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Cojic M, Klisic A, Sahmanovic A, Petrovic N, Kocic G. Cluster analysis of patient characteristics, treatment modalities, renal impairments, and inflammatory markers in diabetes mellitus. Sci Rep 2024; 14:5994. [PMID: 38472402 PMCID: PMC10933260 DOI: 10.1038/s41598-024-56451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is caused by an interplay of various factors where chronic hyperglycemia and inflammation have central role in its onset and progression. Identifying patient groups with increased inflammation in order to provide more personalized approach has become crucial. We hypothesized that grouping patients into clusters according to their clinical characteristics could identify distinct unique profiles that were previously invisible to the clinical eye. A cross-sectional record-based study was performed at the Primary Health Care Center Podgorica, Montenegro, on 424 T2DM patients aged between 30 and 85. Using hierarchical clustering patients were grouped into four distinct clusters based on 12 clinical variables, including glycemic and other relevant metabolic indicators. Inflammation was assessed through neutrophil-to-lymphocyte (NLR) and platelet to lymphocyte ratio (PLR). Cluster 3 which featured the oldest patients with the longest T2DM duration, highest hypertension rate, poor glycemic control and significant GFR impairment had the highest levels of inflammatory markers. Cluster 4 which featured the youngest patients, with the best glycemic control, the highest GFR had the lowest prevalence of coronary disease, but not the lowest levels of inflammatory markers. Identifying these clusters offers physicians opportunity for more personalized T2DM management, potentially mitigating its associated complications.
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Affiliation(s)
- Milena Cojic
- University of Montenegro-Faculty of Medicine, Podgorica, Montenegro.
- Primary Health Care Center, Podgorica, Montenegro.
| | - Aleksandra Klisic
- University of Montenegro-Faculty of Medicine, Podgorica, Montenegro
- Primary Health Care Center, Podgorica, Montenegro
| | - Amina Sahmanovic
- University of Montenegro-Faculty of Medicine, Podgorica, Montenegro
- Primary Health Care Center, Podgorica, Montenegro
| | | | - Gordana Kocic
- Department of Medical Biochemistry, School of Medicine, University of Nis, Niš, Serbia
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Rezaei Shahrabi A, Arsenault G, Nabipoorashrafi SA, Lucke-Wold B, Yaghoobpoor S, Meidani FZ, Rahmati R, Ghaedi A, Khanzadeh S. Relationship between neutrophil to lymphocyte ratio and diabetic peripheral neuropathy: a systematic review and meta-analysis. Eur J Med Res 2023; 28:523. [PMID: 37974254 PMCID: PMC10652461 DOI: 10.1186/s40001-023-01479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The present study aims to review the existing scientific literature on the role of neutrophil to lymphocyte ratio (NLR) in diabetic peripheral neuropathy (DPN) to perform a meta-analysis on the available data. METHODS The electronic repositories Web of Science, PubMed, and Scopus were systematically explored starting from their establishment up until June 9, 2022. RESULTS Fifteen articles were included in the meta-analysis after multiple screening according to the PRISMA guidelines. The combined findings indicated that individuals with DPN had higher levels of NLR in comparison to those without DPN (SMD = 0.61; CI 95% = 0.40-0.81, p < 0.001). In the subgroup assessment based on ethnicity, it was observed that diabetic patients with DPN exhibited increased NLR levels in contrast to those without DPN in studies conducted in India (SMD = 1.30; CI 95% = 0.37-2.24, p = 0.006) and East Asia (SMD = 0.53; CI 95% = 0.34-0.73, p < 0.001) but not in studies conducted in Turkey (SMD = 0.30; CI 95% = - 0.06-0.67, p = 0.104) and Egypt (SMD = 0.34; CI 95% = -0.14-0.82, p = 0.165). The pooled sensitivity of NLR was 0.67 (95% CI = 0.49-0.81), and the pooled specificity was 0.70 (95% CI, 0.56-0.81). The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR) of NLR were 2.30 (95% CI = 1.71-3.09), 0.45 (95%CI = 0.30-0.67), and 5.06 (95% CI = 3.16-8.12), respectively. CONCLUSION NLR serves as a distinct marker of inflammation, and its rise in cases of DPN suggests an immune system imbalance playing a role in the development of the disease.
