The Relation Between Neutrophil–Lymphocyte Ratio and Endothelial Dysfunction

We read the article ‘‘Neutrophil–Lymphocyte Ratio and Carotid– Intima Media Thickness in Patients With Behçet Disease Without Cardiovascular Involvement’’ by Ozturk et al with interest. They evaluated the neutrophil–lymphocyte ratio (NLR), carotid intima–media thickness (cIMT), and Behçet disease (BD) activity in patients without cardiovascular involvement. They reported a high NLR, a positive correlation between cIMT and NLR, and suggested that a high NLR is related to endothelial dysfunction and reflects BD activity. Behçet disease is associated with endothelial dysfunction and chronic inflammation. Endothelial dysfunction is an early step in atherogenesis and it can be assessed by markers such as cIMT and arterial stiffness. A complete blood count routinely measured using automated cell counters is an inexpensive and easy to interpret test. Compared with other markers of endothelial activity, blood parameters such as the NLR are practical and prognostically useful in many conditions. 4 However, in a previous study, Alkaabi et al evaluated the cause of thrombosis in BD. They reported that the values of factor VIII:C, von Willebrand factor antigen, antithrombin, and protein S most likely represent an acute-phase phenomenon and were significantly higher in the BD group. They hypothesized that active BD causes vasculitic endothelial perturbation with dysfunction, leading to an increased propensity for thrombosis. Ozuguz et al reported increased levels of mean high-sensitivity C-reactive protein, erythrocyte sedimentation rate, homocysteine, and asymmetric dimethylarginine (ADMA) in the BD group, especially in those with active disease. Flow-mediated dilatation (FMD) was significantly lower in patients with BD than in controls. The FMD correlated negatively with BD duration and serum ADMA levels; a positive correlation was also seen between serum ADMA levels and BD duration. They concluded that FMD in conjunction with markers of inflammation may evaluate endothelial dysfunction in BD. Ozturk et al showed higher cIMT and NLR levels in patients with BD compared to controls but some of the above-mentioned markers could have been considered and correlated the NLR. In conclusion, the relationship between NLR and other widely accepted markers in BD should be evaluated in largescale prospective randomized trials.