New Inflammatory Marker Associated with Disease Activity in Gouty Arthritis: The Systemic Inflammatory Response Index

Figures & data

Table 1 Baseline Clinical Data and Laboratory Indicators

Item	AG Group	IG Group	HC Group	P value
Age (years)	43.49 ± 13.92	42.15 ± 13.10	42.631 ± 13.62	0.342
BMI (kg/m^2)	25.79 ± 3.40	25.70 ± 3.44	–	0.707
Duration of disease (months)	48.00 (12.00–96.00) ^†	60.00 (24.00–120.00)	–	0.002
Hypertension	93 (19.6%)	70 (17.5%)	–	0.433
Diabetes mellitus	41 (8.6%)	31 (7.8%)	–	0.638
Hyperlipidemia	172 (36.3%) ^†	110 (27.6%)	–	0.006
Renal insufficiency	167 (35.2%)	118 (29.6%)	–	0.076
Renal calculi	86 (18.1%)	86 (21.6%)	–	0.207
Fatty liver	123 (25.9%)	124 (31.1%)	–	0.094
ESR (mm/h)	17.50 (8.00–33.00) ^††	9.00 (3.00–18.00)	–	<0.001
CRP (mg/L)	8.39 (2.77–24.43) ^††	1.77 (0.69–4.65)	–	<0.001
WBC (×10^9/L)	7.87 (6.36–9.66) **^††	6.83 (5.70–8.45) **	5.79 (5.09–6.73)	<0.001
GR (×10^9/L)	5.14 (3.86–6.71) **^††	4.15 (3.29–5.32) **	3.33 (2.81–4.05)	<0.001
LY (×10^9/L)	1.93 (1.51–2.40)	1.98 (1.65–2.44) *	1.84 (1.53–2.27)	0.028
MO (×10^9/L)	0.47 (0.36–0.63) **^††	0.39 (0.32–0.50) **	0.32 (0.27–0.40)	<0.001
PLT (×10^9/L)	209.00 (168.75–259.25) *	204.00 (164.00–244.00)	200.00 (161.00–229.00)	0.012
MLR	0.24 (0.19–0.32) **^††	0.20 (0.15–0.26) *	0.14 (0.18–0.22)	<0.001
NLR	2.61 (1.88–3.90) **^††	2.16 (1.56–2.68) **	1.73 (1.42–2.28)	<0.001
PLR	108.26 (79.85–145.03) ^†	99.40 (77.48–128.06)	101.50 (82.63–127.41)	0.010
SII	543.66 (375.45–798.32) **^††	422.94 (302.49–551.31) **	337.10 (263.55–447.37)	<0.001
SIRI	1.24 (0.79–2.14) **^††	0.82 (0.56–1.21) **	0.56 (0.42–0.88)	<0.001
sUA (μmol/L)	516.80 (425.78–592.93) **	519.50 (414.20–597.70) **	367.60 (328.33–396.03)	<0.001
Creatinine (μmol/L)	83.10 (74.15–95.43) **	82.80 (75.10–93.00) **	76.05 (69.88–81.305)	<0.001

Notes: The results were given as a percentage (%), mean ± SD and median (interquartile range). *P < 0.05, **P < 0.001 vs HC group. ^†P < 0.05, ^††P < 0.001 vs IG group.

Abbreviations: AG, acute gout; IG, intercritical gout; HC, healthy controls; BMI, body mass index; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; WBC, white blood cell count; GR, neutrophil granule count; LY, lymphocyte count; Mo, monocyte count; PLT, platelet count; MLR, monocyte-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SII, systemic immune-inflammatory index; SIRI, systemic inflammatory response index; sUA, serum uric acid.

Figure 1 Comparisons of NLR, MLR, PLR, and SIRI between GA patients and healthy controls. (A) MLR; (B) NLR; (C) PLR; (D) SII; (E) SIRI. ns, P > 0.05.

Abbreviations: AG, acute gout; IG, intercritical gout; HC, healthy controls; MLR, monocyte-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SII, systemic immune-inflammatory index; SIRI, systemic inflammatory response index.

