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Song S, Sun Y, Yu J. Causal relationship between 731 immune cells and the risk of diabetic nephropathy: a two‑sample bidirectional Mendelian randomization study. Ren Fail 2024; 46:2387208. [PMID: 39091101 PMCID: PMC11299454 DOI: 10.1080/0886022x.2024.2387208] [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: 03/11/2024] [Revised: 07/01/2024] [Accepted: 07/28/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE Previous observational studies have indicated associations between various immune cells and diabetic nephropathy (DN). However, the causality remains unclear. We aimed to further evaluate the causal association between immune cells and DN using bidirectional two-sample Mendelian randomization (MR) analysis. METHOD The DN data were retrieved from the IEU OpenGWAS Project database, while the data for 731 immune cells were sourced from GWAS summary statistics by Orru ̀ et al. The investigation into the causal relationship between immune cells and DN employed the inverse variance weighted (IVW), weighted median (WME), and MR-Egger methods. The stability and reliability of the findings underwent evaluation through Cochran's Q test, MR-Egger intercept's P-value, MR-PRESSO, and Leave-One-Out (LOO) method. RESULT The IVW estimates suggested a positive causal effect of CD25 on IgD-CD38dim B cell, CD25 on naive-mature B cell, CD127 on granulocyte, SSC-A on HLA DR + Natural Killer, HLA DR on plasmacytoid Dendritic Cell, and HLA DR on Dendritic Cell on DN. Conversely, the abundance of Myeloid Dendritic Cell, CD62L- Dendritic Cell %Dendritic Cell, CD86+ myeloid Dendritic Cell %Dendritic Cell, CD14- CD16-, CX3CR1 on CD14- CD16-, and SSC-A on CD4+ T cell had negative causal effects on DN. However, after correcting the P value for significant causality results using the FDR method, it was concluded that only Myeloid Dendritic Cells had a causal relationship with DN (FDR-p = 0.041), while the other immune cells showed no significant association with DN, so their relationship was suggestive. The results were stable with no observed horizontal pleiotropy and heterogeneity. Reverse MR analysis indicated no causal relationship between DN and the increased risk of positively identified immune cells. CONCLUSION This study provides an initial insight into the genetic perspective of the causal relationship between immune cells and DN. It establishes a crucial theoretical foundation for future endeavors in precision medicine and individualized treatment.
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Affiliation(s)
- Siyuan Song
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Jiangsu, Nanjing, P.R. China
| | - Yuqing Sun
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Jiangsu, Nanjing, P.R. China
| | - Jiangyi Yu
- Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing University of Chinese Medicine, Jiangsu, Nanjing, P.R. China
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Xie R, Bishai DM, Lui DTW, Lee PCH, Yap DYH. Higher Circulating Neutrophil Counts Is Associated with Increased Risk of All-Cause Mortality and Cardiovascular Disease in Patients with Diabetic Kidney Disease. Biomedicines 2024; 12:1907. [PMID: 39200371 PMCID: PMC11352130 DOI: 10.3390/biomedicines12081907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/15/2024] [Accepted: 08/18/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Accumulating evidence has suggested the pathogenic roles of chronic inflammation and neutrophils in diabetic kidney disease (DKD). This study investigated the relationship between neutrophils, all-cause, and cardiovascular disease (CVD) mortality in type 2 diabetes mellitus (T2DM) patients with DKD. METHODS We used data from the National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2020 to investigate the relationship between circulating neutrophils counts, kidney function indices, all-cause, and CVD mortality in adult T2DM patients with DKD. Clinical predictive models and risk scores for long-term mortality were constructed. RESULTS 44,332 patients [8034 with T2DM and 36,323 without T2DM] were included. Two thousand two hundred twenty patients had DKD, and 775 died (31.5% related to CVD) during a follow-up of 6.18 (range: 5.94-6.42) years. Higher neutrophil counts (Quartile 4, Q4) were associated with increased all-cause and CVD mortality [HR 1.73 (95% CI 1.34-2.25) and 1.81 (95% CI 1.14-2.89), respectively, p < 0.0001 and 0.01]. Neutrophil counts in Q4 showed a positive correlation with urine albumin-creatinine ratio (UACR) but a negative association with eGFR (p < 0.01 for all). Clinical predictive models incorporating neutrophil counts showed satisfactory performance in forecasting 5-year and 10-year CVD mortality-free survival (ROC AUC 0.824 and 0.842, respectively), and the nomogram-predicted survival demonstrated good concordance with observed survival. CONCLUSIONS Higher levels of circulating neutrophil counts show a significant correlation with renal abnormalities and higher all-cause and CVD mortality in T2DM patients with DKD. The novel clinical predictive models and risk scores incorporating neutrophil counts may facilitate stratification and, hence, risk factor management in DKD patients.
