Platelet-to-lymphocyte Ratio and Neutrophil-to-lymphocyte Ratio As Predictors of Refractory Anaphylaxis

Overview

Journal World Allergy Organ J

Specialty Allergy & Immunology

Date 2024 Sep 2

PMID 39220464

Authors

Le Vinh Nghi

Nguyen Hoang Phuc

Pham Dang Hai

Affiliations

Soon will be listed here.

Abstract

Background: Refractory anaphylaxis poses an ongoing, lethal hypersensitivity response that unpredictably involves multiple organs despite appropriate intramuscular (IM) adrenaline injections. Studies on the association of the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) concerning anaphylactic severity have yet to be carried out. The study aimed to evaluate the association between blood PLR and NLR levels and refractory anaphylaxis.

Methods: We carried out a retrospective cross-sectional study in which medical records of patients with anaphylaxis who sought urgent care at the Emergency Department (ED) of Tertiary Hospital in Hanoi, Vietnam, were evaluated. Based on the United Kingdom Resuscitation Council guidelines in 2021, patients were classified as refractory anaphylaxis if they needed more than two appropriate doses of intramuscular adrenaline for anaphylactic symptoms resolution. Clinical data and laboratory results were obtained in the medical records. Logistic regression analysis determined the association between contributing factors and refractory anaphylaxis.

Results: One-hundred eighteen adults (age 51.80 ± 18.25 years) were analyzed, including 38 refractory anaphylaxis patients (32.2%). Refractory anaphylaxis patients exhibited notably elevated platelet-to-lymphocyte ratio (PLR) ( = 0.006) and increased neutrophil-to-lymphocyte ratio (NLR) ( < 0.001) in comparison to non-refractory anaphylaxis patients. Receiver operating characteristic curve (ROC) analysis demonstrated an optimal PLR cutoff value of 129.5 (area under the ROC curve [AUC] 0.658, sensitivity 73.68%, specificity 61.25%, = 0.004) and an optimal NLR cutoff value of 4 (AUC 0.736, sensitivity 65.79%, specificity 73.75%, < 0.001) for refractory anaphylaxis. Multivariate logistic regression analysis revealed a PLR≥129.5 (OR = 4.83, 95% CI: 1.87-12.48) and an NLR≥4 (OR = 4.60, 95% CI: 1.86-11.41) were independently associated with refractory anaphylaxis.

Conclusion: Elevated PLR and NLR serve as independent indicators significantly associated with refractory anaphylaxis.

References

Turner P, Campbell D, Motosue M, Campbell R . Global Trends in Anaphylaxis Epidemiology and Clinical Implications. J Allergy Clin Immunol Pract. 2019; 8(4):1169-1176. PMC: 7152797. DOI: 10.1016/j.jaip.2019.11.027. View

Worm M, Edenharter G, Rueff F, Scherer K, Pfohler C, Mahler V . Symptom profile and risk factors of anaphylaxis in Central Europe. Allergy. 2012; 67(5):691-8. DOI: 10.1111/j.1398-9995.2012.02795.x. View

Braquet P, Rola-Pleszcynski M . Platelet-activating factor and cellular immune responses. Immunol Today. 2014; 8(11):345-51. DOI: 10.1016/0167-5699(87)90010-7. View

Tian B, Zhou H, Xia L, Shen H, Ying S . Balance of apoptotic cell death and survival in allergic diseases. Microbes Infect. 2014; 16(10):811-21. DOI: 10.1016/j.micinf.2014.07.004. View

Tejedor Alonso M, Moro Moro M, Mugica Garcia M . Epidemiology of anaphylaxis. Clin Exp Allergy. 2014; 45(6):1027-39. DOI: 10.1111/cea.12418. View

Korenblat P, Lundie M, Dankner R, Day J . A retrospective study of epinephrine administration for anaphylaxis: how many doses are needed?. Allergy Asthma Proc. 2000; 20(6):383-6. DOI: 10.2500/108854199778251834. View

Webb L, Lieberman P . Anaphylaxis: a review of 601 cases. Ann Allergy Asthma Immunol. 2006; 97(1):39-43. DOI: 10.1016/S1081-1206(10)61367-1. View

Brown S . Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004; 114(2):371-6. DOI: 10.1016/j.jaci.2004.04.029. View

Mochimaru T, Ueda S, Suzuki Y, Asano K, Fukunaga K . Neutrophil-to-lymphocyte ratio as a novel independent predictor of severe exacerbation in patients with asthma. Ann Allergy Asthma Immunol. 2018; 122(3):337-339.e1. DOI: 10.1016/j.anai.2018.11.029. View

10.

Pruc M, Peacock F, Rafique Z, Swieczkowski D, Kurek K, Tomaszewska M . The Prognostic Role of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis. J Clin Med. 2023; 12(21). PMC: 10650024. DOI: 10.3390/jcm12216903. View

11.

Cardona V, Ansotegui I, Ebisawa M, El-Gamal Y, Fernandez Rivas M, Fineman S . World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020; 13(10):100472. PMC: 7607509. DOI: 10.1016/j.waojou.2020.100472. View

12.

Huang W, Huang G, Zhan Q, Chen J, Luo W, Wu L . The neutrophil to lymphocyte ratio as a novel predictor of asthma and its exacerbation: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2020; 24(22):11719-11728. DOI: 10.26355/eurrev_202011_23819. View

13.

Tang R, Xu H, Cao J, Chen S, Sun J, Hu H . Clinical Characteristics of Inpatients with Anaphylaxis in China. Biomed Res Int. 2015; 2015:429534. PMC: 4434168. DOI: 10.1155/2015/429534. View

14.

Jonsson F, Mancardi D, Albanesi M, Bruhns P . Neutrophils in local and systemic antibody-dependent inflammatory and anaphylactic reactions. J Leukoc Biol. 2013; 94(4):643-56. DOI: 10.1189/jlb.1212623. View

15.

Palgan K, Tretyn A . Platelet-activating factor as an endogenous cofactor of food anaphylaxis. Biofactors. 2023; 49(5):976-983. DOI: 10.1002/biof.1956. View

16.

Lorente L, Martin M, Ortiz-Lopez R, Alvarez-Castillo A, Ruiz C, Uribe L . Association between neutrophil-to-lymphocyte ratio in the first seven days of sepsis and mortality. Enferm Infecc Microbiol Clin (Engl Ed). 2022; 40(5):235-240. DOI: 10.1016/j.eimce.2020.11.022. View

17.

Kim S, Kim M, Cho Y . Different clinical features of anaphylaxis according to cause and risk factors for severe reactions. Allergol Int. 2017; 67(1):96-102. DOI: 10.1016/j.alit.2017.05.005. View

18.

Goker A, Ekincioglu E, Alagoz M, Hummatov R, Arkan M, Baskadem Yilmazer A . The association of allergic rhinitis severity with neutrophil-lymphocyte and platelet-lymphocyte ratio in adults. Eur Arch Otorhinolaryngol. 2019; 276(12):3383-3388. DOI: 10.1007/s00405-019-05640-0. View

19.

Goodyear M, Krleza-Jeric K, Lemmens T . The Declaration of Helsinki. BMJ. 2007; 335(7621):624-5. PMC: 1995496. DOI: 10.1136/bmj.39339.610000.BE. View

20.

Vadas P, Perelman B, Liss G . Platelet-activating factor, histamine, and tryptase levels in human anaphylaxis. J Allergy Clin Immunol. 2012; 131(1):144-9. DOI: 10.1016/j.jaci.2012.08.016. View