Association between the neutrophil to lymphocyte ratio and mild cognitive impairment in patients with type 2 diabetes

Yu, Zi-Wei; Wang, Ying; Li, Xin; Tong, Xue-Wei; Zhang, Yitong; Gao, Xinyuan

doi:10.1007/s40520-023-02420-z

Cited by 5 publications

(12 citation statements)

References 34 publications

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“…Cognitive impairment, an important target of vascular damage in diabetes, is associated with both systemic and local brain tissue inflammation involving essential inflammatory cells and molecules. As simple indicators of inflammation, neutrophil to lymphocyte ratio (NLR) [ 23 ] and platelet-to-lymphocyte ratio (PLR) [ 24 ] have been found to be correlated with the development of cognitive impairment in diabetic patients. Platelets act as an atypical first-line inflammatory biomarker by adhering endothelial cells and leukocytes, thereby modulating the activity of inflammatory components of these cells.…”

Section: Discussionmentioning

confidence: 99%

“…Neutrophils, being the majority of white blood cells, play a crucial role in initiating and regulating inflammatory processes. On one hand, activated neutrophils release reactive oxygen species and neutrophilic elastase, which can directly cause damage to brain cells and contribute to the progression of cognitive impairment in diabetic patients [ 23 , 28 ]. On the other hand, activated neutrophils stimulate T lymphocytes by facilitating antigen presentation [ 23 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…On one hand, activated neutrophils release reactive oxygen species and neutrophilic elastase, which can directly cause damage to brain cells and contribute to the progression of cognitive impairment in diabetic patients [ 23 , 28 ]. On the other hand, activated neutrophils stimulate T lymphocytes by facilitating antigen presentation [ 23 , 29 ]. These T lymphocytes enter the central nervous system through the damaged blood-brain barrier, leading to their numbers within peripheral blood [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…These T lymphocytes enter the central nervous system through the damaged blood-brain barrier, leading to their numbers within peripheral blood [ 30 ]. Besides, T lymphocytes further release tumor necrosis factor α (TNF-α), creating a vicious cycle [ 23 ]. The SII is calculated based on three types of circulating immune cells (neutrophils, lymphocytes, and platelets), which are not affected by fluid imbalances [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Joint effect of abnormal systemic immune-inflammation index (SII) levels and diabetes on cognitive function and survival rate: A population-based study from the NHANES 2011–2014

Chen,

Sun,

Han

et al. 2024

PLoS ONE

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Objective The purpose of this study was to investigate whether the combination of abnormal systemic immune-inflammation index (SII) levels and hyperglycemia increased the risk of cognitive function decline and reduced survival rate in the United States. Methods This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) database from 2011–2014 and enrolled 1,447 participants aged 60 years or older. Restricted cubic splines (RCS), linear regression and kaplan-meier(KM) curve were employed to explore the combined effects of abnormal SII and hyperglycemia on cognitive function and survival rate, and subgroup analysis was also conducted. Results The RCS analysis revealed an inverted U-shaped relationship between lgSII levels and cognitive function. Linear regression analysis indicated that neither abnormal SII nor diabetes alone significantly contributed to the decline in cognitive function compared to participants with normal SII levels and blood glucose. However, when abnormal SII coexisted with diabetes (but not prediabetes), it resulted to a significant decline in cognitive function. After adjusting for various confounding factors, these results remained significant in Delayed Word Recall (β:-0.76, P<0.05) and Digit Symbol Substitution tests (β:-5.02, P<0.05). Nevertheless, these results showed marginal significance in Total Word Recall test as well as Animal Fluency test. Among all subgroup analyses performed, participants with both abnormal SII levels and diabetes exhibited the greatest decline in cognitive function compared to those with only diabetes. Furthermore, KM curve demonstrated that the combination of abnormal SII levels and diabetes decreased survival rate among participants. Conclusion The findings suggest that the impact of diabetes on cognitive function/survival rate is correlated with SII levels, indicating that their combination enhances predictive power.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Joint effect of abnormal systemic immune-inflammation index (SII) levels and diabetes on cognitive function and survival rate: A population-based study from the NHANES 2011–2014

