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

Abstract

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.

Monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and the risk of all-cause and cardiovascular mortality: a nationwide cohort study in the United States

“…A Turkish study also reported that the highest MHR was related to a 1.8-fold and 1.5-fold risk of in-hospital and long-term cardiovascular mortality, respectively [ 28 ]. Additionally, this relationship was confirmed in patients diagnosed with renal insufficiency [ 18 , 30 ] and type 2 diabetes [ 19 ]. However, cardiovascular mortality did not differ between the low-MHR and high-MHR groups in a study of patients commencing dialysis [ 31 ].…”

Three Nutritional Indices Are Effective Predictors of Mortality in Patients With Type 2 Diabetes and Foot Ulcers

“…Hypoalbuminemia was associated with mortality in patients regardless of the implicated disease, even in a healthy population ( 25 ). Lymphocytes reflected the immune regulatory response ( 26 ). Lymphocyte count and leukocyte ratios that mainly included lymphocyte were predictors of mortality in patients with type 2 diabetes and DFUs ( 26 , 27 ).…”

“…Lymphocytes reflected the immune regulatory response ( 26 ). Lymphocyte count and leukocyte ratios that mainly included lymphocyte were predictors of mortality in patients with type 2 diabetes and DFUs ( 26 , 27 ). Lower BMI was found to be associated with mortality in patients with diabetes and DFUs in recent studies ( 28 , 29 ), which was consistent with our finding: BMI was negatively associated with all-cause mortality in the unadjusted Cox regression analyses.…”

Prognostic impact of liver fibrosis and steatosis by transient elastography for cardiovascular and mortality outcomes in individuals with nonalcoholic fatty liver disease and type 2 diabetes: the Rio de Janeiro Cohort Study

“…We also evaluated whether LSM, CAP or both were able to improve risk discrimination in relation to a basic standard risk factor model. For addressing it, we performed analyses using two metrics of model risk discrimination improvement: the increase in C-statistics (i.e., the area under curve applied to time-to-event Cox analysis) and the relative Integrated Discrimination Improvement (IDI) index, which measures the percentage increase in the discrimination slope after including the TE parameters in relation to that of the basic model [ 25 , 26 , 28 ]. In all analyses a two-tailed probability value < 0.05 was considered significant.…”