The relationship between peripheral blood inflammatory markers and diabetic macular edema in patients with severe diabetic retinopathy

BackgroundThe primary aim of this study was to investigate the correlation between diabetic retinopathy (DR) and the HALP score (hemoglobin, albumin, lymphocyte, and platelet) in individuals with diabetes within the United States population.MethodsThis cross-sectional investigation was based on the National Health and Nutrition Examination Survey (NHANES) database from 2003-2018. The following module calculated the HALP score: HALP score = [lymphocytes (/L) × hemoglobin (g/L) × albumin (g/L)]/platelets (/L). By performing the receiver operating characteristic (ROC) analysis, the optimal cutoff value of HALP was ascertained. Restricted cubic splines (RCS), multivariable logistic regression analysis, sensitivity analysis, and subgroup analysis were conducted to evaluate the effect of the HALP score on DR patients. Finally, the decision curve analysis (DCA) and clinical impact curve (CIC) were conducted to estimate the predictive power and clinical utility of the HALP score with clinical indicators.ResultsAccording to the cutoff value (42.9) determined by the ROC curve, the participants were stratified into a lower HALP group (HALPlow) and a higher HALP group (HALPhigh). An L-shaped relationship between HALP score and DR risk was presented in the RCS model (P for nonlinearity <0.001). The DR risk sharply decreased with the increase of HALP, and the decline reached a plateau when HALP was more than 42.9. After fully adjustment, the multivariate logistic regression analysis found that HALPlow was an independent risk factor for DR (OR = 1.363, 95% CI: 1.111-1.671, P < 0.001). Besides, sensitivity analysis showed consistent results. Furthermore, the combination of HALP score and clinical indicators demonstrated predictive power and clinical utility, as shown by the ROC curve, DCA, and CIC.ConclusionThe HALP score has an L-shaped correlation with the risk of DR, and thus, the HALP score may contribute to the timely intervention of diabetes patients.

Section: Discussionmentioning

confidence: 99%

The L-shape relationship between hemoglobin, albumin, lymphocyte, platelet score and the risk of diabetic retinopathy in the US population

Ding,

Zeng,

Wei

et al. 2024

“…For peripheral blood lymphocytes, Zhu et al. ( 23 ) found the inverse relationship between and DME, indicating that for patients suffering from severe DR, lymphocyte percentage may be an important diagnostic tool for detecting the onset and progress of DME. Our results showed a critical association between DME and lymphocyte counts, but no association between CMT and lymphocyte counts.…”

Section: Discussionmentioning

confidence: 99%

“…The complete blood count is an affordable and readily available test; white blood cell (WBC, also known as leukocyte) and its subtypes are considered to be the biomarkers of inflammatory response, as their activation results in the synthesis of inflammatory cytokines. Recently, increasing concern has been demanded regarding WBC and its subtypes and its relations in several ocular inflammatory conditions such as uveitis ( 17 – 19 ), DR ( 20 – 22 ), and DME ( 23 – 25 ). All these inflammation indexes derived by peripheral complete blood count parameters including the neutrophil-to-lymphocyte ratio (NLR) ( 24 , 26 ) and systemic immune-inflammation index (SII, calculated as platelet count*neutrophil count/lymphocyte count) ( 24 , 27 ) have been investigated as potential biomarkers for predicting or guiding treatment in DME.…”

Section: Introductionmentioning

confidence: 99%

The correlation between peripheral complete blood count parameters and diabetic macular edema in proliferative diabetic retinopathy patients: a cross-sectional study

Lei

Liu

et al. 2023

BackgroundNumerous studies have demonstrated that retinal chronic inflammation plays a critical role in the pathogenesis of diabetic macular edema (DME). However, studies about the association between peripheral complete blood count, an inexpensive and easily measurable laboratory index, and DME are limited.Research design and methodsThe current study was a hospital-based, cross-sectional study. The participants were inpatients with type 2 diabetes who underwent vitrectomy for PDR, and the contralateral eyes in these PDR patients meeting the criteria were included in the study. Central macular thickness (CMT) was measured automatically and the DME was characterized as CMT ≥ 300 μm.ResultsA total of 239 PDR participants were enrolled. The average age was 55.46 ± 10.08 years old, and the average CMT was 284.23 ± 122.09 μm. In the fully adjusted model, for CMT, the results revealed a significantly negative association between CMT and both white blood cell (WBC) count and neutrophil count (β = −11.95, 95% CI: −22.08, −1.82; p = 0.0218; β = −14.96, 95% CI: −28.02, −1.90; p = 0.0259, respectively); for DME, the results showed an inverse association between DME and WBC count, monocyte count, and eosinophil count (OR = 0.75, 95% CI: 0.59, 0.95; p = 0.0153; OR = 0.07, 95% CI: 0.00, 0.92; p = 0.0431; OR = 0.03, 95% CI: 0.00, 0.88; p = 0.0420, respectively).ConclusionsIn conclusion, our results suggest that WBC and its subtypes in circulation may play an important role in the pathogenesis of DME in PDR patients.

