Prognostic Value of Inflammation Scores and Hematological Indices in IgA and Membranous Nephropathies: An Exploratory Study

Overview

Journal Medicina (Kaunas)

Publisher MDPI

Specialty General Medicine

Date 2024 Aug 29

PMID 39202473

Authors

Nicolae Pana

Gabriel Stefan

Tudor Popa

Otilia Ciurea

Simona Hildegard Stancu

Cristina Capusa

Affiliations

Soon will be listed here.

Abstract

Systemic-inflammation-based prognostic scores and hematological indices have shown value in predicting outcomes in various clinical settings. However, their effectiveness in predicting outcomes specifically for IgA nephropathy (IgAN) and membranous nephropathy (MN), the most common primary glomerular diseases diagnosed by kidney biopsy, has not been thoroughly investigated. We conducted a retrospective, observational study involving 334 adult patients with biopsy-proven IgAN (196 patients) and MN (138 patients) from January 2008 to December 2017 at a tertiary center. We assessed six prognostic scores [Glasgow prognostic score (GPS), modified GPS (mGPS), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-C-reactive protein ratio (LCRP)] and two hematological indices [red blood cell distribution width (RDW), platelet distribution width (PDW)] at diagnosis and examined their relationship with kidney and patient survival. End-stage kidney disease (ESKD) occurred more frequently in the IgAN group compared to the MN group (37% vs. 12%, = 0.001). The mean kidney survival time was 10.7 years in the IgAN cohort and 13.8 years in the MN cohort. After adjusting for eGFR and proteinuria, lower NLR and higher LCRP were significant risk factors for ESKD in IgAN. In the MN cohort, no systemic-inflammation-based scores or hematological indices were associated with kidney survival. There were 38 deaths (19%) in the IgAN group and 29 deaths (21%) in the MN group, showing no significant difference in mortality rates. The mean survival time was 13.4 years for the IgAN group and 12.7 years for the MN group. In the IgAN group, a lower PLR was associated with a higher mortality after adjusting for age, the Charlson comorbidity score, eGFR, and proteinuria. In patients with MN, higher NLR, PLR, and RDW were associated with increased mortality. NLR and LCRP are significant predictors of ESKD in IgAN, while PLR is linked to increased mortality. In MN, NLR, PLR, and RDW are predictors of mortality but not kidney survival. These findings underscore the need for disease-specific biomarkers and indicate that systemic inflammatory responses play varying roles in the progression and outcomes of these glomerular diseases. Future studies on larger cohorts are necessary to validate these markers.

References

Hoxha E, Reinhard L, Stahl R . Membranous nephropathy: new pathogenic mechanisms and their clinical implications. Nat Rev Nephrol. 2022; 18(7):466-478. DOI: 10.1038/s41581-022-00564-1. View

Yoshitomi R, Nakayama M, Sakoh T, Fukui A, Katafuchi E, Seki M . High neutrophil/lymphocyte ratio is associated with poor renal outcomes in Japanese patients with chronic kidney disease. Ren Fail. 2019; 41(1):238-243. PMC: 6450582. DOI: 10.1080/0886022X.2019.1595645. View

Chai L, Cai K, Wang K, Luo Q . Relationship between blood neutrophil-lymphocyte ratio and renal tubular atrophy/interstitial fibrosis in IgA nephropathy patients. J Clin Lab Anal. 2021; 35(6):e23774. PMC: 8183917. DOI: 10.1002/jcla.23774. View

Yuan Q, Wang J, Peng Z, Zhou Q, Xiao X, Xie Y . Neutrophil-to-lymphocyte ratio and incident end-stage renal disease in Chinese patients with chronic kidney disease: results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). J Transl Med. 2019; 17(1):86. PMC: 6420746. DOI: 10.1186/s12967-019-1808-4. View

Gan W, Guan Q, Hu X, Zeng X, Shao D, Xu L . The association between platelet-lymphocyte ratio and the risk of all-cause mortality in chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol. 2022; 54(11):2959-2967. DOI: 10.1007/s11255-022-03234-0. View

Tonelli M, Wiebe N, James M, Naugler C, Manns B, Klarenbach S . Red cell distribution width associations with clinical outcomes: A population-based cohort study. PLoS One. 2019; 14(3):e0212374. PMC: 6415845. DOI: 10.1371/journal.pone.0212374. View

