Role of parameters in whole blood analysis as an indicator of systemic inflammation in pediatric patients with rheumatic valve disease

Purpose: Acute Rheumatic Fever (ARF) is a multisystem inflammatory disease that develops due to autoimmunity after being treated poorly of Group A Beta Hemolytic Streptococcal throat infection in susceptible individuals. The most important cause of mortality and morbidity of the disease is carditis and rheumatic heart disease (RHD). This study aimed to identify markers that can play a role as indicators of chronic inflammation in whole blood analysis in pediatric patients with ARF. This prospective study's patient was composed of pediatric patients with ARF who were followed up at the pediatric cardiology unit of Bezmialem Vakif University Hospital. The control group was made up of healthy children with the same age and sex as the patient group. Another aim of this study was to investigate the effect of regular ARF prophylaxis on these markers. Methods: In our study, a total of 100 children with ARF between the ages of 4 and 18 years were followed up at the pediatric cardiology outpatient clinic of Bezmialem Vakif University Hospital composed the patient group. The control group was made up of 100 healthy children of the same sex and age group as the patient group. All children in the patient group regularly receive deposilin prophylaxis every 21 days. The results of whole blood analysis of sick and healthy children were examined in the Nucleus system, and all data were entered into the system. Age and gender information in the records entered as data. Our study included many whole blood parameters that are reported to alterations in chronic inflammatory diseases in the literature. These parameters were CRP, Erythrocyte Distribution Width (RDW), Platelet Distribution Width (PDW), Mean Platelet Volume (MPV) and leukocyte subtypes, neutrophil, lymphocyte, monocyte counts and their ratios to each other (neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte) rate). The markers that can be used as an indicator of chronic inflammation were determined By statistically comparing all these parameters in the patient and control groups. Our study aimed to investigate the effect of regular ARF prophylaxis on these markers by comparing the results with the literature. The distribution of variables was measured with the Kolmogorov-Smirnov test. The Mann-Whitney U Test was used in the analysis of quantitative independent data. Chi-square test was used in the analysis of qualitative independent data. Spearman correlation analysis was used in the correlation analysis. Results: There was no significant difference in gender distribution (p > 0.05) between the group of children with rheumatic heart disease (RHD) and healthy children. Leukocyte count, lymphocyte count, and basophil count were significantly lower in the patient group than in the control group (p <0.05). In addition, basophil count was significantly higher (p < 0.05) in the patient group. Erythrocyte Distribution Width (EDW) value was significantly (p < 0.05) higher in the patient group than in the control group. No statistically significant difference was found between the groups (p > 0.05) when the patient and control groups were compared in terms of platelet distribution width (PDW) and mean platelet volume (MPV). While there was no statistically significant difference in neutrophil/lymphocyte, platelet/lymphocyte ratios in the RHD group compared to the control group, a significant decrease was found in the Monocyte Lymphocyte Ratio (p < 0.05). Conclusion: There was not any statically significant increase in acute and chronic inflammatory cells in our patient group. On the contrary, in our study, we found that leukocyte count, lymphocyte count, basophil count, and monocyte/lymphocyte ratio decreased and RDW value increased in pediatric patients with RHD who received regular secondary deposilin prophylaxis. The low leukocyte, lymphocyte, basophil count and monocyte/lymphocyte ratio were attributed to our patients' regular use of deposilin prophylaxis, unlike the studies reported in the literature about pediatric patients with RHD. Therefore, we think that low leukocyte, lymphocyte, basophil count and monocyte/lymphocyte ratio can be used as markers due to the fact that deposilin prophylaxis was performed regularly in pediatric patients with RHD. The notable elevation of RDW value in the patient group was not caused by chronic inflammation instead it was related to the deterioration of the heart valve surface anatomy in our patients. Key words: rheumatic heart disease, acute rheumatic fever, whole blood analysis