HEMATOLOGIC INDICES AS POTENTIAL BIOMARKERS IN URTICARIA: A COMPARATIVE CASE–CONTROL STUDY IN ALBANIAN POPULATION

Abstract

Urticaria is primarily a mast cell–mediated inflammatory disorder in which basophils, eosinophils, platelets, and multiple inflammatory mediators contribute to its pathophysiology. Routinely available hemogram-derived inflammatory indices may provide inexpensive and objective measures of systemic inflammatory alterations and may have potential value as biomarkers of disease activity, particularly in chronic urticaria, where disease assessment relies substantially on subjective patient-reported outcomes. Although several hematological ratios and indices have been investigated in urticaria, data from the Albanian population remain limited. This study evaluated selected hematological parameters in hospitalized patients with high disease activity urticaria compared with controls and assessed their associations with C-reactive protein (CRP). This cross-sectional retrospective case-control study included 113 patients hospitalized with diagnosis urticaria at the main tertiary hospital center in Tirana and 398 controls who underwent hemogram testing as part of routine health examinations in private practice. The median age was 50 (32–57) years in the urticaria group and 42 (32–54) years in controls with no statistical difference between groups, while females comprised 83 (73.45%) and 269 (67.59%), respectively. Acute urticaria was diagnosed in 55 (48.67%) patients and chronic urticaria in 58 (51.33). All evaluated hematological parameters differed significantly between patients with urticaria and controls (p < 0.001). Patients with urticaria had statistically significant lower absolute eosinophil, basophil, and lymphocyte counts and PDW (platelet distribution width), while MPV (mean platelet volume) and NLR (neutrophil to lymphocyte ratio) were higher. Undetectable eosinophil and basophil counts were observed in 79 (69.91%) and 99 (87.61%) urticaria patients, respectively.  Spearman’s rank correlation analysis showed that NLR was positively correlated with CRP (ρ = 0.233, p = 0.013) and inversely correlated with eosinophils (ρ = −0.487, p < 0.001) and basophils (ρ = −0.276, p = 0.003). Eosinophils and basophils were moderately positively correlated (ρ = 0.430, p < 0.001), while basophils were inversely correlated with CRP (ρ = −0.230, p = 0.014) and eosinophils with MPV (ρ = −0.1919, p = 0.042). No significant correlations were observed between CRP and eosinophils, MPV, or PDW, or between NLR and MPV or PDW. No significant changes were found between groups of chronic and acute urticaria for studied variables. Hospitalized patients with urticaria demonstrated a distinct hematological profile, particularly increased NLR and MPV and decreased eosinophil, basophil, lymphocyte, and PDW values. The association between NLR and CRP suggests potential relevance as a low-cost marker of systemic inflammation. Further prospective studies are needed to validate these findings in the Albanian population and to determine the potential utility of these hematological indices as markers of urticaria disease activity.