Associations between the Neutrophil-to-Lymphocyte Ratio and Diabetic Complications in Adults with Diabetes: A Cross-Sectional Study

Wan, Heng; Wang, Yuying; Fang, Sijie; Chen, Yi; Zhang, Wen; Xia, Fangzhen; Wang, Ningjian; Lu, Yingli

doi:10.1155/2020/6219545

Cited by 75 publications

(89 citation statements)

References 38 publications

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“…In a cross-sectional study involving 114 T2DM patients, an independent association between NLR and DN was found [ 30 ]. Another cross-sectional survey also confirmed that NLR was positively associated with the prevalence of diabetic kidney disease [ 31 ]. Regarding RDW, its relationship with renal function has been observed in patients with T2DM [ 32 ].…”

Section: Discussionmentioning

confidence: 87%

A Nomogram Model that Predicts the Risk of Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Retrospective Study

Wang

Rong

et al. 2021

International Journal of Endocrinology

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Objective. To construct a novel nomogram model that predicts the risk of diabetic nephropathy (DN) incidence in Chinese patients with type 2 diabetes mellitus (T2DM). Methods. Questionnaire surveys, physical examinations, routine blood tests, and biochemical index evaluations were conducted on 1095 patients with T2DM from Guilin. A least absolute contraction selection operator (LASSO) regression and multivariable logistic regression analysis were used to screen out DN risk factors. A logistic regression analysis incorporating the screened risk factors was used to establish a predictive nomogram model. The performance of the nomogram model was evaluated using the C-index, an area under the receiver operating characteristic curve (AUC), calibration plots, and a decision curve analysis. Bootstrapping was applied for internal validation. Results. Independent predictors for DN incidence risk included gender, age, hypertension, medicine use, duration of diabetes, body mass index, blood urea nitrogen level, serum creatinine level, neutrophil to lymphocyte ratio, and red blood cell distribution width. The nomogram model exhibited moderate prediction ability with a C-index of 0.819 (95% confidence interval (CI): 0.783–0.853) and an AUC of 0.813 (95%CI: 0.778–0.848). The C-index from internal validation reached 0.796 (95%CI: 0.763–0.829). The decision curve analysis displayed that the DN risk nomogram was clinically applicable when the risk threshold was between 1 and 83%. Conclusion. Our novel and simple nomogram containing 10 factors may be useful in predicting DN incidence risk in T2DM patients.

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Section: Discussionmentioning

confidence: 87%

A Nomogram Model that Predicts the Risk of Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Retrospective Study

Wang

Rong

et al. 2021

International Journal of Endocrinology

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“…Elevated NLR in CVDs, especially in myocardial infarction and heart failure, is indicative of poor prognosis; in these studies, NLR was usually determined to be >3 7,8,36 . Increased NLR is also observed in patients with diabetes 9 . In addition, as patients with diabetics are often co‐morbid with other systemic conditions, the NLR ratio can be >4 10 .…”

Section: Discussionmentioning

confidence: 97%

“…Platelets are also involved in immune responses in inflamed gingivae through interactions with leukocytes 5 . In recent studies, the neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐leukocyte ratio (PLR), defined as the ratio of absolute neutrophil or platelet and lymphocyte counts, have been proposed as effective biomarkers in the prognosis of several cardiovascular diseases (CVDs), 7,8 diabetes 9,10 and other inflammatory diseases 11,12 . NLR was reported to increase in patients with periodontitis and systemic diseases, for example, in the presence of hyperlipemia, NLR was higher in patients with periodontitis than those without 13 .…”

Section: Introductionmentioning

confidence: 99%

Elevated neutrophil‐to‐lymphocyte ratio but not platelet‐to‐lymphocyte ratio is associated with generalized aggressive periodontitis in a Chinese population

