Сочетание уровня ЛДГ/лимфоцитов и С-реактивного белка после плазмафереза выявляет пациентов с анкилозирующим спондилитом, находящихся в группе высокого риска смертности

Post-plasma exchange (PLEX) values of the lactate dehydrogenase (LDH)/lymphocyte ratio and C-reactive protein (CRP) may pinpoint patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) at high risk of in-hospital mortality, according to a study published in  Medicine. PLEX, a procedure to remove circulating antibodies and inflammatory substances from the patient’s blood, is sometimes used in severe cases of AAV. Still, evidence concerning its benefits remains mixed. This retrospective, single-center study included 33 patients with severe AAV who were admitted to the intensive care unit at Ege University between January 2010 and June 2021 and received at least 3 PLEX sessions. All patients had renal involvement; 24 had granulomatosis with polyangiitis, and 9 had microscopic polyangiitis. Every patient received cyclophosphamide, high-dose corticosteroids, and PLEX. Biochemical parameters were measured immediately before the first PLEX and after the final session. Patients were classified according to in-hospital mortality, and a classification and regression tree model was developed to identify mortality predictors.  The patients had a median age of 55 years, and 19 of 33 were male. Thirteen patients died during hospitalization, amounting to an in-hospital mortality rate of 39.4%. Nine deaths were attributed to AAV-related organ failure, 3 to septic shock, and 1 to an undetermined cause. Nonsurvivors were older than survivors, with median ages of 64 and 54 years, respectively. After the final PLEX session, the median LDH/lymphocyte ratio was 1.1 among nonsurvivors and 0.3 among survivors ( P  <.001). Median final CRP levels were 10.2 and 2.8 mg/L, respectively ( P  =.008). Nonsurvivors also had higher post-PLEX LDH, neutrophil-to-lymphocyte ratios, liver enzymes, bilirubin, and globulin levels, as well as lower lymphocyte and albumin levels. A post-PLEX LDH/lymphocyte ratio above 0.55 was the strongest predictor of death. Among patients above this level, all 11 with CRP above 0.67 mg/dL died. The model had a sensitivity of 76.9% and specificity of 80.0%. “A high LDH/lymphocyte ratio may represent the coexistence of ongoing tissue injury and impaired immune recovery more effectively than either LDH or lymphocyte count alone. In our model, CRP provided an additional inflammatory dimension, reflecting persistent acute-phase activation after PLEX. Thus, the combination of LDH/lymphocyte ratio and CRP may capture different aspects of post-PLEX clinical risk: tissue injury and metabolic stress, impaired immune reserve, and unresolved systemic inflammation,” the study authors wrote. This article originally appeared on Rare Disease Advisor References: Yuksel HC, Kilincer Bozgul SM, Acar C, et al.  Dynamic lactate dehydrogenase/lymphocyte ratio and C-reactive protein as predictors of mortality after plasma exchange in ANCA-associated vasculitis: a retrospective case control study.  Medicine. Published online August 21, 2026. doi:10.1097/MD.0000000000050314