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Affiliation(s)
- Ruiyan Xie
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR 999077, China
| | - David M. Bishai
- Division of Health Economics, Policy and Management, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 999077, China
| | - David T. W. Lui
- Division of Endocrinology and Metabolism, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR 999077, China; (D.T.W.L.)
| | - Paul C. H. Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR 999077, China; (D.T.W.L.)
| | - Desmond Y. H. Yap
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR 999077, China
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Caloian CS, Șurlin P, Ciurea A, Pop D, Caloian B, Leucuța DC, Țigu AB, Rasperini G, Micu IC, Stanomir A, Soancă A, Roman A. Exploring Periodontal Conditions, Salivary Markers, and Systemic Inflammation in Patients with Cardiovascular Diseases. Biomedicines 2024; 12:1341. [PMID: 38927548 PMCID: PMC11201987 DOI: 10.3390/biomedicines12061341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/06/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background: This cross-sectional investigation appreciated the role of serum C-reactive protein (CRP), several hematologic-cell markers, and salivary inflammation-related molecules [calprotectin (S100A8/A9), interleukin-1β (IL-1β), kallikrein] to predict periodontitis in patients with atherosclerotic cardiovascular disease (ACVD), arrhythmia, or both. Also, we appreciated the relationship between the inflammatory burden and periodontal destruction with the type of cardiac pathology. (2) Methods: Demographic, behavioral characteristics, periodontal indicators, blood parameters, and saliva samples were collected. (3) Results: All 148 patients exhibited stage II or III/IV periodontitis. Stage III/IV cases exhibited significantly increased S100A8/A9 levels (p = 0.004). A positive correlation between S100A8/A9 and IL-1β [0.35 (<0.001)], kallikrein [0.55 (<0.001)], and CRP [0.28 (<0.001)] was observed. Patients with complex cardiac involvement had a significantly higher number of sites with attachment loss ≥ 5 mm [19 (3-30)] compared to individuals with only arrhythmia [9 (3.25-18)] or ACVD [5 (1-12)] [0.048♦ {0.162/0.496/0.14}]. (4) Conclusions: Severe, extensive attachment loss may be indicative of patients with complex cardiac conditions, which underscores the essential role of periodontal status in relation to systemic diseases. The correlations between the rising trends of the inflammatory parameters suggest a potential interconnection between oral and systemic inflammation.
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Affiliation(s)
- Carmen Silvia Caloian
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.); (A.R.)
| | - Petra Șurlin
- Department of Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania;
| | - Andreea Ciurea
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.); (A.R.)
- Emergency County Clinical Hospital Cluj, 400006 Cluj-Napoca, Romania;
| | - Dana Pop
- Emergency County Clinical Hospital Cluj, 400006 Cluj-Napoca, Romania;
- Department of Cardiology-Rehabilitation, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 4000347 Cluj-Napoca, Romania
| | - Bogdan Caloian
- Emergency County Clinical Hospital Cluj, 400006 Cluj-Napoca, Romania;
- Department of Cardiology-Rehabilitation, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 4000347 Cluj-Napoca, Romania
| | - Daniel Corneliu Leucuța
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Adrian Bogdan Țigu
- Research Centre for Advanced Medicine (MEDFUTURE), Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Giulio Rasperini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS Ca’ Granda Policlinic, Via della Commenda 12, 20122 Milan, Italy;
| | - Iulia Cristina Micu
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.); (A.R.)
| | - Alina Stanomir
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.); (A.R.)
| | - Andrada Soancă
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.); (A.R.)
- Emergency County Clinical Hospital Cluj, 400006 Cluj-Napoca, Romania;
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (C.S.C.); (A.C.); (I.C.M.); (A.S.); (A.R.)
