Correlation of Platelet-albumin Ratio with Clinicopathological Features of IgA Nephropathy

Abstract

Background Immunoglobulin A (IgA) nephropathy (IgAN) is a chronic inflammatory illness involving multiple factors and genes, platelet-albumin ratio (PAR) is regarded as a novel marker of inflammation, but the connection between PAR and IgA nephropathy remains unclear. Objective To examine the correlation of PAR with the clinicopathological indicators of IgAN and to evaluate the clinical significance of PAR in IgAN. Methods From October 2019 to August 2020, 210 patients with IgAN diagnosed by percutaneous renal biopsy at the Department of Nephrology of the First Affiliated Hospital of Kunming Medical University were selected as study subjects, general inforamtion of the included patients (gender, age, systolic blood pressure, diastolic blood pressure and disease duration), laboratory indicators〔white blood cell (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute monocyte count (AMC), platelet count (PLT), serum albumin (ALB), serum uric acid (SUA), blood urea nitrogen (BUN), serum creatinine (Scr), IgA, immunoglobulin M (IgM), immunoglobulin G (IgG), serum complement C3, serum complement C4, urine red blood cell count (URBC), 24 h urinary microalbumin (24 h mALB), 24 h micrototal protein (24 h MTP) 〕, percutaneous renal biopsy pathology results, calculated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), PAR, immunoglobulin A-to-complement C3 ratio (IgA/C3), immunoglobulin G-to-complement C3 ratio (IgG/C3), complement C3-to-complement C4 ratio (C3/C4), and estimated glomerular filtration rate (eGFR) were collected. The study subjects were divided into three groups: group Q1 (PAR≤5.626 5), group Q2 (5.6265<PAR≤6.984 3) and group Q3 (PAR>6.984 3), each group of 70 cases. The differences in the baseline inforamtion among the three groups were compared, Spearman correlation analysis and Logistic regression analysis were used to explore the correlation between PAR and IgAN clinicopathological indicators of IgAN, receiver operating characteristic (ROC) curves were plotted to analyze the predictive value of PAR on pathological indicators. Results There were significant differences in gender, WBC, ANC, PLT, PLR, PAR, URBC, ALB, IgG/C3, 24 h-mALB, 24 h-MTP, M lesions, Lee classification among the three groups (P<0.05). Spearman correlation analysis showed that PAR was positively correlated with PLT, WBC, ANC, PLR, URBC, 24 h-mALB, 24 h-MTP, M lesions, E lesionsand Lee classification, and negatively correlated with ALB and IgG/C3 (P<0.05). Multivariate Logistic regression analysis showed that PAR〔OR=2.688, 95%CI (1.178, 6.135) 〕 and ALB〔OR=0.736, 95%CI (0.587, 0.923) 〕 were independent influencing factors for M1 lesions in IgAN patients (P<0.05), ALB〔OR=0.896, 95%CI (0.824, 0.973) 〕 was an independent influencing factor for E1 lesions (P<0.05). The ROC curve showed that area-under-curve (AUC) of PAR predicting M1 and E1 lesions in IgAN patients was 0.727 and 0.599, respectively. Conclusion PAR was significantly correlated with the clinical manifestations and the degree of M and E lesions of IgAN, which has clinical significance in evaluating IgAN activity. Patients with high PAR levels should be treated more aggressively to inhibit active lesions and improve renal outcomes.

Keywords

• glomerulonephritis, iga|oxford classification of iga nephropathy|platelet-albumin ratio|clinicopathological features|root cause analysis