“…One study showed that ( 26 ) Platelets and neutrophils interact with each other, and under inflammatory stimulation neutrophils produce platelet chemokines and activating factors, and activated platelets release large amounts of pro-inflammatory and pro-angiogenic factors that damage vascular endothelial cells, leading to increased vascular permeability, edema, and exudation, which further activate neutrophils to release more inflammatory mediators and induce chronic microangiopathy and inflammatory responses ( 26 ), promoting DN ( 27 ) and DR ( 28 ) of progression. Recent findings suggest that Lymphocyte percentage can be used as an inflammatory marker for the development of DME in patients with severe DR ( 29 ).The NLR and PLR in the DR/DN group in this study were significantly higher than those in the DR group, suggesting a more severe inflammatory response in DR/DN; previous studies also found that NLR predicted DN progression ( 30 ) and the severity of DR ( 31 ); a recent study ( 32 ) demonstrated that NLR and PLR are risk factors for DN and may be predictors of early DN patients ( 33 ); another study ( 34 ) also showed that NLR was an independent risk factor for DR, DN, and DR/DN, Latest Research suggest that PLR may be an independent risk factor for evaluating DR in type 2 diabetes patients ( 35 ).The present study found that both NLR and PLR were independent risk factors for DR/DN, and the risk of DR complicated by DN was significantly increased when PLR > 103.73. Previous studies found that PLR also predicted diabetes-related lower extremity vascular disease ( 36 ), atherosclerosis and diabetic foot ulcers ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Characterization of peripheral blood inflammatory indicators and OCT imaging biological markers in diabetic retinopathy with or without nephropathy

Xie

Xiaojuan

et al. 2023

ObjectiveTo observe the distribution characteristics of peripheral blood inflammatory indexes and retinal macular area optical coherence tomography (OCT) imaging biomarkers in patients with diabetic retinopathy (DR) with or without diabetic nephropathy (DN), in order to seek clinical biomarkers that can predict the development of DR and DN.MethodsA total of 169 inpatients with DR who visited the ophthalmology department of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from October 2020 to June 2022 and had complete clinical data were collected, and the patients with DR were divided into two major groups, DR and DR/DN, according to whether they had DN, and then further divided into four subgroups, Non-proliferative DR(NPDR), proliferative DR(PDR), NPDR/DN and PDR/DN, according to the stage of DR. The distribution characteristics of peripheral blood inflammatory indexes [Neutrophil to lymphocyte ratio(NLR) and Platelet to neutrophil ratio(PLR)], renal function indexes [Cystatin-C(CYS-C), Creatinine(Crea), Uric acid(UA)and Urinary albumin to creatinine ratio(UACR)] and OCT imaging indexes [Hyperreflective foci(HRF), Disorgnization of retinal inner layers(DRIL), Outer retinal tubulations(ORTs), Central retinal thickness(CRT), Retinal nerve fiber layer(RNFL) and Ganglion cell layer(GCL)] were analyzed between the above subgroups.ResultsThere was no difference between DR and DR/DN groups in terms of gender, family history of diabetes, duration of diabetes and Body mass index(BMI) (P>0.05), the mean age of the DR/DN group was significantly lower than that of the DR group (P<0.05), and the proportion of the DR/DN group with a history of hypertension was significantly higher than that of the DR group (P<0.05); there was no significant difference in hemoglobin A1C(HbA1c) between DR and DR/DN groups (P>0.05). (P>0.05), Hemoglobin(HGB) was significantly higher in the DR group than in the DR/DN group (P <0.05), NLR, PLR, Crea, UA and CYS-C were significantly higher in the DR/DN group than in the DR group (P<0.05); there was no significant difference in the comparison of HRF, DRIL, ORTs positive rate and CRT between the DR and DR/DN groups (P>0.05). RNFL and GCL thickness were significantly lower in the DR/DN group than in the DR group (P<0.05); history of hypertension (OR=2.759), NLR (OR=1.316), PLR (OR=1.009), Crea (OR=1.018), UA (OR=1.004), CYS-C (OR=3.742) were the independent (OR=0.951), age (OR=0.951), HGB (OR=0.976), RNFL (OR=0.909) and GCL (OR=0.945) were independent protective factors for DR/DN; RNFL (OR=0.899) and GCL (OR=0.935) were independent protective factors for NPDR/DN, RNFL (OR=0.852) and GCL (OR=0.928) were independent protective factors for PDR/DN. ROC curve analysis showed that the area under the curve (AUC) for CYS-C, PLR, Crea, UA and the combination of the four indicators to predict DR/DN were 0.717, 0.625, 0.647, 0.616 and 0.717, respectively.Conclusions(1) Low age combined with hypertension HGB, NLR, PLR, CYS-C, Crea and UA may be serum biological markers for predicting DN in DR; meanwhile, PLR, CYS-C, Crea, UA and the combination of the four indicators can be used for risk assessment and adjunctive diagnosis of DN in DR combined with hypertension. (2) The RNFL and GCL thickness in the temporal aspect of the central macular sulcus may be imaging biological markers for predicting DN in DR; meanwhile, GCL thickness may have important value for risk prediction and diagnosis of DN in combination with DR.