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. 2024 Sep 28;14(1):22470.
doi: 10.1038/s41598-024-72977-w.

Evaluation of disease activity in systemic lupus erythematosus using standard deviation of lymphocyte volume combined with red blood cell count and lymphocyte percentage

Juan Zhao #  1 , Wanchan Peng #  1 , Siyu Wu  1 , Wei Wang  2
Affiliations

Evaluation of disease activity in systemic lupus erythematosus using standard deviation of lymphocyte volume combined with red blood cell count and lymphocyte percentage

Juan Zhao et al. Sci Rep. .

Abstract

Systemic lupus erythematosus (SLE) commonly damages the blood system and often manifests as blood cell abnormalities. The performance of biomarkers for predicting SLE activity still requires further improvement. This study aimed to analyze blood cell parameters to identify key indicators for a SLE activity prediction model. Clinical data of 138 patients with SLE (high activity, n = 40; moderate activity, n = 44; mild activity, n = 37; low activity, n = 17) and 100 healthy controls (HCs) were retrospectively analyzed. Data from 89 paired admission-discharge patients with SLE were collected. Differences and associations between blood cell parameters and disease indicators, as well as the relationship between the these parameters and organ damage, were examined. Machine-learning methods were employed to develop a prediction model for disease activity evaluation. Most blood cell parameters (22/26, 84.62%) differed significantly between patients with SLE and HCs. Analysis of 89 paired patients with SLE revealed significant changes in most blood cell parameters at discharge. The standard deviation of lymphocyte volume (SD-V-LY), red blood cell (RBC) count, lymphocyte percentage (LY%), hemoglobin(HGB), hematocrit(HCT), and neutrophil percentage(NE%) correlated with disease activity. By employing machine learning, an optimal model was established to predict active SLE using SD-V-LY, RBC count, and LY% (area under the curve [AUC] = 0.908, sensitivity = 0.811). External validation indicated impressive performance (AUC = 0.940, sensitivity = 0.833). Correlation analysis revealed that SD-V-LY was positively correlated with ESR, IgG, IgA, and IgM but was negatively correlated with C3 and C4. The RBC count was linked to renal and hematopoietic system impairments, whereas LY% was associated with joint/muscle involvement. In conclusion, SD-V-LY is associated with SLE disease activity. SD-V-LY combined with RBC count and LY% contributes to a prediction model, which can be utilized as an effective tool for assessing SLE activity.

Keywords: Disease activity; Lymphocyte percentage; Machine learning; Red blood cell; Standard deviation of lymphocyte volume; Systemic lupus erythematosus.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The distribution of SD-V-LY, RBC count, and LY% in SLE patients with different disease activities. Standard deviation of lymphocyte volume (SD-V-LY) (a), red blood cell (RBC) count (b), and lymphocyte percentage (LY%) (c) among the subgroups were differentially distributed. The 138 patients with systemic lupus erythematosus (SLE) at admission were classified into four subgroups according to the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K): low activity (SLEDAI-2 ≤ 4, n = 17), mild activity (5 ≤ SLEDAI-2 K ≤ 9, n = 37), moderate activity (10 ≤ SLEDAI-2 K ≤ 14, n = 44), and high activity (SLEDAI-2 K ≥ 15, n = 40). Bonferroni correction was applied to adjust for multiple comparisons. *p < 0.05; **p < 0.01.
Fig. 2
Fig. 2
The associations between SD-V-LY and various SLE disease indicators. Standard deviation of lymphocyte volume (SD-V-LY) is widely associated with indicators of systemic lupus erythematosus (SLE). The SD-V-LY values in patients with SLE increased as the antinuclear antibody (ANA) titer increased (a). For anti-dsDNA-, anti-Smith-, anti-ribosome P-, and anti-nucleosome-positive patients with SLE, the SD-V-LY values were significantly higher than those of negative patients. Moreover, SD-V-LY values were notably higher in patients with SLE with abnormal complement protein 4 (C4), complement protein 3 (C3), and erythrocyte sedimentation rate (ESR) (b). Bonferroni correction was applied to adjust for multiple comparisons, and the Mann-Whitney U test was employed for comparisons between the two groups.*p < 0.05; **p < 0.01; ***p < 0.001. Normal: variable results that are within the reference range or are negative. Abnormal: variable results that are outside the reference range or are positive.
Fig. 3
Fig. 3
Associations of SD-V-LY with other SLE disease indicators. Associations of the standard deviation of lymphocyte volume (SD-V-LY) with the erythrocyte sedimentation rate (ESR) (a), complement protein 4 (C4) (b), complement protein 3 (C3) (c), immunoglobulin G (IgG) (d), immunoglobulin A (IgA) (e), and immunoglobulin M (IgM) (f) in patients with systemic lupus erythematosus (SLE). Spearman’s rank correlation coefficients were used to assess the associations between SD-V-LY values and these disease indicators in 138 patients with SLE. Statistical significance was set at p < 0.05.
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