Study Identifies Simple Markers for Inflammatory Burden Among Patients with Psoriasis

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Several inexpensive and simple markers for evaluating inflammatory burden among patients with psoriasis, new findings suggest, included such markers as monocyte-high-density lipoprotein cholesterol ratio, Systemic Inflammation Response Index, neutrophil-to-lymphocyte ratio, and C-reactive protein values.¹

These markers were identified in new research conducted with the aim of assessing the systemic inflammatory burden in this widespread skin disease, specifically though the evaluation of different inflammatory markers. The team also sought to investigate the connection between such markers and severity of psoriasis.

The study was authored in part by Berna Solak, MD, from the department of dermatology at the Sakarya University School of Medicine in Turkey. Solak et al. noted that, prior to this analysis, neutrophil-to-lymphocyte ratio had been the most extensively evaluated in relation to psoriasis, adding that additional research has been deemed as warranted.²

“We deemed it appropriate to present our study involving a substantial number of cases, concurrently examining various inflammatory parameters such as the Systemic Immune Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), NLR, MHR, PLR, MLR, and C-reactive protein (CRP),” Solak and colleagues wrote.¹

Research Design

The investigative team’s retrospective study looked at individuals included in a dermatology outpatient clinic and their medical records from January 2016 - December 2022. Those given a diagnosis of psoriasis vulgaris were specifically examined, with comparisons being made by the team to a control cohort of healthy subjects who had volunteered.

Data for participants undergoing systemic treatment that were collected by the investigators included lab values and Psoriasis Area Severity Index (PASI) scores, both of which were identified just prior to the initiation of therapy. They also looked at their demographic information. For individuals not being given systemic treatment, data was gathered by the investigators at the time of their admission to the clinic.

Detailed records among all subjects were gathered, specifically regarding waist circumference, demographics, body mass index (BMI), and an array of clinical parameters such as HDL cholesterol, C-reactive protein, creatine, and complete blood counts including neutrophils, white blood cells, lymphocytes, platelets, monocytes, and serum hemoglobin levels.

Among each individual with psoriasis, the research team identified their disease’s duration and the subject’s PASI scores. A total of 278 individuals with psoriasis in the study were analyzed as well as 90 healthy subjects.

Notable Findings

In the team’s findings, it was noted that those reporting psoriasis were shown to have significantly elevated levels in a variety of inflammation markers. These were reported to include Systemic Inflammation Response Index, systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, monocyte-high-density lipoprotein cholesterol ratio, levels of serum C-reactive protein, neutrophil count, monocyte count, body mass index, and waist circumference (P < .001, P = .001, P < .001, P = .014, P < .001, P < .001, P = .046, P < .001, and P = .011, respectively).

For individuals with severe disease (PASI >10), the investigators concluded that levels of neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, platelet-to-lymphocyte ratio, and C-reactive proteins were substantially higher compared to levels among subjects with mild to moderate disease (PASI ≤10).

In their receiver operating characteristic curve analysis, the research team determined the best cut-off values (based on AUC, sensitivity, and specificity) for markers such as systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were shown to be 552.9 (0.579, 61%, 58%), 2.11 (0.592, 62%, 57%), and 111.9 (0.578, 64%, 46%), respectively.

Additionally, the team reported that parameters such as participants’ monocyte-to-lymphocyte ratio, Systemic Inflammation Response Index, systemic immune-inflammation index, monocyte-HDL cholesterol ratio, neutrophil-to-lymphocyte ratio, and C-reactive protein were found to correlate with their PASI scores.

“We, in a study involving several novel inflammatory markers simultaneously with a relatively larger sample size, demonstrated the significant increase of these markers in psoriasis patents. And the findings of this study should urge the conduction of future studies which will investigate whether these markers would explain the relationship between psoriasis and inflammatory conditions better than (C-reactive protein) does.”₁

References

1. ^{Solak B, Kara RÖ. Assessing systemic inflammatory markers in psoriasis: A retrospective study. Trop Med Int Health. 2024. https://doi.org/10.1111/tmi.14052.}
2. ^{Paliogiannis P, Satta R, Deligia G, Farina G, Bassu S, Mangoni AA, et al. Associations between the neutrophil-to-lymphocyte and the platelet-to-lymphocyte ratios and the presence and severity of psoriasis: a systematic review and meta-analysis. Clin Exp Med. 2019; 19(1): 37–45.}