Clinical Study On Novel Biomarkers In Patients With The Acute Phase Of Thromboangiitis Obliterans

Objective:The acute exacerbations and progressive deterioration seen in thromboangiitis obliterans(TAO)have been related to poor clinical outcomes.Therefore,monitoring the acute phase of TAO is critical for clinical management.However,at present,there is no clear research and elaboration about reliable laboratory biomarkers could be available to monitor the acute phase.Here,we have studied the association of laboratory biomarkers with the acute phase of TAO.Methods:We conducted a retrospective case-control study on 121 patients(53 patients in the acute phase,68 patients in the non-acute phase)with TAO and 98 healthy controls(45 non-smokers and 53 smokers).Normal distributions of data were examined using the Kolmogorov-Smirnow test.The differences were assessed in the measured parameters between patients and controls,and between acute phase and non-acute phase patients by Independent-Samples T test,Mann-Whitney's U test or?~2 test.Correlations between related biomarkers and classic acute phase reactants were evaluated with Spearman's correlation coefficient.Analyzing and discussing the correlativities,such as specificity and sensitivity,between novel laboratory biomarkers and the acute phase of TAO by univariate and multivariate logistic regression models,receiver operating characteristic(ROC)and area under the curve(AUC).Results:By analyzing these laboratory biomarkers,including neutrophil-to-lymphocyte rate(NLR),lymphocyte-to-monocyte rate(LMR),platelet-to-neutrophil rate(PNR),fibrinogen(FIB)and apolipoprotein A–I(ApoA-I),significantly higher NLR level,as well as lower LMR,PNR,ApoA-I levels were observed in patients with TAO,especially in the acute phase,particularly the acute phase.Significantly increased FIB was only observed in the acute phase of TAO comparing with the non-acute phase,but there was no significant difference between the normal control group and the TAO patient group.A positive correlation was found between NLR and with C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)in the acute phase(r=0.881,p<0.001 or r=0.637,p=0.008).Moreover,NLR,PNR and FIB levels of 3.38,42.30and 3.81g/L were shown to be the predictive cut-off values for the acute phase of TAO(sensitivity 73.6,84.9 and 67.9%,specificity 92.5,77.4 and 94.3%;area under the curve(AUC)0.878,0.859 and 0.874),respectively.FIB level was independently associated with the AP-TAO(OR=12.312,p=0.006).Conclusions:Our findings suggest NLR,PNR and FIB have good diagnostic and predictive value for the acute phase of TAO,and the cut-offs NLR>3.38 and PNR<42.30 were determined to have good specificity and sensitivity,respectively.Lastly,a FIB cut-off of>3.81 g/L displayed great specificity and was an independent risk factor for the acute phase of TAO.