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Affiliation(s)
| | | | - Seyed Ali Nabipoorashrafi
- Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, Tehran, Iran
| | | | - Shirin Yaghoobpoor
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zari Meidani
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Rahem Rahmati
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Arshin Ghaedi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Tamaki S, Nagai Y, Shutta R, Masuda D, Yamashita S, Seo M, Yamada T, Nakagawa A, Yasumura Y, Nakagawa Y, Yano M, Hayashi T, Hikoso S, Nakatani D, Sotomi Y, Sakata Y. Combination of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as a Novel Predictor of Cardiac Death in Patients With Acute Decompensated Heart Failure With Preserved Left Ventricular Ejection Fraction: A Multicenter Study. J Am Heart Assoc 2022; 12:e026326. [PMID: 36565197 PMCID: PMC9973595 DOI: 10.1161/jaha.122.026326] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel inflammation markers. Their combined usefulness for estimating the prognosis of patients with heart failure with preserved ejection fraction (HFpEF) admitted for acute decompensated heart failure remains elusive. Methods and Results We investigated 1026 patients registered in the Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction. Both NLR and PLR values were measured at the time of admission. Comorbidity burden was defined as the number of occurrences of 8 common comorbidities of HFpEF. The primary end point was cardiac death. The patients were stratified into 3 groups based on the optimal cut-off values of NLR and PLR on the receiver operating characteristic curve analysis for predicting cardiac death (low NLR and PLR, either high NLR or PLR, and both high NLR and PLR). After a median follow-up of 429 days, 195 patients died, with 85 of these deaths attributed to cardiac causes. An increased comorbidity burden was significantly associated with a higher proportion of patients with high NLR (>4.5) or PLR (>193), or both. High NLR and PLR values were independently associated with cardiac death, and a combination of both values was the strongest predictor (hazard ratio, 2.66 [95% CI, 1.51%-4.70%], P=0.0008). A significant difference was found in the rate of cardiac death among the 3 groups stratified by NLR and PLR values. Conclusions The combination of NLR and PLR is useful for the prediction of postdischarge cardiac death in patients with acute HFpEF. Registration URL: ClinicalTrials.gov; Unique identifier: UMIN000021831.
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Affiliation(s)
- Shunsuke Tamaki
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Yoshiyuki Nagai
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Ryu Shutta
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | - Daisaku Masuda
- Department of CardiologyRinku General Medical CenterOsakaJapan
| | | | - Masahiro Seo
- Division of CardiologyOsaka General Medical CenterOsakaJapan
| | - Takahisa Yamada
- Division of CardiologyOsaka General Medical CenterOsakaJapan
| | - Akito Nakagawa
- Division of CardiologyAmagasaki Chuo HospitalAmagasakiJapan,Department of Medical InformaticsOsaka University Graduate School of MedicineOsakaJapan
| | | | | | | | | | - Shungo Hikoso
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Daisaku Nakatani
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yohei Sotomi
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yasushi Sakata
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
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Fang L, Wang Y, Zhang H, Jiang L, Jin X, Gu Y, Wu M, Pei S, Cao Y. The neutrophil-to-lymphocyte ratio is an important indicator correlated to early neurological deterioration in single subcortical infarct patients with diabetes. Front Neurol 2022; 13:940691. [PMID: 36341126 PMCID: PMC9632421 DOI: 10.3389/fneur.2022.940691] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background and purpose This study aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and early neurological deterioration (END) among cases suffering from single subcortical infarction (SSI) and diabetes. Methods We collected the data of patients with SSI admitted to our hospital between January 2019 and December 2020 retrospectively. A score of ≥2 elevations in overall National Institutes of Health Stroke Scale (NIHSS) score or ≥1 increase in motor NIHSS score in 5-day post-admission was considered END. Furthermore, logistic regression was used to analyze the relationship between NLR and END among SSI cases. Results Altogether, we enrolled 235 consecutive SSI cases, of which 53 (22.5%) were diagnosed with END, while 93 (39.5%) were diabetic. In patients with diabetes, the value of NLR increased markedly among the patients with END (median, 3.59; IQR, 2.18–4.84) compared to patients without END (median, 2.64; IQR, 1.89–3.18; P = 0.032). Meanwhile, in patients without diabetes, NLR was not significantly associated with END. In the multivariate analysis, NLR values were positively related to END (adjusted odds ratio (OR), 1.768; 95% CI, 1.166–2.682, P = 0.007) upon adjusting age, SSI type, lesion diameter, initial NIHSS, fasting blood glucose (FBG), 2-h postprandial blood glucose (2hPBG), and estimated glomerular filtration rate (eGFR). The subgroup analysis showed that the relationship between NLR and END was more pronounced in the branch atheromatous disease (BAD) (adjusted OR, 1.819; 95% CI, 1.049–3.153, P = 0.033) and anterior SSI subgroups (adjusted OR, 2.102; 95% CI, 1.095–4.037, P = 0.026). Conclusion NLR value was significantly related to END among SSI patients with diabetes and was recognized as an independent factor in predicting the risk of END.