Chen,

Sun,

Han

et al. 2024

PLoS ONE

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“…Increasing evidence strongly support the association between increased NLR values and a variety of pathological conditions characterized by a proin ammatory status. NLR increased values were observed in infectious diseases, such as acute exacerbations of chronic obstructive pulmonary disease (2), pneumonia (3), COVID-19 (4) and sepsis (5), and non-infectious diseases, including atherosclerotic coronary artery disease (CAD) (6, 7), stroke (8), neurodegenerative diseases (9), cancers (10), kidney diseases (11), and acute kidney injury (AKI) (12). In all these conditions, NLR is emerging as a biomarker of disease severity and for mortality risk estimation.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study.

Rosa,

Sabbatinelli,

Soraci

et al. 2023

Preprint

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Background The Neutrophil-to-lymphocyte ratio (NLR) is a marker of poor prognosis in hospitalized older patients with different diseases, but there is still no consensus on the optimal cut-off value to identify older patients at high-risk of in-hospital mortality. Therefore, in this study we aimed at both validating NLR as a predictor of death in older hospitalized patients and assess whether the presence of specific acute diseases can modify its predictive value.Methods this prospective cohort study included 5,034 hospitalizations of older patients admitted to acute care units in the context of the ReportAge study. NLR measured at admission was considered as the exposure variable, while in-hospital mortality was the outcome of the study. ROC curves with Youden’s method and restricted cubic splines were used to identify the optimal NLR cut-off of increased risk. Cox proportional hazard models, stratified analyses, and Kaplan-Meier survival curves were used to analyse the association between NLR and in-hospital mortality.Results both continuous and categorical NLR value (cut-off ≥ 7.95) predicted mortality in bivariate and multivariate prognostic models with a good predictive accuracy. The magnitude of this association was even higher in patients without sepsis, congestive heart failure, and pneumonia, and those with higher eGFR, albumin, and hemoglobin (p < 0.001). A negative multiplicative interaction was found between NLR and eGFR (p = 0.001).Conclusions NLR at admission is a readily available and cost-effective biomarker that could improve identification of geriatric patients at high risk of death during hospital stay independent of admitting diagnosis, kidney function and hemoglobin levels.

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Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study

Di Rosa,

Sabbatinelli,

Soraci

et al. 2023

J Transl Med

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Background The Neutrophil-to-lymphocyte ratio (NLR) is a marker of poor prognosis in hospitalized older patients with different diseases, but there is still no consensus on the optimal cut-off value to identify older patients at high-risk of in-hospital mortality. Therefore, in this study we aimed at both validating NLR as a predictor of death in older hospitalized patients and assess whether the presence of specific acute diseases can modify its predictive value. Methods This prospective cohort study included 5034 hospitalizations of older patients admitted to acute care units in the context of the ReportAge study. NLR measured at admission was considered as the exposure variable, while in-hospital mortality was the outcome of the study. ROC curves with Youden’s method and restricted cubic splines were used to identify the optimal NLR cut-off of increased risk. Cox proportional hazard models, stratified analyses, and Kaplan–Meier survival curves were used to analyse the association between NLR and in-hospital mortality. Results Both continuous and categorical NLR value (cut-off ≥ 7.95) predicted mortality in bivariate and multivariate prognostic models with a good predictive accuracy. The magnitude of this association was even higher in patients without sepsis, congestive heart failure, and pneumonia, and those with higher eGFR, albumin, and hemoglobin (p < 0.001). A negative multiplicative interaction was found between NLR and eGFR < 45 (p = 0.001). Conclusions NLR at admission is a readily available and cost-effective biomarker that could improve identification of geriatric patients at high risk of death during hospital stay independent of admitting diagnosis, kidney function and hemoglobin levels.

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Association between the neutrophil to lymphocyte ratio and mild cognitive impairment in patients with type 2 diabetes

Cited by 5 publications

References 34 publications

Joint effect of abnormal systemic immune-inflammation index (SII) levels and diabetes on cognitive function and survival rate: A population-based study from the NHANES 2011–2014

Joint effect of abnormal systemic immune-inflammation index (SII) levels and diabetes on cognitive function and survival rate: A population-based study from the NHANES 2011–2014

Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study.

Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study

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