{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:54:55Z","timestamp":1792684495634,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Reliable laboratory markers that accurately reflect disease activity in ankylosing spondylitis (AS) are limited. Conventional acute-phase reactants do not consistently correlate with clinical activity. Composite hematological indices derived from complete blood count may better capture systemic inflammatory burden. In this study, we aimed to investigate hematologic parameters in AS and to assess their relationships with disease activity. Materials and Methods: This retrospective observational study included 196 patients with AS. Disease activity was defined as a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) \u22654. Demographic variables, laboratory parameters, hematological indices, and extra-articular manifestations were evaluated. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression with ten-fold cross-validation. Variables with non-zero coefficients were entered into a multivariable logistic regression model. Model performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: Ninety-seven (49%) patients had active disease. LASSO regression identified erythrocyte sedimentation rate (ESR), white blood cell count, red cell distribution width (RDW), platelet-to-lymphocyte ratio (PLR), and selected extra-articular manifestations as relevant predictors. In multivariable logistic regression, ESR (OR 1.03, 95% CI 1.00\u20131.06), white blood cell count (OR 1.23, 95% CI 1.04\u20131.46), and PLR (OR 1.01, 95% CI 1.003\u20131.020) were independently associated with active disease, while RDW showed a borderline association. The model demonstrated good discriminative ability (AUC 0.77, 95% CI 0.69\u20130.84). Conclusions: PLR is independently associated with disease activity in ankylosing spondylitis and improves discrimination when incorporated into a multivariable model. Easily accessible hematological indices may complement traditional inflammatory markers in the assessment of disease activity in routine clinical practice.<\/jats:p>","DOI":"10.3390\/medicina62030497","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:05:44Z","timestamp":1772795144000},"page":"497","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hematological Indices as Potential Biomarkers of Disease Activity in Ankylosing Spondylitis: LASSO-Based Multivariable Modelling"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5706-4943","authenticated-orcid":false,"given":"Sema","family":"Kaymaz-Tahra","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Bahcesehir University, Istanbul 34732, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1568-9345","authenticated-orcid":false,"given":"Cans\u0131n","family":"Ta\u015fk\u0131n","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Bahcesehir University, Istanbul 34732, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7477-6640","authenticated-orcid":false,"given":"Alpaslan","family":"Tanoglu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Bahcesehir University, Istanbul 34732, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1016\/S0140-6736(07)60635-7","article-title":"Ankylosing spondylitis","volume":"369","author":"Braun","year":"2007","journal-title":"Lancet"},{"key":"ref_2","first-page":"S43","article-title":"Genetics of ankylosing spondylitis","volume":"20","author":"Brown","year":"2002","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_3","first-page":"980","article-title":"Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis","volume":"26","author":"Spoorenberg","year":"1999","journal-title":"J. Rheumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jbspin.2007.06.016","article-title":"Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis","volume":"75","author":"Kisacik","year":"2008","journal-title":"Jt. Bone Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1080\/14397595.2019.1645373","article-title":"Red cell distribution width, platelet-to-lymphocyte ratio, and mean platelet volume in ankylosing spondylitis and their correlations with inflammation: A meta-analysis","volume":"30","author":"Song","year":"2020","journal-title":"Mod. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Liang, T., Chen, J., Xu, G., Zhang, Z., Xue, J., Zeng, H., Jiang, J., Chen, T., Qin, Z., and Li, H. (2021). Platelet-to-Lymphocyte Ratio as an Independent Factor Was Associated With the Severity of Ankylosing Spondylitis. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.760214"},{"key":"ref_7","first-page":"e6025","article-title":"The Role of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers of Disease Activity in Ankylosing Spondylitis","volume":"11","author":"Zeb","year":"2019","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"126","DOI":"10.3109\/09537100903470306","article-title":"The platelet functions in patients with ankylosing spondylitis: Anti-TNF-alpha therapy decreases the mean platelet volume and platelet mass","volume":"21","author":"Yazici","year":"2010","journal-title":"Platelets"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/art.1780270401","article-title":"Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria","volume":"27","author":"Valkenburg","year":"1984","journal-title":"Arthritis Rheum."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1136\/ard.2009.108233","article-title":"The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): Validation and final selection","volume":"68","author":"Rudwaleit","year":"2009","journal-title":"Ann. Rheum. