Hidradenitis Suppurativa Severity Determined by Elevated Leukocyte Profile

Kayla M. Babbush MD

A new longitudinal study of hidradenitis suppurativa detailed inflammatory markers and leukocyte profiles that indicated disease severity over time.

Patients with the inflammatory skin disease had elevated leukocytes and C-reactive protein (CRP) levels.

The inflammatory markers and leukocyte profiles detailed in the study had not been previously evaluated in a longitudinal study as signs of HS severity. However, several cross-sectional studies have identified that these markers could aid in determining the severity of the disease.

As such, an investigative team led by Kayla Babbush, MD, from the Department of Medicine at the Albert Einstein College of Medicine in NY, explored the utility of these biomarkers in HS through examining the longitudinal dynamic between serum inflammatory markers and leukocyte profiles.

Patients who were currently undergoing care at the Einstein/Montefiore HS Center in the Bronx were between March 2019 and November 2020 were considered for the study.

Those with recorded disease severity form an in-person visit and a blood sample within 3 days of that visit were included, of whom there 530 patients were identified. However, 404 met the criteria.

Data on subsequent visits were collected when available, with the mean time between visits being 112.6 days.

Demographics such as age, gender, race, ethnicity, BMI, smoking status, disease severity, and numerical rating scale (NRS) pain scores were recorded, while serum sample analyses including CRP, ESR, and IL-6 were conducted.

From there, participants were categorized as having either mild or severe HS based on disease severity, and inflammatory markers and leukocyte profiles were compared using chi-square test, Fischer’s exact test, and t tests when appropriate.

Of the 404 eligible participants, 298 (73.8%) were female with a mean age of 35.9 years. The mean BMI was 33.6 ± 8.2, and 68 (16.8%) were smokers.

No significant differences in age, race, ethnicity, and smoking status were observed when comparing mild versus severe disease.

However, a higher proportion of men had severe disease (P<0.01) and higher mean BMI (P=0.04). Notably, patients with severe disease had elevated CRP (OR 1.87, 95% CI 1.49, 2.34), and ESR and IL-6 measures were significantly higher in this group as well (P<0.01).

Increases in leukocytes (OR 1.20, 95% CI 1.10, 1.32), neutrophils (OR 1.34, 95% CI 1.20, 1.50), eosinophils (OR 6.31, 95% CI 1.09, 36.51), and neutrophil-lymphocyte ratios (OR 1.91, 95% CI 1.50, 2.43) were strongly associated with severe disease after adjusting for age, gender, BMI, and smoking status.

Investigators suggested that the role molecules played in the pathogenesis of the disease explained the correlation with disease severity and utility as biomarkers.

Likewise, increased leukocytes aligned with disease severity with the proposed inflammatory pathogenesis of HS.

“These markers reflect the degree of inflammation present at various points in the progression of HS using critical laboratory measures that affirm clinically determined disease severity and corroborate response to treatment,” the team wrote. “These standardized parameters may offer further insight regarding the management and study of HS.”

The study, "Serum inflammatory markers and leukocyte profiles accurately describe hidradenitis suppurativa disease severity," was published online in the International Journal of Dermatology.