The prognostic value of lymphocyte-to-monocyte ratio in nephropathy of type 2 diabetes mellitus

Abstract

Background Inflammatory markers like interleukin-1, 6, and 8, transforming growth factor-β (TGF-β)1, and tumor necrosis factor-α have been found to be associated with diabetic nephropathy (DN), indicating that its pathogenesis may be inflammatory. These inflammatory markers are not routinely used, so, creating the need for easily and routinely done markers aim to enhance the prognostic process of diabetic microvascular complications. Lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) can be routinely assessed, in addition to being considered as predictors for the survival of patients in renal diseases and malignancies. Aim The aim was to evaluate the prognostic value of LMR in DN of type 2 diabetes mellitus, and to compare it with other ratios: NLR and PLR. Patients and methods A case–control study including 100 type 2 diabetes mellitus patients and 25 apparently healthy controls. It was carried out at the inpatient and outpatient clinics, Internal Medicine Department, Al-Azhar University Hospital, New Damietta. Three groups were formed according to urinary albumin-to-creatinine ratio; group I, type 2 diabetics with normoalbuminuria, group II, type 2 diabetics with increased albuminuria, with further division into group IIA: with microalbuminuria/group IIB: macroalbuminuria or overt DN, and group III: controls. Full history, clinical examination, and laboratory tests: urinary albumin-to-creatinine ratio and complete urine analysis, complete blood count with assessment of LMR, NLR, and PLR, beside, blood sugar, HbA1c, renal function with assessment of estimated glomerular filtration rate, liver function, abdominal ultrasonography, fundus examination, and ECG were done for all the participants. Results The LMR mean was 2.4/2.8/3.2/2.1 in group I/IIA/IIB/III, respectively, showing the increasing ratios in parallel with the progression of DN severity and albuminuria through the groups, with the highest ratios in group IIB of overt DN. The NLR mean was 1.8/2.9/3.7/1.2 and the PLR mean was 175, 8/249, 2/277, 3/108, 3 in the corresponding group. Receiver operating characteristic curve analysis for ratios between groups I and IIA demonstrated that with a best cutoff point of 2.66 for the LMR, the sensitivity was 44%, the specificity: 92% (the ability of the LMR to predict DN risk); 2.2 for the NLR, the sensitivity: 84%, the specificity: 98%; 207 for the PLR, the sensitivity: 72%, and the specificity: 80%. So, in predicting the DN risk, NLR came first as regards the specificity followed by LMR and then PLR, but followed by PLR and then LMR as regards the sensitivity. Conclusion LMR may be considered as a surrogate inflammatory marker for DN in early stages and in between stages, but it is not better than NLR as a screening tool for DN diagnosis.

Impact of Vitamin D3 Correction on New Chronic Inflammation Markers : Neutrophil - To - Lymphocyte Ratio, Platelet - To - Lymphocyte Ratioin Patient With Vitamin D3 Deficiency and Diabetes Type 2/Diabetic Nephropathy

“…In relation to the DN, values in present study were slightly lower than in the study performed in diabetic patients in Egypt, where in the group of patients with DN, NLR was 3.7 (normal value 1.7) and PLR 277.3 (normal value 108,3) in a somewhat younger population of participants (average age=57 years) then in present study. (Alsayyad MM et al 2019).The most comparable to present study findings are those reported by Akbas EM.et al (2016) at the University Hospital Ataturk in Anatolia. In contrast to other studies conducted in healthy participants, this one included patients who have been treated for some ill condition.…”

Novel findings in Differential Leucocyte Count in early Type 2 Diabetes in the backdrop of normal Total Leucocyte Count: a peephole view via the COVID-19 doorway

“…LMR has been touted as the next surrogate inflammatory marker in diabetic nephropathy and this may be because lymphocytes are the mainstay of chronic inflammation. 17 But contrary to literature, in early T2D and in PDM, there was a definite decrease in LMR. As it is not a scenario of chronic inflammation in our subjects, lymphocytes are not dominating but instead in early metabolic disorders monocytes seem to be driving the LMR ratios as also evidenced by the significantly higher AMC values.…”

“…Monocytes, part of innate immune system, present antigens to lymphocytes, part of adaptive immune system. 17 There was no significant correlation of any WBC or WBC derived parameters with Fasting Glucose levels. AMC showed significant but very weak correlation with 1hrPG, 2hrPG.…”

“…16 Ratios like LMR, NLR and PLR are considered more robust markers than total leukocyte counts, neutrophils, and lymphocytes in view of their stability against physiological and pathological factors which can induce variability in the latter parameters. 17 Therefore, a significant difference in LMR becomes more important. LMR may be considered to be a measure of: 1.…”

“…Balance between adaptive and innate immune system ie effective capacity of individual's immune systemthe lower the LMR, the stronger the innate immunity as against adaptive immunity; 2. Balance between favourable and unfavourable outcomes in inflammatory scenarios the lower the LMR, the more unfavourable the outcome 17 . This suggests that some stimulus (like infectious agent) has triggered the innate immunity but has not proceeded to elicit the adaptive response.…”