Association between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and diabetic retinopathy among diabetic patients without a related family history

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background: Diabetic retinopathy (DR) is a specific neurovascular complication of diabetes mellitus (DM). Clinically, family history is a widely recognized risk factor for DR,assisting diagnosis and risk strata. However, among a great amount of DR patients without hereditary history like hypertension and diabetes, direct and simple risk factors to assist clinical decisions are still required. Herein, we intend to investigate the associated risk factors for these DR patients based on systemic inflammatory response indexes, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Methods: We consecutively enrolled 1030 patients with a definite diagnosis of type 2 diabetes mellitus(T2DM) from the endocrinology department of the Second hospital of People in Yun Nan. Based on funduscopy and family history checking, we excluded patients with a family history of hypertension and diabetes and finally enrolled 264 patients with DR and 206 patients with non diabetic retinopathy(NDR).Through correlation analysis, univariate and multivariate regression, we further explore the association between NLR, PLR, and DR. On top of that we investigate the effect of NLR and PLR on risk reclassification of DR. Results: Compared with NDR patients, NLR and PLR levels are significantly higher among DR patients (NLR:2.36±1.16 in DR group versus 1.97±1.06 in NDR group, p&lt;0.001; PLR: 11.62±4.55 in DR group versus10.56±4.45 in NDR group, p=0.012). According to univariate analysis, NLR and PLR add risks to DR. After fully adjusting co-founders, NLR, as both continuous and categorical variate, remains an independent risk factor for DR(OR(95%CI):1.37 (1.06,1.78) P= 0.018). And though PLR not independently associated with DR as a continuous variable (OR (95%CI)1.05 (0.99, 1.11) p=0.135 ), the highest quantile of PLR add two-fold increased risk (OR(95％CI) 2.20 (1.05, 4.59) p=0.037) in the fully adjusted model for DR. In addition, addition of PLR and NLR to the established factor hemoglobin (Hb) improved the discriminability of the model and assisted the reclassification of DR. After combining PLR and NLR the Area under curve (AUC) of Hb based model raised from 0.76 to 0.78, with a category-free net reclassification improvement (NRI) of 0.532 (p &lt; 0.001) and Integrated discrimination improvement (IDI) of 0.029(p &lt; 0.001). Conclusions: Systemic inflammatory response indexes NLR and PLR were associated with the presence of DR among patients without associated family history and contributed to improvements in re-classification in addition to Hb.</jats:p>

The relationship between the neutrophil-to-lymphocyte ratio and diabetic retinopathy in adults from the United States: results from the National Health and nutrition examination survey

“…NLR was also considered a prognostic and predictive factor for DM and its complications [21,22]. Wang et al found that NLR was related to DR in patients with diabetes who had no associated family history in China [23]. Nevertheless, further research is required to determine whether this is the same in different regions, populations, and types of diabetes.…”

Correlation between the platelet‐to‐lymphocyte ratio and diabetic foot ulcer in patients with type 2 diabetes mellitus

“…As a simple and economical experimental index, the PLR has been confirmed to be closely related to T2DM and its chronic complications, cardiovascular disease, peripheral arterial disease, and tumors 7‐17 . We found that the PLR was significantly elevated in patients with DFU and it was identified as an independent risk factor for DFU.…”

“…As a simple and economical experimental index, the PLR has been confirmed to be closely related to T2DM and its chronic complications, cardiovascular disease, peripheral arterial disease, and tumors. [7][8][9][10][11][12][13][14][15][16][17] We found that the PLR was significantly elevated in patients with DFU and it was identified as an independent risk factor for DFU. The results of the ROC curve further showed that the PLR could be used as a simple clinical indicator for the clinical diagnosis of DFU, which was consistent with the findings of a previous study.…”

The relationship between peripheral blood inflammatory markers and diabetic macular edema in patients with severe diabetic retinopathy

“…Platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and neutrophil to lymphocyte ratio (NLR) are potential inflammatory markers for diabetes and its complications (10)(11)(12). The associations between PLR, NLR, and MLR with DR progression have been described in the literature (13)(14)(15); however, the relationship between peripheral blood inflammatory markers and severe DR with DME remains to be clarified.…”