- Emergency County Clinical Hospital Cluj, 400006 Cluj-Napoca, Romania;
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Serban D, Papanas N, Dascalu AM, Kempler P, Raz I, Rizvi AA, Rizzo M, Tudor C, Silviu Tudosie M, Tanasescu D, Pantea Stoian A, Gouveri E, Ovidiu Costea D. Significance of Neutrophil to Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) in Diabetic Foot Ulcer and Potential New Therapeutic Targets. INT J LOW EXTR WOUND 2024; 23:205-216. [PMID: 34791913 DOI: 10.1177/15347346211057742] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetic foot ulcer (DFU) is a well-known complication of diabetes and a significant burden on the national health systems. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio are inexpensive and easily accessible biomarkers that have proved to be useful in several inflammatory, infectious and cardiovascular diseases. We carried out a comprehensive review examining the association of NLR and PLR with the onset and progression of DFU. PLR and NLR were significantly increased in patients with DFU, compared with a control group of T2DM patients without DFU, and correlate well with DFU severity, evaluated by Wagner and IWGDF grading scales. In patients with diabetic foot infections (DFI), elevated NLR and PLR were correlated with osteomyelitis, increased risk of amputation, and septic complications. The significance of the elevated value of these biomarkers in DFU is related to chronic hyperglycemia and low-grade systemic inflammation, atherosclerotic and vascular complications, and also the associated septic factor. Serial, dynamic follow-up can provide useful information in planning and monitoring DFU treatment, as well as in risk stratification of these vulnerable patients. Further randomized studies are needed to set the cut-off values with clinical significance.
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Affiliation(s)
- Dragos Serban
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, ; ;
- Fourth Department of General Surgery, Emergency University Hospital, Romania,
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece,
| | - Ana Maria Dascalu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, ; ;
- Department of Ophthalmology, Emergency University Hospital Bucharest, Romania
| | | | | | - Ali A Rizvi
- Emory University, Atlanta, GA, USA,
- University of South Carolina School of Medicine Columbia, SC, USA
| | - Manfredi Rizzo
- University of South Carolina School of Medicine Columbia, SC, USA
- Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Italy,
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,
| | - Corneliu Tudor
- Fourth Department of General Surgery, Emergency University Hospital, Romania,
| | - Mihail Silviu Tudosie
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania, ; ;
- Clinical Emergency Hospital, Bucharest, Romania
| | | | | | | | - Daniel Ovidiu Costea
- Ovidius University, Constanta, Romania,
- Emergency County Hospital, Constanta, Romania
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Gao JL, Shen J, Yang LP, Liu L, Zhao K, Pan XR, Li L, Xu JJ. Neutrophil-to-lymphocyte ratio associated with renal function in type 2 diabetic patients. World J Clin Cases 2024; 12:2308-2315. [PMID: 38765748 PMCID: PMC11099408 DOI: 10.12998/wjcc.v12.i14.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/14/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a leading risk factor for the development and progression of chronic kidney disease (CKD). However, an accurate and convenient marker for early detection and appropriate management of CKD in individuals with T2DM is limited. Recent studies have demonstrated a strong correlation between the neutrophil-to-lymphocyte ratio (NLR) and CKD. Nonetheless, the predictive value of NLR for renal damage in type 2 diabetic patients remains understudied. AIM To investigate the relationship between NLR and renal function in T2DM patients. METHODS This study included 1040 adults aged 65 or older with T2DM from Shanghai's Community Health Service Center. The total number of neutrophils and lymphocytes was detected, and NLR levels were calculated. CKD was defined as an estimated glomerular filtration rate ≤ 60 mL/min/1.73 m². Participants were divided into four groups based on NLR levels. The clinical data and biochemical characteristics were compared among groups. A multivariate logistic regression model was used to analyze the association between NLR levels and CKD. RESULTS Significant differences were found in terms of sex, serum creatinine, blood urea nitrogen, total cholesterol, and low-density lipoprotein cholesterol among patients with T2DM in different NLR groups (P < 0.0007). T2DM patients in the highest NLR quartile had a higher prevalence of CKD (P for trend = 0.0011). Multivariate logistic regression analysis indicated that a high NLR was an independent risk factor for CKD in T2DM patients even after adjustment for important clinical and pathological parameters (P = 0.0001, odds ratio = 1.41, 95% confidence intervals: 1.18-1.68). CONCLUSION An elevated NLR in patients with T2DM is associated with higher prevalence of CKD, suggesting that it could be a marker for the detection and evaluation of diabetic kidney disease.
