Clinical relevance of neutrophil-to-lymphocyte ratio and mean platelet volume in pediatric Henoch–Schonlein Purpura: a meta-analysis

Figures & data

Figure 1. Flow chart of literature search and selection

Table 1. The basic characteristics of the included studies

Study	Recruitment duration	Country	Age	Sample size	Girls (%)	Definition of gastrointestinal involvement	Medication prior to blood sampling	Infections	NOS score
			(years)
Benzer et al. [35]	2008–2013	Turkey	6.8 ± 3.02	75	49.37	GI bleeding	NR	NR	6
Ekinci et al. [14]	NR	Turkey	7.6 ± 3.1	214	43.5	Severe colicky abdominal pain/bowel edema in ultrasonography/overt GI bleeding	No	NR	6
Gayret et al. [27]	2013–2016	Turkey	7.82 ± 3.01	119	37	GI bleeding	No	NR	6
Hong et al [6].	2005–2017	Korea	6.6 ± 2.8	141	44.7	GI bleeding	No	No	7
Liao et al. [34]	2015–2017	China	7.62 ± 3.44	121	38	GI bleeding	NR	NR	6
Karadağ et al. [5]	2016–2019	Turkey	7.5 ± 3.5	376	47.1	Abdominal pain/vomiting/hematemesis/melena/massive GI bleeding/intussusception	NR	NR	6
Makay et al. [15]	2006–2013	Turkey	6.5 ± 2.6	63	47.6	GI bleeding	NR	NR	6
Sun et al. [25]	2010–2012	China	7.6	137	40.1	GI bleeding	NR	NR	6
Yakut et al. [26]	2015–2018	Turkey	7 ± 3.6	49	42.3	GI bleeding	NR	NR	6
Wang et al. [28]	2012–2014	China	6.85 ± 2.65	524	40.5	GI bleeding	NR	NR	6
Zhai et al. [36]	2014–2016	China	7.7 ± 2.8	148	45.3	GI bleeding	No	No	7
Zhang et al. [29]	2011–2017	China	NR	201	NR	GI bleeding	NR	NR	6

Abbreviation: GI: Gastrointestinal; NR: not reported; NOS: Newcastle-Ottawa scale.

Figure 2. Meta-analysis of eight studies reporting the association between NLR and the GI involvement in HSP patients. SMD: standard mean difference; NLR: neutrophil-to-lymphocyte ratio; HSP: Henoch-Schonlein Purpura; GI: gastrointestinal

Figure 3. Meta-analysis of 10 studies reporting the association between MPV and the GI involvement in HSP patients. SMD: standard mean difference; MPV: mean platelet volume; HSP: Henoch-Schonlein Purpura; GI: gastrointestinal

Figure 4. Sensitivity analysis for NLR (a) and MPV (b). SMD: standard mean difference. NLR: neutrophil-to-lymphocyte ratio; MPV: mean platelet volume

Table 2. Subgroup analysis for the association between NLR and the severe GI involvement in HSP

Subgroup	Study numbers	SMD (95 CI%)	p-value	Heterogeneity
				I^2 (%)	p-value
1. Age
< 7 years	2	2.17 (0.15–4.18)	0.04	94.5	< 0.01
≥ 7 years	6	1.13 (0.40–1.86)	< 0.01	95.0	< 0.01
Combined	8	1.37 (0.70–2.05)	< 0.01	94.8	< 0.01
2. Country
China	2	2.32 (1.33–3.31)	< 0.01	92.1	< 0.01
Korea	1	1.16 (0.60–1.71)	< 0.01	-	-
Turkey	5	1.00 (0.34–1.66)	< 0.01	93.3	< 0.01
Combined	9	1.37 (0.70–2.05)	< 0.01	94.8	< 0.01
3. Definition of severe GI involvement
GI bleeding	6	1.71 (0.85–2.58)	< 0.01	93.9	< 0.01
Other	2	0.43 (0.06–0.80)	0.02	66.3	0.09
Combined	8	1.37 (0.70–2.05)	< 0.01	94.8	< 0.01

Abbreviation: GI: Gastrointestinal; SMD: standard mean difference. NLR: neutrophil-to-lymphocyte ratio; HSP: Henoch-Schonlein Purpura.

Table 3. Subgroup analysis for the association between MPV and the severe GI involvement in HSP

Subgroup	Study numbers	SMD (95 CI%)	p-value	Heterogeneity
				I^2 (%)	p-value
1. Age
< 7 years	3	−0.87 (−2.02–0.29)	0.14	92	< 0.01
≥ 7 years	6	−0.15 (−0.33–0.04)	0.11	51.0	0.07
Combined	9	−0.34 (−0.64 – −0.05)	0.02	82.7	< 0.01
2. Country
China	4	−0.03 (−0.23–0.17)	0.78	40.0	0.17
Korea	1	0.00 (−0.54–0.54)	1	-	-
Turkey	5	−0.66 (−1.24 – −0.07)	0.03	88.9	< 0.01
Combined	10	−0.29 (−0.56 – −0.01)	0.04	82.1	< 0.01
3. Definition of severe GI involvement
GI bleeding	8	−0.30 (−0.66–0.05)	0.09	83.9	< 0.01
Other	2	−0.26 (−0.80–0.28)	0.34	84.4	0.01
Combined	10	−0.29 (−0.56 – −0.01)	0.04	82.1	< 0.01

Abbreviation: GI: Gastrointestinal; SMD: standard mean difference; MPV: mean platelet volume; HSP: Henoch-Schonlein Purpura.

Figure 5. Funnel plot describing the publication bias of MPV. SE: standard error. SMD: standard mean difference; MPV: mean platelet volume

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