Meta-Analysis Of The Correlation Between RDW,NLR,PLR And Renal Damage In Children With Henoch Schonlein Purpura

BackgroundHenoch Schonlein purpura(HSP)is the most common vasculitis in children,which can partly involve the kidney to develop into Henoch Schonlein purpura nephritis(HSPN).It may even progress to renal failure or End-stage renal disease(ESRD),which can seriously affect the long-term prognosis.Therefore,early diagnosis of kidney damage plays a crucial role in avoiding or delaying the occurrence of end-stage renal disease.In recent years,more and more studies have reported on Red blood cell distribution width(RDW),Neutrophil to lymphocyte ratio(NLR),Platelet to lymphocyte ratio(PLR)and renal damage in children with HSP,but the conclusions are controversial and there is a lack of systematic evidence-based studies.ObjectiveTo compare the differences between RDW,NLR and PLR in children with and without renal damage in HSP,and systematically evaluate the possible association between RDW,NLR and PLR and renal damage in children with HSP,so as to provide reliable basis for early clinical identification of renal damage.MethodsSearch Chinese and English databases by computer:China National Knowledge Infrastructure,Wanfang,VIP,CBM,Pub Med,Web Of Science,Scopus,Ovid MEDLINE,Cochrane Library and Embase.The time limit for retrieval is from the establishment of the database to January 2023.Studies on the association of RDW and/or NLR and/or PLR with renal impairment in children with HSP were included,and mean and standard deviations of RDW,NLR and PLR were extracted,either directly from the included studies or by corresponding calculations of the included study data.Newcastle-Ottawa Quality Assessment Scale(NOS)was used for quality assessment.The data were analyzed statistically by Stata 15.1 and Rev Man5.4.Standardized mean difference(SMD)and 95%Confidence interval(CI)were used as the statistics for effect analysis.Cochrane’s Q test and I~2 statistics were used to evaluate the inter-study heterogeneity,and subgroup analysis was conducted to explore the influencing factors of significant heterogeneity,funnel plot and Egger test to evaluate publication bias.ResultsFinally,21 studies were included,involving a total of 4601 children,including 2 retrospective cohort studies and 19 case-control studies.Of these,11 studies reported an association between RDW and renal involvement in children with HSP,including 2961 children;13 studies reported the association between NLR and renal involvement in children with HSP,including 2146 children;8 studies reported the relationship between PLR and renal involvement in children with HSP,including 1160 children,with the following results:(1)Among the 11 studies on the relationship between RDW and renal damage in children with HSP,the level of RDW in HSP with renal damage group was significantly higher than in the non-renal damage group(SMD=0.70,95%CI=[0.42,0.97],P<0.001).In addition,the results of subgroup analysis showed that the combined results of each subgroup were consistent with the total combined results in different diagnostic criteria of HSP,diagnostic criteria of renal damage and NOS score subgroups,and the difference was statistically significant(P<0.05).The influencing factors of significant heterogeneity were not found by subgroup analysis.Sensitivity analysis showed that the results were stable,funnel chart and Egger test showed that there was no publication bias.(2)Among the 13 studies on the relationship between NLR and renal damage in children with HSP,the level of NLR in HSP with renal damage group was significantly higher than in the non-renal damage group(SMD=0.38,95%CI=[0.07,0.69],P=0.016).In addition,the results of subgroup analysis showed that the combined results were consistent with the total results in the cohort study,Asian countries and HSP diagnostic criteria of 2010EULAR/PRINTO/PRES subgroup,and the difference was statistically significant(P<0.05),while the other subgroups were inconsistent with the total results,the difference was not statistically significant(P>0.05).The influencing factors of significant heterogeneity were not found by subgroup analysis.Sensitivity analysis showed that the results were stable,funnel chart and Egger test showed that there was no publication bias.(3)Among the 8 studies on the relationship between PLR and renal damage in children with HSP,there was no significant difference in PLR level between HSP with renal damage group and non-renal damage group(SMD=0.24,95%CI=[-0.11,0.60],P=0.181).In addition,the results of subgroup analysis showed that the combined results were consistent with the total combined results in different research types,races and NOS score subgroups.The influencing factors of significant heterogeneity were not found by subgroup analysis.Sensitivity analysis showed that the results were stable.ConclusionRDW and NLR are correlated with HSP renal damage in children,and may be potential indicators to predict HSP kidney damage in children.It is not yet possible to prove the correlation between PLR and HSP renal damage in children.