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Affiliation(s)
- Jin-Li Gao
- Department of Prevention and Health Care, Community Health Service Center of Miaohang Town, Shanghai 200443, China
| | - Jue Shen
- Department of Prevention and Health Care, Community Health Service Center of Songnan Town, Shanghai 200434, China
| | - Li-Ping Yang
- Department of Prevention and Health Care, Community Health Service Center of Songnan Town, Shanghai 200434, China
| | - Li Liu
- Department of General Practice, Community Health Service Center of Songnan Town, Shanghai 200434, China
| | - Kai Zhao
- Department of General Practice, Community Health Service Center of Songnan Town, Shanghai 200434, China
| | - Xiao-Rong Pan
- Department of General Practice, Community Health Service Center of Songnan Town, Shanghai 200434, China
| | - Lei Li
- Department of Administrative, Community Health Service Center of Songnan Town, Shanghai 200434, China
| | - Ji-Ji Xu
- Department of General Practice, Community Health Service Center of Songnan Town, Shanghai 200434, China
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Chen G, Che L, Lai M, Wei T, Chen C, Zhu P, Ran J. Association of neutrophil-lymphocyte ratio with all-cause and cardiovascular mortality in US adults with diabetes and prediabetes: a prospective cohort study. BMC Endocr Disord 2024; 24:64. [PMID: 38730476 PMCID: PMC11084136 DOI: 10.1186/s12902-024-01592-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The neutrophil-lymphocyte ratio (NLR) is a novel hematological parameter to assess systemic inflammation. Prior investigations have indicated that an increased NLR may serve as a potential marker for pathological states such as cancer and atherosclerosis. However, there exists a dearth of research investigating the correlation between NLR levels and mortality in individuals with diabetes and prediabetes. Consequently, this study aims to examine the connection between NLR and all-cause as well as cardiovascular mortality in the population of the United States (US) with hyperglycemia status. METHODS Data were collected from a total of 20,270 eligible individuals enrolled for analysis, spanning ten cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The subjects were categorized into three groups based on tertiles of NLR levels. The association of NLR with both all-cause and cardiovascular mortality was evaluated using Kaplan-Meier curves and Cox proportional hazards regression models. Restricted cubic splines were used to visualize the nonlinear relationship between NLR levels and all-cause and cardiovascular mortality in subjects with diabetes after accounting for all relevant factors. RESULTS Over a median follow-up period of 8.6 years, a total of 1909 subjects with diabetes died, with 671 deaths attributed to cardiovascular disease (CVD). And over a period of 8.46 years, 1974 subjects with prediabetes died, with 616 cases due to CVD. The multivariable-adjusted hazard ratios (HRs) comparing high to low tertile of NLR in diabetes subjects were found to be 1.37 (95% CI, 1.19-1.58) for all-cause mortality and 1.63 (95% CI, 1.29-2.05) for CVD mortality. And the correlation between high to low NLR tertile and heightened susceptibility to mortality from any cause (HR, 1.21; 95% CI, 1.03-1.43) and CVD mortality (HR, 1.49; 95% CI, 1.08-2.04) remained statistically significant (both p-values for trend < 0.05) in prediabetes subjects. The 10-year cumulative survival probability was determined to be 70.34%, 84.65% for all-cause events, and 86.21%, 94.54% for cardiovascular events in top NLR tertile of diabetes and prediabetes individuals, respectively. Furthermore, each incremental unit in the absolute value of NLR was associated with a 16%, 12% increase in all-cause mortality and a 25%, 24% increase in cardiovascular mortality among diabetes and prediabetes individuals, respectively. CONCLUSIONS The findings of this prospective cohort study conducted in the US indicate a positive association of elevated NLR levels with heightened risks of overall and cardiovascular mortality among adults with diabetes and prediabetes. However, potential confounding factors for NLR and the challenge of monitoring NLR's fluctuations over time should be further focused.
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Affiliation(s)
- Guangshu Chen
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, Guangdong, China
| | - Li Che
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Meizheng Lai
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, Guangdong, China
| | - Ting Wei
- Department of Hematology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, China
| | - Chuping Chen
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, Guangdong, China
| | - Ping Zhu
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, Guangdong, China.
| | - Jianmin Ran
- Department of Endocrinology and Metabolism, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, 510220, Guangdong, China.