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1136\/ard.2009.110767","article-title":"Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: A consensual approach by the ASAS\/OMERACT MRI group","volume":"68","author":"Rudwaleit","year":"2009","journal-title":"Ann. Rheum. Dis."},{"key":"ref_12","first-page":"80","article-title":"Correlation of serum IL-6, TNF-alpha levels and disease activity in patients with ankylosing spondylitis","volume":"28","author":"Zhao","year":"2024","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/labmed\/lmab029","article-title":"Serum IL-6 and TNF-alpha Levels Are Correlated with Disease Severity in Patients with Ankylosing Spondylitis","volume":"53","author":"Du","year":"2022","journal-title":"Lab. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1093\/rheumatology\/33.10.927","article-title":"Serum cytokines (IL-6, TNF-alpha, IL-1 beta and IFN-gamma) in ankylosing spondylitis: A close correlation between serum IL-6 and disease activity and severity","volume":"33","author":"Gratacos","year":"1994","journal-title":"Br. J. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1007\/s10067-015-2949-3","article-title":"Biomarkers for diagnosis, monitoring of progression, and treatment responses in ankylosing spondylitis and axial spondyloarthritis","volume":"34","author":"Reveille","year":"2015","journal-title":"Clin. Rheumatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s42358-020-0113-5","article-title":"Neutrophil\/lymphocyte and platelet\/lymphocyte ratios as potential markers of disease activity in patients with Ankylosing spondylitis: A case-control study","volume":"60","author":"Awadh","year":"2020","journal-title":"Adv. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1002\/art.42333","article-title":"Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Biomarkers in Axial Spondyloarthritis: Observational Studies From the Program to Understand the Longterm Outcomes in Spondyloarthritis Registry","volume":"75","author":"Sen","year":"2023","journal-title":"Arthritis Rheumatol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Moon, D.H., Kim, A., Song, B.W., Kim, Y.K., Kim, G.T., Ahn, E.Y., So, M.-W., and Lee, S.-G. (2023). High Baseline Neutrophil-to-Lymphocyte Ratio Could Serve as a Biomarker for Tumor Necrosis Factor-Alpha Blockers and Their Discontinuation in Patients with Ankylosing Spondylitis. Pharmaceuticals, 16.","DOI":"10.3390\/ph16030379"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00296-024-05763-6","article-title":"Monitoring disease activity and treatment response in ankylosing spondylitis: A retrospective study of hematologic inflammatory markers","volume":"45","author":"Gokcen","year":"2024","journal-title":"Rheumatol. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e70166","DOI":"10.1111\/1756-185X.70166","article-title":"Clinical Significance of Hematological Indices as Disease Activity Markers in Patients With Ankylosing Spondylitis Following Treatment With Tumor Necrosis Factor Inhibitors","volume":"28","author":"Kim","year":"2025","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1038\/nri2956","article-title":"Platelets and the immune continuum","volume":"11","author":"Semple","year":"2011","journal-title":"Nat. Rev. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Gros, A., Ollivier, V., and Ho-Tin-Noe, B. (2014). Platelets in inflammation: Regulation of leukocyte activities and vascular repair. Front. Immunol., 5.","DOI":"10.3389\/fimmu.2014.00678"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1182\/blood-2013-11-462432","article-title":"Emerging roles for platelets as immune and inflammatory cells","volume":"123","author":"Morrell","year":"2014","journal-title":"Blood"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"628","DOI":"10.5858\/133.4.628","article-title":"Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients","volume":"133","author":"Lippi","year":"2009","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"86","DOI":"10.3109\/10408363.2014.992064","article-title":"Red blood cell distribution width: A simple parameter with multiple clinical applications","volume":"52","author":"Salvagno","year":"2015","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.1093\/rheumatology\/keaa692","article-title":"Incidence of extra-articular manifestations in ankylosing spondylitis, psoriatic arthritis and undifferentiated spondyloarthritis: Results from a national register-based cohort study","volume":"60","author":"Bengtsson","year":"2021","journal-title":"Rheumatology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1136\/annrheumdis-2013-203582","article-title":"Prevalence of extra-articular manifestations in patients with ankylosing spondylitis: A systematic review and meta-analysis","volume":"74","author":"Stolwijk","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1186\/s13075-016-1093-z","article-title":"Prevalence of peripheral and extra-articular disease in ankylosing spondylitis versus non-radiographic axial spondyloarthritis: A meta-analysis","volume":"18","author":"Landewe","year":"2016","journal-title":"Arthritis Res. Ther."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/497\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:56:10Z","timestamp":1772798170000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/3\/497"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["medicina62030497"],"URL":"https:\/\/doi.org\/10.3390\/medicina62030497","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]}}}