Wang

et al. 2020

Journal of Periodontology

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Background Host inflammatory mediators are associated with tissue destruction in patients suffering from generalized aggressive periodontitis (GAgP). However, the correlations between neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) with GAgP remain unknown. Methods Periodontal clinical parameters, including probing depth (PD), bleeding index (BI) and attachment loss (AL) were collected from patients with GAgP and healthy controls. Complete blood cells analyses were obtained; further, NLR and PLR were calculated using neutrophil, platelet, and lymphocyte counts. Smooth curve fitting and segmented regression models were used to analyze the roles and predictive value of NLR with GAgP. Results In total, 505 participants from a Chinese population were recruited, including 133 healthy controls and 372 patients with GAgP. Periodontal clinical parameters, NLR, and neutrophil counts were significantly higher in patients with GAgP than the control group. Moreover, NLR was positively correlated with the risk and clinical parameters of GAgP. When NLR < 3, the risk of GAgP increased by 20.6% for each 0.1 increase in NLR, reaching saturation when NLR > 3. An increase in NLR equivalent to 1 was associated with an increase in PD, BI, and AL by 0.41 mm, 0.26, and 0.57 mm, respectively. Notably, PLR did not show obvious correlations with GAgP. Conclusions NLR but not PLR may be a potential marker to identify GAgP in healthy individuals, particularly in a Chinese population.

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“…Inflammatory cells contribute to atherosclerotic lesion initiation, progression and its disruption that cause cardiovascular events [ 3 ]. Further, there are also evidences that inflammation may play a key role in occurrence of microvascular complications [ 2 , 4 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Increasing concern has been demanded to leukocytes subtypes and its relations. Indeed, the neutrophyl-to-lymphocyte and the lymphocyte-to-monocyte ratios, and additionally other relations such as the platelet-to-lymphocyte, monocyte-to-HDL-cholesterol and also other hematological parameters such as the red blood cell distribution width (RDW), have been investigated as potential risk markers in several clinical conditions [ 3 , 6 – 8 , 11 – 19 ]. These are inexpensive and easily-obtained measures to investigate inflammatory parameters and potential risk markers.…”

Section: Introductionmentioning

confidence: 99%

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

Cardoso

Leite

Salles

2021

Cardiovasc Diabetol

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Background The prognostic importance of several hematological parameters has been scarcely investigated in type 2 diabetes. So, we aimed to evaluate their prognostic importance for development of complications in a cohort of type 2 diabetes. Methods In a prospective study, 689 individuals with type 2 diabetes had blood red cell, platelet and leukocyte parameters obtained at baseline. Multivariate Cox analyses examined the associations between several hematological parameters (including neutrophyl-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte, and monocyte-to-HDL ratios) and the occurrence of microvascular (retina, renal and peripheral neuropathy) and cardiovascular complications (total cardiovascular events [CVEs], and major adverse CVEs [MACEs]), and all-cause and cardiovascular mortality. Improvements in risk discrimination were assessed by C-statistics and Integrated Discrimination Improvement (IDI) index. Results During a median follow-up of 10.5 years, 212 patients had a CVE (174 MACEs), 264 patients died (131 cardiovascular deaths); 206 had a renal, 161 a retinopathy and 179 patients had a neuropathy outcome. In multivariate-adjusted analyses, the lymphocytes count and lymphocyte-to-monocyte ratio were protective (hazard ratios [HRs]: 0.77 and 0.72, respectively), whereas the neutrophyl-to-lymphocyte and platelet-to-lymphocyte ratios were associated with increased risks (HRs: 1.19 and 1.17) for all-cause mortality. For cardiovascular mortality, the monocytes count, the neutrophyl-to-lymphocyte and monocyte-to-HDL ratios were associated with increased risks and the lymphocyte-to-monocyte ratio was protective. Higher lymphocyte-to-monocyte ratio was protective for renal failure outcome. However, none of them improved risk discrimination. Conclusions Low lymphocytes count and leukocyte ratios that mainly included lymphocytes were predictors of macrovascular complications and mortality in individuals with type 2 diabetes. However, they did not improve risk prediction over traditional risk factors.

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Associations between the Neutrophil-to-Lymphocyte Ratio and Diabetic Complications in Adults with Diabetes: A Cross-Sectional Study

Cited by 75 publications

References 38 publications

A Nomogram Model that Predicts the Risk of Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Retrospective Study

A Nomogram Model that Predicts the Risk of Diabetic Nephropathy in Type 2 Diabetes Mellitus Patients: A Retrospective Study

Elevated neutrophil‐to‐lymphocyte ratio but not platelet‐to‐lymphocyte ratio is associated with generalized aggressive periodontitis in a Chinese population

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

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