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Scutca AC, Jugănaru I, Nicoară DM, Brad GF, Bugi MA, Asproniu R, Cristun LI, Mărginean O. Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus. J Clin Med 2024; 13:2582. [PMID: 38731111 PMCID: PMC11084164 DOI: 10.3390/jcm13092582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: Although most cases of new-onset type 1 diabetes mellitus (T1DM) are managed without serious events, life-threatening complications do arise in a subset of patients. Our objective was to assess the correlation between elevated SIRI values and adverse events related to the onset of T1DM. (2) Methods: This retrospective study, spanning ten years, included 187 patients with new-onset T1DM divided into three groups based on SIRI tertiles. The primary outcome was the occurrence of acute complications during hospital admission, while the secondary outcome was prolonged Intensive Care Unit (ICU) admission. (3) Results: Patients with high SIRI values were more likely to experience higher disease activity, leading to longer ICU admission times and more frequent complications. Multivariate logistic regression analysis revealed that the SIRI was independently associated with acute complications (p = 0.003) and prolonged ICU length of stay (p = 0.003). Furthermore, receiver operating characteristic analysis demonstrated the SIRI's superior predictive accuracy compared to venous pH (AUC = 0.837 and AUC = 0.811, respectively) and to the individual component cell lineages of the SIRI. (4) Conclusions: These findings emphasize the potential utility of the SIRI as a prognostic marker in identifying patients at increased risk during T1DM hospital admissions.
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Affiliation(s)
- Alexandra-Cristina Scutca
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Iulius Jugănaru
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Research Center for Disturbances of Growth and Development in Children BELIVE, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Delia-Maria Nicoară
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
| | - Giorgiana-Flavia Brad
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Meda-Ada Bugi
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Raluca Asproniu
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
| | - Lucian-Ioan Cristun
- Ph.D. School Department, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (D.-M.N.); (G.-F.B.); (R.A.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania;
- Research Center for Disturbances of Growth and Development in Children BELIVE, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
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Li J, Wang X, Jia W, Wang K, Wang W, Diao W, Ou F, Ma J, Yang Y. Association of the systemic immuno-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with diabetic microvascular complications. Front Endocrinol (Lausanne) 2024; 15:1367376. [PMID: 38660516 PMCID: PMC11039910 DOI: 10.3389/fendo.2024.1367376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Background The systemic immuno-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are widely used and have been shown to be predictive indicators of various diseases. Diabetic nephropathy (DN), retinopathy (DR), and peripheral neuropathy (DPN) are the most prominent and common microvascular complications, which have seriously negative impacts on patients, families, and society. Exploring the associations with these three indicators and diabetic microvascular complications are the main purpose. Methods There were 1058 individuals with type 2 diabetes mellitus (T2DM) in this retrospective cross-sectional study. SII, NLR, and PLR were calculated. The diseases were diagnosed by endocrinologists. Logistic regression and subgroup analysis were applied to evaluate the association between SII, NLP, and PLR and diabetic microvascular complications. Results SII, NLR, and PLR were significantly associated with the risk of DN [odds ratios (ORs): 1.52, 1.71, and 1.60, respectively] and DR [ORs: 1.57, 1.79, and 1.55, respectively] by multivariate logistic regression. When NLR ≥2.66, the OR was significantly higher for the risk of DPN (OR: 1.985, 95% confidence interval: 1.29-3.05). Subgroup analysis showed no significant positive associations across different demographics and comorbidities, including sex, age, hypertension, HbA1c (glycated hemoglobin), and dyslipidemia. Conclusion This study found a positive relationship between NLR and DN, DR, and DPN. In contrast, SII and PLR were found to be only associated with DN and DR. Therefore, for the diagnosis of diabetic microvascular complications, SII, NLR and PLR are highly valuable.
