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<p>The neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammation, may assist in differentiating polycythemia vera (PV) from secondary polycythemia (SP), especially when access to <i>JAK2</i> mutation testing is limited due to cost or delayed turnaround. We retrospectively analyzed 655 patients with erythrocytosis who underwent <i>JAK2</i> mutation testing between 2007 and 2024 across three South Korean tertiary hospitals. PV and SP were diagnosed per 2016 WHO criteria. NLR was calculated from complete blood counts and compared to serum erythropoietin (EPO) using receiver operating characteristic (ROC) analysis. The mean NLR was significantly higher in PV than SP (6.92 vs. 2.24, <i>p</i> &lt; 0.001). NLR outperformed EPO in distinguishing PV (AUC 0.919 vs. 0.835, <i>p</i> &lt; 0.001), and the combination further improved diagnostic accuracy (AUC 0.955). Notably, 98.8% (159/161) of patients with NLR &lt; 1.5 had SP, suggesting these patients may safely undergo delayed <i>JAK2</i> testing while secondary causes are prioritized. NLR may serve as a cost-effective triage marker to identify patients at low risk for PV, potentially reducing unnecessary molecular testing and expediting appropriate diagnostic pathways in erythrocytosis.</p>

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Low neutrophil-to-lymphocyte ratio identifies secondary polycythemia in patients with erythrocytosis

  • 期刊论文

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  • 发表日期：

    2025年11月26日

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  • Seug Yun Yoon,
  • Seong Soon Kwon,
  • Sun Young Jeong,
  • Min-Young Lee,
  • Kyoung Ha Kim,
  • Se Hyung Kim,
  • Sang Byung Bae,
  • Namsu Lee,
  • Sung Kyu Park,
  • Jong-Ho Won

摘要

The neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammation, may assist in differentiating polycythemia vera (PV) from secondary polycythemia (SP), especially when access to JAK2 mutation testing is limited due to cost or delayed turnaround. We retrospectively analyzed 655 patients with erythrocytosis who underwent JAK2 mutation testing between 2007 and 2024 across three South Korean tertiary hospitals. PV and SP were diagnosed per 2016 WHO criteria. NLR was calculated from complete blood counts and compared to serum erythropoietin (EPO) using receiver operating characteristic (ROC) analysis. The mean NLR was significantly higher in PV than SP (6.92 vs. 2.24, p < 0.001). NLR outperformed EPO in distinguishing PV (AUC 0.919 vs. 0.835, p < 0.001), and the combination further improved diagnostic accuracy (AUC 0.955). Notably, 98.8% (159/161) of patients with NLR < 1.5 had SP, suggesting these patients may safely undergo delayed JAK2 testing while secondary causes are prioritized. NLR may serve as a cost-effective triage marker to identify patients at low risk for PV, potentially reducing unnecessary molecular testing and expediting appropriate diagnostic pathways in erythrocytosis.