{
  "abstract": "Introduction Elevated neutrophil-to-lymphocyte ratio (NLR) >2.95 has been associated with worse outcomes in systemic sclerosis (SSc). We aimed to evaluate whether elevated NLR can serve as a marker of disease onset in SSc, to further define an NLR cutoff predictive of poor outcomes and to examine NLR longitudinal variations.Material and Methods Adult patients with systemic sclerosis (SSc) from Maccabi Healthcare Services (MHS), a 2.7-million-member Israeli health provider, were identified between 2003 and 2023 using ICD-9 codes. Inclusion required either a diagnosis made by a rheumatologist or documentation of diagnosis in the medical record accompanied by serological confirmation.Results Of 1,752 patients meeting inclusion criteria, 241 were excluded due to steroid use to avoid its confounding effect. The final cohort included 1,511 patients, of whom 1,232 had baseline NLR data ( figure 1a). The mean NLR at diagnosis was 2.2±1.4; 9% had NLR 3–4, and 6.5% had NLR >4. In patients with a baseline NLR greater than 3 (n=191, mean 4.4=2), there was a significant increase in NLR at disease onset compared to levels measured 1–15 years earlier (p<0.0001) (figure 1b). Notably, 36% of these patients had SSc-specific antibodies detectable up to 15 years before diagnosis. Following diagnosis, NLR remained persistently elevated over 15 years unaffected by treatments. Kaplan–Meier curves stratification into 4 NLR categories (0–1.99, 2.00–2.99, 3.00–3.99, >4.0) revealed a clear stepwise decline in survival with increasing NLR (log-rank p<0.001) both at 5-year and 10-year (figure 1c). Patients with NLR > 4 at diagnosis were older (59.8±15.7 vs. 53.2±15.4, p=0.001), suffered more frequently from interstitial lung disease (ILD) and pulmonary hypertension (PAH), (p<0.001), and had higher 5-year and 10-year mortality rates compared to NLR<2 (30% vs. 6% and 33% vs. 10%, respectively, p<0.001) (figure 1a). In a multivariable Cox regression, adjusted for age, sex, ILD, and PAH, NLR above 3 and to a further extent above 4 were significantly associated with mortality (HR 1.7, p=0.025 and HR 2.8, p<0.001, respectively). A cutoff of NLR>4 was highly predictive of mortality with specificity of 93% and a NPV of 85.9%.Conclusions We propose that an elevated NLR signifies disease onset in a subset of SSc patients with unfavorable outcomes. Specifically, we refined the NLR cut-off at diagnosis to >4, identifying it as a more specific threshold for distinguishing patients at increased risk of mortality. NLR is a simple, cost-effective prognostic biomarker that may help in early identification of high-risk patients who may benefit from prompt and intensive intervention.Abstract P.229 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion Israel institute of technology, Haifa, Israel"
      ],
      "name": "Doron Rimar"
    },
    {
      "affiliations": [
        "Maccabi Healthcare Services, HaMered 27, Tel-Aviv, Israel"
      ],
      "name": "Shlomit Yaari"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion Israel institute of technology, Haifa, Israel"
      ],
      "name": "Gleb Slobodin"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion Israel institute of technology, Haifa, Israel"
      ],
      "name": "Shiri Keret"
    }
  ],
  "title": "P.229 Neutrophil-to-lymphocyte ratio as a biomarker for disease onset and severity in systemic sclerosis – real-world data from a large healthcare provider in Israel",
  "uid": "473d09b5-6331-5fdd-b80c-10f62a1859aa"
}