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Affiliation(s)
- Jiahang Li
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Xueying Wang
- Department of Traditional Chinese Medicine, The First Affiliated Hospital-of Air Force Medical University, Xi’an, China
| | - Wenjing Jia
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
- Department of Pharmacy, The Hospital of Traditional Chinese Medicine in Changwu Country, Changwu, China
| | - Kai Wang
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
- Department of Pharmacy, Sanya Rehabilitation and Recuperation Center, Joint Logistics Support Force, People's Liberation Army, Sanya, China
| | - Wenju Wang
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Weibo Diao
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Feiya Ou
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Jing Ma
- Department of Traditional Chinese Medicine, The First Affiliated Hospital-of Air Force Medical University, Xi’an, China
| | - Yan Yang
- Department of Pharmacy, The Second Affiliated Hospital of Air Force Medical University, Xi’an, China
- Department of Traditional Chinese Medicine, The First Affiliated Hospital-of Air Force Medical University, Xi’an, China
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9
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Kaczmarek K, Małkiewicz B, Gurwin A, Krawczyk WM, Skonieczna-Żydecka K, Lemiński A. Prognostic Value of Postneoadjuvant Chemotherapy Neutrophil-to-Lymphocyte Ratio in Patients undergoing Radical Cystectomy. J Clin Med 2024; 13:1953. [PMID: 38610718 PMCID: PMC11012838 DOI: 10.3390/jcm13071953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Neutrophil-to-lymphocyte ratio (NLR), a widely assessed biomarker in most common diseases, is typically evaluated before treatment initiation. However, data on NLR in the post-treatment setting is limited. Therefore, we assessed the NLR calculated after neoadjuvant chemotherapy (NAC) initiation in patients with bladder cancer (BC). We hypothesised that changes in blood cells after NAC could be a marker of tumour response and long-term survival. Materials and Methods: Our study included 214 patients who underwent NAC followed by radical cystectomy (RC) in two urological departments, wherein post-NAC NLR was used to categorize patients into the low (NLR ≤ 1.75) and high (NLR > 1.75) groups. Results: Logistic regression analysis indicated that a post-NAC NLR ≥ 1.75 is a good biomarker for pathologic response (odds ratio (OR), 0.045; p <0.001), emphasizing its ability to predict patient survival. The HRs for overall survival and cancer-specific survival were 2.387 (p = 0.048) and 2.342 (p < 0.001), respectively. Conclusions: We believe that post-NAC NLR can be used for patient stratification after NAC. Consequently, the post-NAC NLR may serve as a guide for the decision-making process regarding RC versus bladder-preserving strategies.
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Affiliation(s)
- Krystian Kaczmarek
- Department of General and Oncological Urology, Independent Provincial Public Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
| | - Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (B.M.)
| | - Adam Gurwin
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland; (B.M.)
| | - Wiktor Mateusz Krawczyk
- Department of Urology and Urological Oncology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Karolina Skonieczna-Żydecka
- Department of Biochemical Sciences, Pomeranian Medical University, Władysława Broniewskiego 24, 71-460 Szczecin, Poland;
| | - Artur Lemiński
- Department of General and Oncological Urology, Independent Provincial Public Integrated Hospital, Arkońska 4, 71-455 Szczecin, Poland
- Department of Biochemical Sciences, Pomeranian Medical University, Władysława Broniewskiego 24, 71-460 Szczecin, Poland;
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10
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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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11
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Gan W, Chen J, Zhu F, Fang X, Zeng X, Xiao W, Chen W. Prognostic value of neutrophil-to-lymphocyte ratio on proteinuria remission in patients with idiopathic membranous nephropathy. Int Urol Nephrol 2024; 56:1185-1193. [PMID: 37733125 DOI: 10.1007/s11255-023-03803-x] [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: 04/08/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND As a novel marker of inflammation, the neutrophil-to-lymphocyte ratio (NLR) has been studied in various diseases. However, NLR in idiopathic membranous nephropathy (IMN) has been rarely studied. We sought to assess the role of NLR in predicting proteinuria remission in IMN. METHODS This retrospective study involved 561 patients with IMN from January 2018 to December 2022 in Department of Nephrology of Wuhan Central Hospital. All baseline data were collected before the immunosuppressive regiment was administered. The Cox proportional hazards model and Kaplan-Meier curve were applied to assess the prognostic value of NLR for proteinuria remission. RESULTS The area under the receiver operating characteristic curve revealed that the optimal cut-off NLR value for predicting proteinuria non-remission was 2.63, with a sensitivity and specificity of 58.2% and 72.7%, respectively. Kaplan-Meier curves showed a lower rate of proteinuria remission in patients with high NLR compared with low NLR (Log-rank = 5.04, p = 0.025). Multivariate Cox regression analysis showed that high NLR was an independent risk factor for proteinuria non-remission after adjustment (HR = 1.579, 95% CI 1.052-2.683, p = 0.023). Subgroup analysis indicated that high NLR was a risk factor for proteinuria non-remission especially in IMN patients with 24 h proteinuria ≥ 1 g (HR = 1.818, 95% CI 1.031-2.573, p = 0.012) and chronic kidney disease (CKD) stage 3-4 (HR = 1.935, 95% CI 1.084-2.495, p = 0.015). CONCLUSION The current study shows that NLR is an independent risk factor for proteinuria non-remission in IMN. More attention should be paid to IMN patients with high NLR, especially for those patients with 24 h proteinuria ≥ 1 g and CKD stage 3-4.