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Affiliation(s)
- Lijun Fang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Yali Wang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Hong Zhang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Lingling Jiang
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Xuehong Jin
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Yongquan Gu
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Minya Wu
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
| | - Shaofang Pei
- Department of Neurology, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China
- *Correspondence: Shaofang Pei
| | - Yongjun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Yongjun Cao
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OZİSİK H, CETİNKALP S, SUNER A, OZGEN G, SAYGİLİ F, ERDOGAN M. Tip 2 diabetes mellituslu hastalarda nötrofil lenfosit oranı ile diyabet kontrolü arasındaki ilişki. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1168234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The current study was purposed to examine the association between NLR and the control of glucose in patients with T2DM. We also aimed to reveal correlations between microalbuminuria, Mean Platelet Volume (MPV), Red Blood Cell Distribution (RDW), and glycosylated hemoglobin (HbA1c). Materials and Methods: It was a retrospective study arranged in Ege University, in Endocrinology Department. We collected the fields of 198 patients having type 2 diabetes mellitus (T2DM), and they were categorized into two groups, patients with controlled T2DM (Hba1c≤7%) (n=82) and uncontrolled T2DM (Hba1c>7%) (n=116). Results: There were no statistically significant differences between NLR, RDW and MPV in two groups (p=0.123, p=0.298, p=0.595 respectively). Duration of T2DM 5 years and below and after 5 years between two groups was statistically important (p=0.002). NLR was found higher in uncontrolled T2DM than controlled T2DM, but not statistically significant. Receiver operating characteristic curve of NLR, RDW, MPV, WBC were not found significant (p>0.05). Conclusion: Our study revealed that duration of T2DM may predict microalbuminuria, and evaluated the relationship between RDW, MPV, NLR and Hba1c, microalbuminuria levels together in the patients with T2DM. According to NLR, RDW and MPV levels, we did not detect any statistically differences between uncontrolled T2DM than controlled T2DM.
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Affiliation(s)
- Hatice OZİSİK
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkiye
| | - Sevki CETİNKALP
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkiye
| | - Aslı SUNER
- Ege University, Department of Biostatistics and Medical Informatics, İzmir, Turkiye
| | - Gokhan OZGEN
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkiye
| | - Fusun SAYGİLİ
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkiye
| | - Mehmet ERDOGAN
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkiye
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Chen H, Su L, Bao J, Zhang K, Li Y, Mao E. The impact of pulmonary tuberculosis on immunological and metabolic features of diabetic patients. Front Immunol 2022; 13:973991. [PMID: 36081511 PMCID: PMC9446150 DOI: 10.3389/fimmu.2022.973991] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Impaired immune responses have been observed in patients with type-2 diabetes mellitus (T2DM), which increases susceptibility to tuberculosis infection. However, the effect of the tuberculosis infection on the immunological and metabolic features of T2DM is largely unknown. To investigate this question, age- and sex-matched patients with pulmonary tuberculosis (PTB), T2DM, or T2DM combined with PTB were recruited from the Infectious Disease Hospital of Heilongjiang Province between January and September 2020. Healthy subjects were used as controls. Cytokines and chemokines in fasting serum samples were determined using the Quantibody Inflammation Array. Compared with T2DM alone, patients with T2DM combined with PTB have higher fasting blood glucose levels and monocyte counts in circulation. Among the four groups, circulating IL-10 levels peaked in patients with T2DM and PTB (p<0.05). Univariate linear analysis showed that serum IL-10 levels were positively associated with myeloid cells but negatively correlated with lymphocyte counts in these patients (p<0.05). Serum IL-6 levels were 1.6-fold higher in patients with T2DM plus PTB than in those with T2DM alone. In conclusion, PTB infection in patients with T2DM had distinct inflammatory profiles and sustained hyperglycaemia compared with PTB or T2DM alone. IL-10 levels and elevated monocyte counts could be hallmarks of patients with T2DM infected with PTB.
