Neutrophil–Lymphocyte Ratio in Behçet Disease

We read with interest the letter by Unlu et al regarding our article entitled ‘‘Neutrophil–lymphocyte ratio (NLR) and carotid-intima media thickness in patients with Behçet disease without cardiovascular involvement.’’ Behçet disease (BD) is a chronic, multisystemic, inflammatory condition. Unlu et al commented on the relation between thrombosis and inflammatory markers in BD. This disease is commonly associated with vascular system morbidity and mortality presenting as vasculitis, thromboembolism, and pulmonary artery aneurysm. Increased inflammatory response in BD may lead to endothelial dysfunction (ED), which results in vasculopathy. Endothelial dysfunction is considered to play an important role in the pathogenesis of vasculitis and thrombosis in BD. Therefore, there is a need to search for markers of ED and hemostasis (eg, NLR, endocan, and mean platelet volume). The NLR is an easy, cheap, noninvasive, and widely available laboratory marker used to evaluate systemic inflammation. We reported a high NLR, a positive correlation between carotid intima–media thickness and NLR, and suggested that a high NLR is related to ED and reflects BD activity. We have also reported that patients with BD had significantly higher serum levels of endocan as candidate endothelial immunoinflammatory marker, and these levels correlated positively with C-reactive protein, erythrocyte sedimentation rate, and BD activity. Serum levels of endocan were higher in patients with systemic involvement. However, the pathogenesis of vasculitis and thrombosis in BD is probably affected by many factors. For example, male sex, younger age of onset, and HLAB51 positivity in BD have been strongly associated with vascular involvement. Thus, the NLR itself alone without other inflammatory markers may provide less information about vascular involvement of patients with BD. So we suggest that the NLR should be evaluated together with other factors.