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Affiliation(s)
- Wenyuan Gan
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Jian Chen
- Information Center, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Fan Zhu
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Xun Fang
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Xingruo Zeng
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Wei Xiao
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
| | - Wenli Chen
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
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12
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Jin S, Yin JB, Li W, Zang LL. Effect of neutrophil to lymphocyte ratio on prognosis of elderly patients with severe sepsis combined with diabetes mellitus. BMC Geriatr 2024; 24:211. [PMID: 38424501 PMCID: PMC10905898 DOI: 10.1186/s12877-024-04757-0] [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: 09/11/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) in the short-term prognosis of elderly patients with severe sepsis combined with diabetes mellitus (DM). METHODS The clinical data of 162 elderly patients with severe sepsis combined with DM from January 2018 to December 2022 were retrospectively collected. These patients were divided into a survival group (n = 104) and a death group (n = 58) according to 90-day prognosis. The number of neutrophils, lymphocytes, and NLR were compared. The optimal cut-off value for NLR to predict 90-day prognosis in elderly patients with severe sepsis combined with DM was determined using Receiver Operator Characteristic (ROC) curves, and the patients were divided into high and low NLR groups depending on the optimal cut-off value. The Kaplan-Meier method was used to plot the survival curves of the high and low NLR groups. Risk factors for the 90-day death in elderly patients with severe sepsis combined with DM were analyzed by a multivariate cox regression model. RESULTS There were no significant differences in gender, age, history of hypertension and hyperlipidemia, intensive care unit (ICU) stay, duration of mechanical ventilation, and oxygenation index between the survival group and death group (p > 0.05). However, acute physiological and chronic health evaluation II (APACHE II) scores, and sepsis-related organ failure assessment (SOFA) scores were significantly lower in the survival group compared with the death group (p < 0.05). In the survival group, neutrophils counts and NLR were much lower than those in the death group, while lymphocytes counts were much higher (p < 0.05). ROC curves showed that the optimal cut-off value for NLR to predict 90-day mortality in elderly patients with severe sepsis combined with DM was 3.482. Patients were divided into high NLR and low NLR groups based on whether NLR was ≥ 3.482. In terms of the log-rank test results, patients in the low NLR group had a significantly higher 90-day survival rate than those in the high NLR group (Logrank χ2 = 8.635, p = 0.003). The multivariate cox regression model showed that the length of ICU stay longer than 15 days and NLR ≥ 3.482 were independent risk factors for 90-day prognosis in elderly patients with severe sepsis combined with DM. CONCLUSION NLR ≥ 3.482 can be used to predict whether poor prognosis occurs in the short term after illness in elderly patients with severe sepsis combined with DM, and has good assessment value.
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Affiliation(s)
- Shan Jin
- Department of Neurology, Shandong Province 960th Hospital of the People's Liberation Army, 250031, Jinan, Shandong, China.
| | - Jun-Bin Yin
- Department of Neurology, Shandong Province 960th Hospital of the People's Liberation Army, 250031, Jinan, Shandong, China
| | - Wei Li
- Department of Neurology, Shandong Province 960th Hospital of the People's Liberation Army, 250031, Jinan, Shandong, China
| | - Li-Li Zang
- Department of Neurology, Shandong Province 960th Hospital of the People's Liberation Army, 250031, Jinan, Shandong, China
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13
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Fang Y, Wang B, Pang B, Zhou Z, Xing Y, Pang P, Zheng D, Zhang G, Yang B. Exploring the relations of NLR, hsCRP and MCP-1 with type 2 diabetic kidney disease: a cross-sectional study. Sci Rep 2024; 14:3211. [PMID: 38332001 PMCID: PMC10853504 DOI: 10.1038/s41598-024-53567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/02/2024] [Indexed: 02/10/2024] Open
Abstract
Type 2 diabetic kidney disease (T2DKD) is a common microvascular complication of type 2 diabetes mellitus (T2DM), and its incidence is significantly increasing. Microinflammation plays an important role in the development of T2DKD. Based on this, this study investigated the value of inflammatory markers including neutrophil-lymphocyte ratio (NLR), high-sensitivity C-reactive protein (hs-CRP), monocyte chemoattractant protein-1 (MCP-1) in the prediction of T2DKD. This was a cross-sectional survey study. A total of 90 patients with T2DM, who were hospitalized in the nephrology and endocrinology departments of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from June 2021 to January 2022, were included and divided into three groups (A1, A2, A3) according to the urinary albumin-to-creatinine ratio (UACR). Observe and compare the basic information, clinical and laboratory data, and the inflammatory markers NLR, hs-CRP, MCP-1. Results revealed that high levels of NLR (OR = 6.562, 95% CI 2.060-20.902, P = 0.001) and MCP-1 (OR = 1.060, 95% CI 1.026-1.095, P < 0.001) were risk factors in the development of T2DKD. Receiver operating characteristic curve analysis showed that the area under curve of NLR and MCP-1 in diagnosing T2DKD were 0.760 (95% CI 0.6577-0.863, P < 0.001) and 0.862 (95% CI 0.7787-0.937, P < 0.001). Therefore, the inflammatory markers NLR and MCP-1 are risk factors affecting the development of T2DKD, which of clinical value may be used as novel markers of T2DKD.
