Medical Journal of The Islamic Republic of Iran (MJIRI)
Iran University of Medical Sciences
Tue, Sep 8, 2026
[Archive]
Volume 40, Issue 1 (1-2026)
Med J Islam Repub Iran 2026 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Bamedi M S, Ansari H, Alijani E, Shahriari H, Khazaei H A, Azizi S G. The Role of Systemic Inflammatory Ratios in Refractory Chronic Spontaneous Urticaria Patients with Gastroesophageal Reflux Disease. Med J Islam Repub Iran 2026; 40 (1) :683-688
URL: http://mjiri.iums.ac.ir/article-1-10139-en.html
URL: http://mjiri.iums.ac.ir/article-1-10139-en.html
Mohammad Sina Bamedi 
, Hossein Ansari , Ebrahim Alijani , Hossein Shahriari , Hossein Ali Khazaei , Seyed Ghader Azizi
, Hossein Ansari , Ebrahim Alijani , Hossein Shahriari , Hossein Ali Khazaei , Seyed Ghader Azizi
Clinical Immunology Research Center, Zahedan University of Medical Sciences, Zahedan, Iran , sg.azizi@zaums.ac.ir
Abstract: (259 Views)
Background: Refractory chronic spontaneous urticaria (R-CSU) is characterized by systemic mast-cell-driven inflammation, which may present with extra-cutaneous conditions such as gastroesophageal reflux disease (GERD). The utility of simple blood-derived inflammatory ratios that characterize this systemic inflammation is currently limited. We investigated the neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), and platelet-to-lymphocyte ratio (PLR) as potential inflammatory markers in patients with R-CSU, both with and without GERD.
Methods: A retrospective case-control study was conducted involving 116 patients with recurrent chronic spontaneous urticaria (R-CSU) between 2023 and 2024 at Ali ibn Abi Talib Hospital in Zahedan. Among these patients, 58 were diagnosed with GERD, while the remaining 58 were not. Initially, GERD was clinically confirmed, after which complete blood count (CBC) parameters were utilized to calculate the neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), and platelet-to-lymphocyte ratio (PLR). Group differences were analyzed using Mann–Whitney U tests and multivariate regression, adjusted for potential confounders. Receiver operating characteristic (ROC) analysis was employed to assess diagnostic accuracy.
Results: NLR was significantly higher in R-CSU patients with GERD compared to those without GERD (NLR: 2.05 ± 1.7 vs 1.05 ± 0.91, P = 0.041; ELR: 0.26 ± 0.18 vs 0.21 ± 0.11, P = 0.084). In contrast, PLR did not differ significantly (P = 0.500). In the multivariate analysis, NLR remained an independent predictor of GERD comorbidity after adjustment (β = 0.41, P < 0.001). ROC analysis identified an NLR cut-off of 1.24, demonstrating 81% sensitivity and 64% specificity for distinguishing R-CSU with GERD.
Conclusion: Elevated NLR and ELR indicate systemic inflammation in patients with refractory CSU and GERD. These findings support the hypothesis that systemic inflammation contributes to extracutaneous symptoms in this population. Routine, readily available CBC-derived ratios may serve as cost-effective markers for identifying systemic inflammatory activity in R-CSU.
Methods: A retrospective case-control study was conducted involving 116 patients with recurrent chronic spontaneous urticaria (R-CSU) between 2023 and 2024 at Ali ibn Abi Talib Hospital in Zahedan. Among these patients, 58 were diagnosed with GERD, while the remaining 58 were not. Initially, GERD was clinically confirmed, after which complete blood count (CBC) parameters were utilized to calculate the neutrophil-to-lymphocyte ratio (NLR), eosinophil-to-lymphocyte ratio (ELR), and platelet-to-lymphocyte ratio (PLR). Group differences were analyzed using Mann–Whitney U tests and multivariate regression, adjusted for potential confounders. Receiver operating characteristic (ROC) analysis was employed to assess diagnostic accuracy.
Results: NLR was significantly higher in R-CSU patients with GERD compared to those without GERD (NLR: 2.05 ± 1.7 vs 1.05 ± 0.91, P = 0.041; ELR: 0.26 ± 0.18 vs 0.21 ± 0.11, P = 0.084). In contrast, PLR did not differ significantly (P = 0.500). In the multivariate analysis, NLR remained an independent predictor of GERD comorbidity after adjustment (β = 0.41, P < 0.001). ROC analysis identified an NLR cut-off of 1.24, demonstrating 81% sensitivity and 64% specificity for distinguishing R-CSU with GERD.
Conclusion: Elevated NLR and ELR indicate systemic inflammation in patients with refractory CSU and GERD. These findings support the hypothesis that systemic inflammation contributes to extracutaneous symptoms in this population. Routine, readily available CBC-derived ratios may serve as cost-effective markers for identifying systemic inflammatory activity in R-CSU.
Keywords: Chronic spontaneous urticaria, Refractory urticaria, Gastroesophageal reflux disease, Systemic inflammation, Neutrophil-to-lymphocyte ratio, Eosinophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Mast cell activation
: Original Research |
Subject:
Allergy & Clinical Immunology
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