Miyasato Y, Hanna R, Morinaga J, Mukoyama M, Kalantar-Zadeh K . Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis. Nutrients. 2023; 15(2). PMC: 9865495. DOI: 10.3390/nu15020311. View

Zhang A, Dai G, Zhang Q, Huang H, Liu W . The Value of Peripheral Blood Cell Ratios in Primary Membranous Nephropathy: A Single Center Retrospective Study. J Inflamm Res. 2023; 16:1017-1025. PMC: 10010743. DOI: 10.2147/JIR.S404591. View

Stefan G, Stancu S, Zugravu A, Capusa C . Inflammation-based modified Glasgow prognostic score and renal outcome in chronic kidney disease patients: is there a relationship?. Intern Med J. 2021; 52(6):968-974. DOI: 10.1111/imj.15251. View

10.

Catabay C, Obi Y, Streja E, Soohoo M, Park C, Rhee C . Lymphocyte Cell Ratios and Mortality among Incident Hemodialysis Patients. Am J Nephrol. 2017; 46(5):408-416. PMC: 5777311. DOI: 10.1159/000484177. View

11.

Rovin B, Adler S, Barratt J, Bridoux F, Burdge K, Chan T . Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases. Kidney Int. 2021; 100(4):753-779. DOI: 10.1016/j.kint.2021.05.015. View

12.

Yeh H, Lin Y, Ting I, Huang H, Chiang H, Chung C . Variability of red blood cell size predicts all-cause mortality, but not progression to dialysis, in patients with chronic kidney disease: A 13-year pre-ESRD registry-based cohort. Clin Chim Acta. 2019; 497:163-171. DOI: 10.1016/j.cca.2019.07.035. View

13.

Parizadeh S, Jafarzadeh-Esfehani R, Bahreyni A, Ghandehari M, Shafiee M, Rahmani F . The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; current status and prospective. Biofactors. 2019; 45(4):507-516. DOI: 10.1002/biof.1518. View

14.

Stefan G, Stancu S, Zugravu A, Popa O, Zubidat D, Petre N . Negative anti-phospholipase A2 receptor antibody status at three months predicts remission in primary membranous nephropathy. Ren Fail. 2022; 44(1):258-268. PMC: 8863379. DOI: 10.1080/0886022X.2022.2033265. View

15.

Tatar E, Mirili C, Isikyakar T, Yaprak M, Guvercin G, Ozay E . The association of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio with clinical outcomes in geriatric patients with stage 3-5 chronic kidney disease. Acta Clin Belg. 2016; 71(4):221-6. DOI: 10.1080/17843286.2016.1159797. View

16.

Turgutalp K, Kiykim A, Bardak S, Demir S, Karabulut U, Ozcan T . Is the red cell distribution width strong predictor for treatment response in primary glomerulonephritides?. Ren Fail. 2014; 36(7):1083-9. DOI: 10.3109/0886022X.2014.926771. View

17.

Jiang H, Yang S, Chen Z, Li D, Shan Y, Tao Y . Glasgow prognostic score and its derived scores predicts contrast-associated acute kidney injury in patients undergoing coronary angiography. Heliyon. 2023; 9(11):e22284. PMC: 10689934. DOI: 10.1016/j.heliyon.2023.e22284. View

18.

Stefan G, Zugravu A, Stancu S . Glasgow prognostic score as an outcome predictor for patients initiating hemodialysis. Ther Apher Dial. 2023; 28(1):34-41. DOI: 10.1111/1744-9987.14057. View

19.

Zhao Q, Liu X, Jiang T, Wang M, Liu W, Huang Y . The ratio of neutrophils to lymphocytes effectively predicts clinical outcomes in idiopathic membranous nephropathy. Clin Nephrol. 2023; 101(3):101-108. DOI: 10.5414/CN110970. View

20.

Kato A, Tsuji T, Sakao Y, Ohashi N, Yasuda H, Fujimoto T . A comparison of systemic inflammation-based prognostic scores in patients on regular hemodialysis. Nephron Extra. 2014; 3(1):91-100. PMC: 3884192. DOI: 10.1159/000355148. View