartilage. 2002;10:595e601.

Sturmer T, Brenner H, Koenig W, Gunther KP. Severity and extent of osteoarthritis and low grade systemic in- flammation as assessed by high sensitivity C reactive protein. Ann Rheum Dis. 2004; 63:200e5.

Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494-502.

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833-40

Revell PA, Mayston V, Lalor P, Mapp P. The synovial membrane in osteoarthritis: a histological study including the characterisation of the cellular infiltrate present in inflammatory osteoarthritis using monoclonal antibodies. Ann Rheum Dis. 1988;47:300-7.

Özlem T, Ali S, Gülsah K, Engin K, İrfan T, Osman T, Nese O. Blood mean platelet volume and platelet lymphocyte ratio as new predictors of hip osteoarthritis severity. Medicine (Baltimore). 2017;96:e6073.

Gundogdu G, Gundogdu K. A novel biomarker in patients with knee osteoarthritis: adropin. Clin Rheumatol. 2018 Mar 16. doi: 10.1007/s10067-018-4052-z.

Pearle AD, Scanzello CR, George S, Mandl LA, DiCarlo EF, Peterson M, et al. Elevated highsensitivity C-reactive protein levels are associated with local inflammatory findings in patients with osteoarthritis. Osteoarthritis Cartilage. 2007;15:516–23.

Hanada M, Takahashi M, Furuhashi H, Koyama H, Matsuyama Y. Elevated erythrocyte sedimentation rate and high-sensitivity C-reactive protein in osteoarthritis of the knee: relationship with clinical findings and radiographic severity. Ann Clin Biochem. 2016;53:548-53.

Wolfe F. The C-reactive protein but not erythrocyte sedimentation rate is associated with clinical severity in patients with osteoarthritis of the knee or hip. J Rheumatol. 1997;24:1486-8.

Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008; 75:291–4.

Guermazi A, Burstein D, Conaghan P, Eckstein F, Hellio Le Graverand Gastineau MP, Keen H, et al. Imaging in osteoarthritis. Rheum Dis Clin North Am. 2008;34:645-87.

Hunter DJ. Risk stratification for knee osteoarthritis progression: a narrative review. Osteoarthritis Cartilage. 2009;17:1402-7.