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Affiliation(s)
- Haijun Chen
- Department of Computed Tomography, Heilongjiang Provincial Hospital, Harbin, China
| | - Li Su
- Neuroscience Research Institute, Peking University Center of Medical and Health Analysis, Peking University, Beijing, China
| | - Jinhua Bao
- College of Sports and Human Sciences, Harbin Sport University, Harbin, China
| | - Kun Zhang
- Department of Clinical Nutrition, Heilongjiang Provincial Hospital, Harbin, China
| | - Yuze Li
- Department of Clinical Nutrition, Heilongjiang Provincial Hospital, Harbin, China
- Department of the Fourth Internal Medicine, The Fourth Hospital of Heilongjiang Province, Harbin, China
- *Correspondence: Yuze Li, ; Enuo Mao,
| | - Enuo Mao
- Department of Discipline Inspection and Supervision, Heilongjiang Provincial Hospital, Harbin, China
- *Correspondence: Yuze Li, ; Enuo Mao,
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Wang Q, Zhang Z, Chai Q, Shan Y, Lu D, Chen Y, Liu M, Wu W. Correlation Between Retinopathy and Coronary Microcirculation Dysfunction in Patients with Type 2 Diabetes Mellitus. Eur J Ophthalmol 2022; 32:2857-2863. [PMID: 35060405 DOI: 10.1177/11206721221074201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The aim of this study is to evaluate the correlation between retinopathy and coronary microcirculation dysfunction (CMD) in type 2 diabetes mellitus (T2DM) patients. Methods 198 T2DM patients with left ventricular ejection fraction (LVEF)>50%, no epicardial coronary artery stenosis diagnosis by coronary angiography (CAG) and successfully completed coronary blood flow reserve (CFR) test and laboratory examination were enrolled, and fundus examination was performed on all participants. Two groups were divided according to CFR value, including 86 patients with CMD (CFR≤2.5) in study group and 112 patients without CMD (CFR>2.5) in control group. The composition of various retinopathy in two groups was observed, and the correlation between retinopathy and CMD was analyzed using ordered logistic regression. Results There were 13 cases with arteriovenous (A/V) nicking, 4 cases with proliferative diabetic retinopathy (PDR), 14 cases with non-proliferative diabetic retinopathy (NPDR), 17 cases with diabetic retinopathy (DR) with A/V nicking, 38 cases without retinopathy in study group, and 18 cases, 7 cases, 20 cases, 4 cases and 63 cases for each in control group. After adjustment for age, gender, hypertension, diabetes duration, dyslipidemia, glycosylated hemoglobin (HbA1c), body mass index (BMI), A/V nicking, PDR and NPDR, the diference of DR with A/V nicking between study and control group remained statistically signifcant (OR 2.0, 95% CI 0.79 to 3.21, p = 0.001). Conclusion DR with A/V nicking could be used as an independent predictor of T2DM patients with CMD. CFR testing should be performed on patients with this kind of eye sign, even if they do not have any symptoms of heart disease. Meanwhile, DR with A/V nicking might be served as a reference indicator of CMD in T2DM patients with chest pain who were unable to be tested for CFR.
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Affiliation(s)
- Qian Wang
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Ziying Zhang
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Qian Chai
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Yongyan Shan
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Dexue Lu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Yangwen Chen
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Meili Liu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Weihua Wu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
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