Neutrophil-to-Lymphocyte Ratio and Fibroblast Growth Factor 21: Their Role in Early Cardiovascular Involvement in
Mariusz Ciołkiewicz1, Anna Kuryliszyn-Moskal1, Ewa Jabłońska2
1Department of Rehabilitation, Medical University of Bialystok, 24A M. Skłodowskiej-Curie St., 15-276 Bialystok, Poland.
Journal of Clinical Medicine
|December 30, 2025
Summary
Rheumatoid arthritis patients with elevated neutrophil-to-lymphocyte ratio (NLR) and FGF21 levels show early signs of left ventricular diastolic dysfunction (LVDD). These markers, NLR and FGF21, are associated with echocardiographic parameters, suggesting their utility in screening for cardiac involvement in RA.
Area of Science:
- Cardiology
- Rheumatology
- Biomarkers
Background:
- Rheumatoid arthritis (RA) significantly increases cardiovascular risks, with left ventricular diastolic dysfunction (LVDD) being an early indicator of cardiac involvement.
- Early detection of LVDD in RA patients is crucial for managing cardiovascular morbidity and mortality.
Purpose of the Study:
- To determine the incidence of LVDD in RA patients.
- To investigate the association between neutrophil-to-lymphocyte ratio (NLR) and serum FGF21 levels with echocardiographic parameters of LVDD.
- To evaluate the diagnostic utility of NLR and FGF21 for LVDD in RA.
Main Methods:
- A cohort of 51 RA patients underwent echocardiography to assess LVDD.
- Neutrophil-to-lymphocyte ratio (NLR) and serum FGF21 levels were measured.
- Univariate regression models and receiver operating characteristic (ROC) analysis were used to assess associations and diagnostic performance.
Main Results:
- Left ventricular diastolic dysfunction (LVDD) was identified in 19.6% of RA patients.
- NLR showed significant associations with multiple echocardiographic parameters, including E velocity, E/A ratio, e' velocities, and left atrial diameter.
- Serum FGF21 levels were associated with the E/A ratio and lateral e' velocity, with NLR demonstrating a higher diagnostic value (AUC 0.58) than FGF21 (AUC 0.48).
Conclusions:
- Neutrophil-to-lymphocyte ratio (NLR) and FGF21 are linked to echocardiographic indicators of left ventricular diastolic dysfunction (LVDD) even before diagnostic criteria are met.
- Elevated NLR and FGF21 levels in RA patients warrant consideration for LVDD screening to proactively manage cardiac health.
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