Neutrophil: lymphocyte ratio is positively associated with subclinical diabetic cardiomyopathy

Abstract

Background: Subclinical diabetic cardiomyopathy (DCM) occurs frequently in asymptomatic subjects with Type 2 diabetes mellitus (T2DM). The direct association between the immune system and DCM with effective biomarkers has been demonstrated in previous studies. Methods: Five hundred seven subjects with T2DM were recruited from April 2018 to October 2019 and divided into T2DM with cardiac dysfunction (DCM) group and T2DM without cardiac dysfunction (non-DCM) group. The relationship between the quartiles of Neutrophil: lymphocyte ratio (NLR) and subclinical DCM was evaluated by using adjusted logistic regression models.(covariates: age, sex, BMI, duration of diabetes, and hyperlipidemia). Results: Blood NLR was significantly upregulated in DCM group compared to non-DCM group (P = 0.05). Then the adjusted odds ratio (95% CI) of the highest NLR quartile was 14.32 (2.92-70.31) compared with the lowest quartile of NLR after multiple adjusted (P < 0.001). However, there was no significant relation between neutrophil and lymphocyte counts and the occurrence of DCM in T2DM patients. Conclusions: This study demonstrated that NLR was associated with the occurrence of subclinical DCM, suggesting that NLR may be a biomarker for predicting DCM with effectiveness and accuracy.

Identification and verification of immune-related biomarkers and immune infiltration in diabetic heart failure

“…As the first line of defense in the inflammatory response, neutrophils play an important role in the immune response. Studies have shown that neutrophil-to-lymphocyte ratios (NLR) are associated with diabetic heart damage ( 47 , 48 ). A recent study suggested that inflammatory serine proteases produced by neutrophils can aggravate diabetic cardiomyopathy and promote the development of HF ( 49 ).…”

Neutrophil degranulation biomarkers characterize restrictive echocardiographic pattern with diastolic dysfunction in patients with diabetes

“… 7 However, less is known about the role of neutrophils. 24 , 25 Actually, they are more prone to oxidative burst and secretion of extracellular traps, whereas phagocytic and chemotactic activity is reduced in patients with DM. 26 , 27 , 28 With regard to myocardial function, neutrophil degranulation has been associated with increased intraventricular diastolic pressure in patients with hypertensive heart disease 29 and severe chronic kidney disease, 30 but not yet in diabetic patients.…”

Mechanisms and Therapeutic Prospects of Diabetic Cardiomyopathy Through the Inflammatory Response

“…Neutrophils are first-responders and secrete various inflammatory mediators, such as cytokines, microparticles, and neutrophil extracellular traps (NETs), which induce sustained inflammation. Of note, an increased neutrophil/lymphocyte ratio was recently identified as an indicator associated with subclinical DCM ocurrence ( Huang et al, 2020 ). Furthermore, elevated NET release following protein arginine deiminase upregulation in neutrophils ( Wong et al, 2015 ) aggravates cardiac injury due to neutrophil-mediated cell death (NETosis) in diabetes ( Fadini et al, 2016 ).…”