Evaluation of potential inflammatory biomarkers of disease severity in psoriasis: a case control study

Abstract

Background: Psoriasis is a chronic inflammatory skin disorder affecting approximately 2-4% of the global population, characterized by immune dysregulation and keratinocyte hyperproliferation. Although multiple investigations have identified potential biomarkers, no validated panel exists for assessing disease severity. Objectives of the study were to determine levels of serum uric acid (SUA), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), CRP/albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in psoriasis patients versus controls, and assess their correlation with disease severity using psoriasis area severity index (PASI). Methods: This case-control study included 50 psoriasis patients and 50 age- and sex-matched controls. Participants underwent complete blood count, CRP, ESR, serum albumin, and SUA measurements. Disease severity was categorized as mild (PASI <7), moderate (PASI 7-15), or severe (PASI >15). Results: ESR was significantly elevated in cases versus controls (33.24±22.75 versus 19.44±11.50 mm/hour, p<0.001). CAR distribution differed significantly (p<0.001), with 56% of cases having CAR ≤0.1 mg/l versus 2% of controls. SUA showed no overall difference between groups (p=0.468) but significantly correlated with disease severity (p=0.028), increasing from mild (4.76±0.97 mg/dl) to moderate (5.47±1.50 mg/dl) to severe disease (5.77±1.01 mg/dl). CRP, albumin, NLR, and PLR showed no significant differences. Conclusions: ESR and CAR significantly differentiate psoriasis patients from controls. SUA, while not discriminating between cases and controls, correlates with disease severity. These cost-effective biomarkers can complement clinical assessment in psoriasis management.