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

Abstract

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-tolymphocyte 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 < 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 was 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 twofold 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

Neutrophil-to-Lymphocyte Ratio, a Novel Inflammatory Marker, as a Predictor of Bipolar Type in Depressed Patients: A Quest for Biological Markers

“…In recent years, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) have been studied as inflammatory markers in various diseases with chronic subclinical inflammation such as diabetes mellitus, obesity, cardio-vascular diseases, and cancers [ 19 , 20 , 21 , 22 ]. An increased count of neutrophils reflects the intensity of inflammatory response and a decreased count of lymphocytes represents the immune system impairment [ 23 ].…”

Importance of hematological parameters for micro- and macrovascular outcomes in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

“…Several studies investigated the relationships between hematological parameters and the presence of degenerative complications in type 2 diabetes [ 3 , 6 – 8 , 11 , 13 – 15 , 17 , 18 ], but few explored their prognostic importance for adverse outcomes in longitudinal analyses [ 11 , 22 , 23 ]. Otherwise, these previous studies were mainly retrospective [ 11 , 22 ] and focused on specific hematological parameters, such as the NLR [ 11 , 22 ] and monocytes count [ 23 ], and in specific outcomes, such as cardiovascular events [ 11 ], renal function deterioration [ 22 ] and all-cause mortality [ 23 ].…”

“…Otherwise, these previous studies were mainly retrospective [ 11 , 22 ] and focused on specific hematological parameters, such as the NLR [ 11 , 22 ] and monocytes count [ 23 ], and in specific outcomes, such as cardiovascular events [ 11 ], renal function deterioration [ 22 ] and all-cause mortality [ 23 ]. The prognostic importance of other hematological parameters, such as the lymphocyte-to-monocyte, platelet-to-lymphocyte, or monocyte-to-HDL ratios, has never been investigated in type 2 diabetes; only simple associations were examined in cross-sectional analyses [ 6 , 15 , 17 , 18 , 24 ]. Moreover, none of the previous longitudinal studies [ 11 , 22 , 23 ] evaluated whether any of the hematological parameters was able to improve risk discrimination for the specific analyzed outcome.…”

Dietary Intake of Polyphenols or Polyunsaturated Fatty Acids and Its Relationship with Metabolic and Inflammatory State in Patients with Type 2 Diabetes Mellitus

“…In our study, we used commonly known markers from blood counts, such as lymphocytes, neutrophils, platelets, as well as the calculated parameters: PLR, NLR and MPVLR, to assess the immune status. The research conducted to date suggests a link between PLR, NLR and MPVLR and the development of chronic diabetes complications (including foot ulcers, lower extremity arterial disease, retinopathy, peripheral neuropathy and nephropathy) [ 32 , 35 , 65 , 66 , 67 ]. In our study, we found no association between polyphenol consumption and these markers, as confirmed by the low proportion of patients enrolled in the study with chronic complications of diabetes.…”

“…Recent data indicate that MPVLR, calculated from blood counts, is associated with a risk of developing chronic micro- and macrovascular diabetic complications [ 31 , 32 ]. The importance of NLR and PLR in the development of microvascular complications [ 33 ] as predictive and prognostic markers in the development of diabetic nephropathy and retinopathy has also been emphasised [ 34 , 35 ].…”