Table 2 Changes in MLR, NLR, PLR, SII, and SIRI Before and After Treatment in the AG and IG Groups

Item	Group	Before	After	P value*
ESR	AG	17.00 (6.00–32.00)	7.00 (3.00–16.00)	<0.001
	IG	8.00 (3.00–15.00)	2.00 (8.00–16.00)	0.058
CRP	AG	8.12 (2.40–27.41)	2.34 (0.86–4.81)	<0.001
	IG	1.30 (0.59–3.67)	1.28 (0.68–3.02)	0.561
MLR	AG	0.24 (0.18–0.32)	0.20 (0.16–0.26)	<0.001
	IG	0.20 (0.15–0.25)	0.20 (0.16–0.24)	0.409
NLR	AG	2.51 (1.80–3.79)	2.04 (1.52–2.60)	<0.001
	IG	2.12 (1.55–2.62)	1.91 (1.50–2.65)	0.191
PLR	AG	109.21 (83.68–146.86)	95.97 (75.65–121.60)	<0.001
	IG	99.62 (77.97–126.30)	99.53 (83.64–128.26)	0.477
SII	AG	563.08 (382.58–821.84)	397.54 (298.90–521.93)	<0.001
	IG	387.77 (299.26–517.80)	409.50 (282.41–557.10)	0.989
SIRI	AG	1.12 (0.70–2.28)	0.86 (0.54–1.18)	<0.001
	IG	0.80 (0.55–1.18)	0.78 (0.52–1.08)	0.393

Notes: The results were given as the median (interquartile range). *Significance of difference between pre- and post-treatment.

Abbreviations: AG, acute gout; IG, intercritical gout; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; MLR, monocyte-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SII, systemic immune-inflammatory index; SIRI, systemic inflammatory response index.

Figure 2 Changes in MLR, NLR, PLR, SII, and SIRI before and after treatment in the AG and IG groups. (A) ESR; (B) CRP; (C) MLR; (D) NLR; (E) PLR; (F) SII; (G) SIRI. ns, P > 0.05.

Abbreviations: AG, acute gout; IG, intercritical gout; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; MLR, monocyte-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SII, systemic immune-inflammatory index; SIRI, systemic inflammatory response index.

Table 3 Correlation Analysis of MLR, NLR, PLR, SII, and SIRI with Disease Activity Markers in Patients with Gouty Arthritis

Item	MLR		NLR		PLR		SII		SIRI
	r	P	r	P	r	P	r	P	r	P
ESR	0.250	<0.001	0.270	<0.001	0.205	<0.001	0.306	<0.001	0.285	<0.001
CRP	0.391	<0.001	0.389	<0.001	0.173	<0.001	0.376	<0.001	0.441	<0.001

Abbreviations: ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; MLR, monocyte-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SII, systemic immune-inflammatory index; SIRI, systemic inflammatory response index.

Table 4 Multivariate Logistic Regression Analysis of Acute Gout Attack in Patients with Gouty Arthritis

Independent variable	B	Wald	P value	Exp (B)	95% CI
Duration of disease	−0.003	8.803	0.003	0.997	0.995–0.999
Hyperlipidemia	0.448	7.532	0.006	1.565	1.137–2.155
ESR	0.013	7.419	0.006	1.013	1.004–1.023
CRP	0.056	33.924	<0.001	1.058	1.038–1.078
SIRI	0.406	17.227	<0.001	1.501	1.229–1.818
Normal	−0.981	33.607	<0.001	0.375	–

Abbreviations: ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; SIRI, systemic inflammatory response index.

Table 5 Evaluation of the Diagnostic Efficacy of MLR, NLR, PLR, SII and SIRI for AG Using ROC Curves

Index	AUC	Asymptotically Approaching 95% Confidence Interval		Optimum Truncation Value	Sensitivity (%)	Specific Degrees (%)
		The Lower Limit	Ceiling
ESR	0.664	0.628	0.699	16.5	53.6%	74.4%
CRP	0.755	0.724	0.787	6.77	55.5%	84%
MLR	0.652	0.616	0.688	0.276	40.7%	83.0%
NLR	0.650	0.614	0.686	2.917	42.4%	81.7%
PLR	0.559	0.521	0.597	138.887	28.1%	83.2%
SII	0.647	0.610	0.683	568.504	48.1%	77.9%
SIRI	0.674	0.639	0.709	1.226	50.6%	77.7%

Abbreviations: ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; MLR, monocyte-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SII, systemic immune-inflammatory index; SIRI, systemic inflammatory response index.

Figure 3 Evaluation of the diagnostic efficacy of MLR, NLR, PLR, SII and SIRI for AG using ROC curves.

Abbreviations: ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; MLR, monocyte-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; SII, systemic immune-inflammatory index; SIRI, systemic inflammatory response index.