The relationship between the neutrophil-to-lymphocyte ratio and diabetic retinopathy in adults from the United States: results from the National Health and nutrition examination survey

Abstract

Background Diabetic retinopathy (DR) is a common complication of diabetes mellitus (DM). Systemic inflammation is intimately associated with DR. The neutrophil-to-lymphocyte ratio (NLR) index is a relatively new indicator of inflammation. Methods This cross-sectional study was carried out among adults with DM based on the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2016. NLR was presented as absolute neutrophil counts/ absolute lymphocyte counts. The relationship of NLR levels to DR was analyzed using multivariable logistic regression. Results There were 2772 eligible subjects extracted from the NHANES. In the multivariate analysis, NLR was related to the risk of DR after adjustment for potential confounders. The association between NLR levels and DR was nonlinear, with an inflection point of 4.778. Compared with the baseline values, NLR was not statistically significant on the right side of the inflection point (1.000, 0.914 to 1.094, 0.9974) but was positively associated with DR on the left side (1.236, 1.132 to 1.349, < 0.0001). Conclusions NLR reflects systemic inflammation that may increase the risk of DR. NLR positively correlates with DR when its value is less than 4.778.

The Value of White Cell Inflammatory Biomarkers as Potential Predictors for Diabetic Retinopathy in Type 2 Diabetes Mellitus (T2DM)

“…The differences may be related to the methodology of research and classification of DR but also patients’ age, BMI, comorbidities, and geographical and ethnic differences. Moreover, the relationship between NLR and DR appears to be non-linear [ 49 ], and some studies have suggested that changes in NLR and PLR may be more informative when analyzed as continuous variables rather than categorical variables based on arbitrary cut-off values [ 2 , 50 , 51 ]. T2DM patients often present with a unique but diverse series of risk factors, comorbidities, and complications, which may accumulate over time due to an inappropriate lifestyle [ 52 ].…”

The Correlation of the Neutrophil-to-Lymphocyte Ratio With Microvascular Complications in Patients With Diabetes Mellitus

“…In 2020, Li et al identified an elevated NLR as a dependable marker for diabetic retinopathy [ 26 ]. In a multivariate analysis conducted by He et al in 2022, the NLR was related to the risk of diabetic retinopathy [ 27 ].…”

Cellular communication network factor 1 promotes retinal leakage in diabetic retinopathy via inducing neutrophil stasis and neutrophil extracellular traps extrusion

“…Pathologically, the increased infiltration of neutrophils and heightened adhesion between neutrophils and the endothelium result in retinal inflammation and vessel leukostasis, contributing to the progression of DR [ 3 ]. To date, studies have confirmed a positive correlation between diabetic retinopathy and both the neutrophil-to-lymphocyte ratio (NLR) and the neutrophil percentage-to-albumin ratio (NAR) in peripheral blood [ 4 ]. NETosis is a specific cell death process of neutrophils [ 5 ] and is characterized by the release of neutrophil extracellular traps (NETs), which are extracellular structures composed of chromatin and proteins such as myeloperoxidase (MPO), citrullinated histone H3 (Cit-H3), and neutrophil elastase (NE) [ 6 ].…”