Neutrophil-to-lymphocyte ratio and microvascular complications in subjects with type 2 diabetes: Pakistan’s perspective
Neutrophil-to-lymphocyte ratio and microvascular complications in subjects with type 2 diabetes: Pakistan’s perspective
Background/aim: The aim of this study is to find the association between diabetic microvascular complications and the neutrophil-tolymphocyte ratio (NLR) in subjects with type 2 diabetes.Materials and methods: This was a retrospective study based on hospital data records from January 2005 to May 2016 at the BaqaiInstitute of Diabetology and Endocrinology. The eligibility criteria included subjects with type 2 diabetes with their latest complete bloodcount while subjects with conditions such as chronic inflammation, cancer, heart failure, and end-stage renal disease were not eligiblefor inclusion. Subjects were divided into two groups: one with any microvascular complications and the other with no microvascularcomplications. Body mass index, anthropometric measurements, and blood pressure were measured.Results: Out of 5620 type 2 diabetic subjects, 3202 (57%) were male and (2418) 43% were female. Among these, 3374 diabetic subjectshad one or more microvascular complications and 2246 had no microvascular complications. The NLR was found to be 1.14 timeshigher in diabetic subjects with at least one microvascular complication as compared to diabetic subjects without any complications(4.34 ± 3.32 vs. 3.36 ± 2.67; P < 0.0001). Factors likely associated with microvascular complications were high levels of NLR, HbA1c,serum creatinine, and systolic blood pressure and longer duration of diabetes.Conclusion: According to the results, the NLR is an efficient, cheaper, and readily available marker of inflammation and it is known asan important predictor for the existence of microvascular complications in subjects with type 2 diabetes.
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- Tabish SA. Is diabetes becoming the biggest epidemic of the
twenty-first century? Int J Health Sci (Qassim) 2007; 1: 5-53.
- International Diabetes Federation. Diabetes Atlas. 7th
ed. Watermael-Boitsfort, Belgium: International Diabetes
Federation; 2015.
- Ryden L, Standhl E, Bartnik M, Berghe GVD, Betteridge J.
Guidelines on diabetes, pre-diabetes, and cardiovascular
disease. Eur Heart J 2007; 28: 88-136.
- Moursy EY, Megallaa MH, Mouftah RF, Ahmed SM.
Relationship between neutrophil lymphocyte ratio and
microvascular complications in Egyptian patients with type 2
diabetes. Am J Intern Med 2015; 3: 250-255.
- Narayan KM, Gregg EW, Fagot-Campagna A, Engelau MM,
Vinicor F. Diabetes: a common, growing, serious, costly and
potentially preventable public health problem. Diab Res Clin
Pract 2000; 50: S77-S84.
- Lou M, Luo P, Tang R, Peng Y, Yu S, Huang W, He L.
Relationship between neutrophil-lymphocyte ratio and insulin
resistance in newly diagnosed type 2 diabetes mellitus patients.
BMC Endo Disord 2015; 15: 9.
- DiGangi C. Neutrophil-lymphocyte ratio: Predicting
cardiovascular and renal complications in patients with
diabetes. J Am Assoc Nurse Pract 2016; 28: 410-414.
- Kurtul BE, Kabatas EU, Zenciroglu A, Ozer PA, Ertugrul GT,
Beken S, Okumus N. Serum neutrophil-to-lymphocyte ratio in
retinopathy of prematurity. J AAPOS 2015; 19: 327-331.
- Ulu SM, Dogan M, Ahsen A, Altug A, Demir K, Acartürk
G, Inan S. Neutrophil-to-lymphocyte ratio as a quick and
reliable predictive marker to diagnose the severity of diabetic
retinopathy. Diab Technol Ther 2013; 15: 942-947.
- Yue S, Zhang J, Wu J, Teng W, Liu L, Chen L. Use of the
monocyte-to-lymphocyte ratio to predict diabetic retinopathy.
Int J Environ Res Public Health 2015; 12: 10009-10019.
- Yan W, Liu C, Li R, Mu Y, Jia Q, He K. Usefulness of the
neutrophil-to-lymphocyte ratio in predicting adverse events in
elderly patients with chronic heart failure. Int Heart J 2016; 57:
615-621.
- Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The
relationship between neutrophil-to-lymphocyte ratio and
inflammation in end-stage renal disease patients. Renal Failure
2012; 34: 155-159.
- Mowat A, Baum J. Chemotaxis of polymorphonuclear
leukocytes from patients with diabetes mellitus. N Engl J
Med 1971; 284: 621-627.
- Alba-Loureiro TC, Munhoz CD, Martins JO, Cerchiaro GA,
Scavone C, Curi R, Sannomiya P. Neutrophil function and
metabolism in individuals with diabetes mellitus. Braz J Med
Biol Res 2007; 40: 1037-1044.
- Chen J, Hong D, Zhai Y, Shen P. Meta-analysis of associations
between neutrophil-to-lymphocyte ratio and prognosis of
gastric cancer. World J Surg Oncol 2015; 13: 122.
- Fawwad A, Sabir R, Riaz M, Moin H, Basit A. Measured versus
calculated LDL-cholesterol in subjects with type 2 diabetes. Pak
J Med Sci 2016; 32: 955-960.
- Kahraman C, Kahraman NK, Aras B, Coşgun S, Gülcan E.
The relationship between neutrophil-to-lymphocyte ratio and
albuminuria in type 2 diabetic patients: a pilot study. Arch Med
Sci 2016; 3: 571-575.
- Wang RT, Zhang JR, Li Y, Liu T, Yu KJ. Neutrophil-lymphocyte
ratio is associated with arterial stiffness in diabetic retinopathy
in type 2 diabetes. J Diab Complic 2015; 29: 245-249.
- Ko SH, Cha BY. Diabetic peripheral neuropathy in type 2
diabetes mellitus in Korea. Diab Metab J 2012; 36: 6-12.
- Akbaş EM, Demirtas L, Ozcicek A, Timuroglu A, Bakirci
EM, Hamur H, Ozcicek F, Turkmen K. Association of epicardial
adipose tissue, neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio with diabetic nephropathy. Int J Clin Exp Med
2014; 7: 1794-1801.
- Afşar B. The relationship between neutrophil lymphocyte ratio
with urinary protein and albumin excretion in newly diagnosed
patients with type 2 diabetes. Am J Med Sci 2014; 347: 217-220.
- Abdul-Rahman IS. Urine albumin/creatinine ratio: a reliable
marker of renal injury in sickle cell nephropathy. Saudi J Med
Med Sci 2014; 2: 17-23.
- Watts GF, Powrie JK, O’Brien SF, Shaw KM. Apolipoprotein
B independently predicts progression of very-low-level
albuminuria in insulin-dependent diabetes mellitus.
Metabolism 1996; 45: 1101-1107.
- Andersson C, van Gaal L, Caterson ID. Relationship between
HbA1c levels and risk of cardiovascular adverse outcomes and
all-cause mortality in overweight and obese cardiovascular
high-risk women and men with type 2 diabetes. Diabetologia
2012; 55: 2348-2355.