Evaluation of complete blood count and acute phase reactants in children with rheumatic heart disease

AIM : Acute rheumatic fever (ARF) is a systemic disease that occurs after group A beta hemolytic streptococcus (GAS) pharyngitis. Rheumatic heart disease (RHD) is accepted as an autoimmune phenomenon that causes valve damage secondary to a non-suppurative complication of group A streptococcal infection. RHD is a chronic heart disease that develops as a result of acute rheumatic fever. In our study, we aimed to reveal the role of complete blood count parameters and acute phase reactants in demonstrating ongoing inflammation in the body in children with a diagnosis of RHD. MATERIALS AND METHODS : In this study; between 01.01.2014 and 31.12.2019, a total of 88 cases, 41 of whom were followed up with the diagnosis of ARF and 47 of which were followed up with the diagnosis of RHD between the ages of 4-18, who applied to the Pediatric Cardiology and General Pediatrics outpatient clinics of Aydın Adnan Menderes University Faculty of Medicine, were included. As the control group, 82 healthy children of similar age and gender, aged 4-18 years, who were evaluated in the Pediatric Cardiology and General Pediatrics outpatient clinics of Aydın Adnan Menderes University Faculty of Medicine, without any systemic or chronic disease, were included. A study form was prepared from the descriptive information of the study, including name-surname, gender, age, year of diagnosis, use and duration of prophylaxis, echocardiography information, complete blood count parameters, biochemical markers (total protein, albumin) and acute phase reactants (ESR, CRP). This form was filled out separately for both the case and control groups from the patient file information registered in the MIA-MED program of our hospital's registry system. RESULTS : The complete blood count parameters of each of the ARF, RHD and control group patients included in our study were examined separately and three groups were determined to be compared with each other, as ARF-RHD, ARF-control and RHD-control. In between ARF, RHD and control groups'; Hb (ARF: 11.6 ± 1.3 gr/dL, RHD: 13.2 ± 1.1gr/dL; p<0.001), (ARF: 11.6 ± 1.3 gr/dL, control: 13.5 ± 1.1 gr/dL; p<0.001), leukocyte (ARF: 11047.1 ± 4533.5/μL, RHD: 8750.2 ± 2522.9/μL; p<0.001), (ARF: 11047.1 ± 4533.5/μL, control: 7869.9 ± 2290.1/μL; p<0.001), (RHD: 8750.2 ± 2522.9 /μL, control: 7869.9 ± 2290.1/μL; p<0.001), neutrophil (ARF: 7498 ± 4369/μL, RHD: 5039.6 ± 2006.9/μL; p<0.001), (ARF: 7498 ± 4369/μL, control: 3933.5 ± 1860.2/μL; p<0.001), (RHD: 5039.6 ± 2006.9/μL, control: 3933.5 ± 1860.2/μL; p<0.001), monocytes (ARF: 750.7 ± 299.8/μL, RHD: 617 ± 237.6/μL); p<0.001), (ARF: 750.7 ± 299.8/μL, control: 517.4 ± 172.6/μL; p<0.001), (RHD: 617 ± 237.6/μL, control: 517.4 ± 172.6/μL; p< 0.001), lymphocyte (ARF: 2569 ± 850.8/μL, control: 3122.3 ± 1193.6/μL; p<0.05); PLT (ARF: 402487.8 ± 144520.1/μL, RHD: 299766 ± 69153.6/μL; p<0.001), (ARF: 402487.8 ± 144520.1/μL, control: 315341.5 ± 76570.7/μL; p<0.001), PCT (ARF: 0.8 ± 1.2%, RHD: 0.3 ± 0.4%; p<0.001), (ARF: 0.8 ± 1.2%, control: 0.3 ± 0.1% ; p<0.001), MPV (ARF: 9 ± 0.9 fL, RHD: 9.6 ± 1.2) fL; p<0.05), (RHD: 9.6 ± 1.2fL, control: 9 ± 1fL; p<0.05), RDW (ARF: 13.6 ± 1.1%, control: 13 ± 0.7%; p<0.05), (RHD : 13.3 ± 1%, control: 13 ± 0.7%; p<0.05), PDW (ARF: 14.7 ± 2, control: 15.8 ± 0.4; p<0.05), (RHD: 14.4 ± 2.6, control: 15.8 ± 0.4 ; a statistically significant difference was found between these values. NLR (ARF: 3.3 ± 2.4, RHD: 2 ± 1.1; p<0.001), (ARF: 3.3 ± 2.4, control: 1.7 ± 2.4; p<0.001), (RHD: 2 ± 1.1, control: 1.7 ± 2.4; p<0.001), MLR (ARF: 0.3 ± 0.2, RHD: 0.2 ± 0.1; p<0.001), (ARF: 0.3 ± 0.2, control: 0.2 ± 0.2; p<0.001), (RHD: 0.2 ± 0.1, control: 0.2 ± 0.2; p<0.001), PLR (ARF: 171.4 ± 78.5, RHD: 116 ± 45.1; p<0.001), (ARF: 171.4 ± 78.5, control: 115.1 ± 65.5; p<0.001) parameters were also found statistically significant. In the ARF group, we found a significant positive correlation between CRP and NLR (r=0.584, p=0.001), MLR (r=0.662, p=0.001), PLR (r=0.560, p=0.001), CRP/ALB (r=0.997, p=0.001). Also, in the ARF group there was a significant positive correlation between ESR and NLR (r=0.439, p=0.004), MLR (r=0.464, p=0.002), PLR (r=0.568, p=0.001), CRP/ALB (r=0.730, p=0.001). Optimal cut-off values of NLR, MLR, PLR, and CRP/ALB ratios were determined for patients in the RHD and ARF groups by ROC analysis. CONCLUSION : At the end of our study; parameters such as leukocyte-neutrophil- monocyte-platelet count, RDW, PCT, NLR, MLR, PLR and CRP/ALB ratio, which increase in various inflammatory diseases and can be measured in routine complete blood count, are correlated with acute phase reactants and progress with inflammation. We observed that these parameters were increased in patients with ARA and RHD compared to the control group. We think that these parameters can be used as new guiding markers in terms of cheap and fast for ARF carditis and RHD prognosis that can be checked during daily practice. Keywords : Rheumatic heart disease, acute rheumatic fever, chronic inflamation, complete blood count, neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, platelet-lymphocyte ratio