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Affiliation(s)
- Yaxuan Fang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Liqizhuang Street, Xiqing District, Tianjin, 300380, China
- Department of Nephrology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Bin Wang
- Department of Endocrinology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Endocrinology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Bo Pang
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zijun Zhou
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Liqizhuang Street, Xiqing District, Tianjin, 300380, China
- Department of Nephrology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yunze Xing
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Liqizhuang Street, Xiqing District, Tianjin, 300380, China
- Department of Nephrology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Pai Pang
- Department of Endocrinology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Endocrinology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Dingyuan Zheng
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Liqizhuang Street, Xiqing District, Tianjin, 300380, China
- Department of Nephrology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Gang Zhang
- The Community Health Service Center of Hangzhou Road Street in Tianjin Binhai New Area, Tianjin, China
| | - Bo Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Liqizhuang Street, Xiqing District, Tianjin, 300380, China.
- Department of Nephrology, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
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14
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Li X, Wang L, Liu M, Zhou H, Xu H. Association between neutrophil-to-lymphocyte ratio and diabetic kidney disease in type 2 diabetes mellitus patients: a cross-sectional study. Front Endocrinol (Lausanne) 2024; 14:1285509. [PMID: 38239986 PMCID: PMC10795842 DOI: 10.3389/fendo.2023.1285509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
Aims This investigation examined the possibility of a relationship between neutrophil-to-lymphocyte ratio (NLR) and diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients. Methods Adults with T2DM who were included in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2020 were the subjects of the current cross-sectional investigation. Low estimated glomerular filtration rate (eGFR) (< 60 mL/min/1.73 m2) or albuminuria (urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g) in T2DM patients were the diagnostic criteria for DKD. Weighted multivariable logistic regression models and generalized additive models were used to investigate the independent relationships between NLR levels with DKD, albuminuria, and low-eGFR. Additionally, we examined the relationships between DKD, albuminuria, and low-eGFR with other inflammatory markers, such as the aggregate index of systemic inflammation (AISI), systemic immune-inflammation index (SII), system inflammation response index (SIRI), and platelet-to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR). Their diagnostic capabilities were evaluated and contrasted using receiver operating characteristic (ROC) curves. Results 44.65% of the 7,153 participants who were recruited for this study were males. DKD, albuminuria, and low-eGFR were prevalent in 31.76%, 23.08%, and 14.55% of cases, respectively. Positive correlations were seen between the NLR with the prevalences of DKD, albuminuria, and low-eGFR. Subgroup analysis and interaction tests revealed that the associations of NLR with DKD, albuminuria, and low-eGFR were not significantly different across populations. In addition, MLR, SII and SIRI showed positive associations with the prevalence of DKD. ROC analysis discovered that when compared to other inflammatory markers (MLR, PLR, SII, SIRI, and AISI), NLR may demonstrate more discriminatory power and accuracy in assessing the risk of DKD, albuminuria, and low-eGFR. Conclusion Compared to other inflammatory markers (MLR, PLR, SII, SIRI, and AISI), NLR may serve as the more effective potential inflammatory marker for identifying the risk of DKD, albuminuria, and low-eGFR in US T2DM patients. T2DM patients with elevated levels of NLR, MLR, SII, and SIRI should be closely monitored for their potential risk to renal function.
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Affiliation(s)
- Xiaowan Li
- Department of Critical Care Medicine, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Lanyu Wang
- Department of Urology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Min Liu
- Department of Critical Care Medicine, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Hongyi Zhou
- Department of Urology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Hongyang Xu
- Department of Critical Care Medicine, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
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15
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Li D, Gu H, Chen L, Wu R, Jiang Y, Huang X, Zhao D, Liu F. Neutrophil-to-lymphocyte ratio as a predictor of poor outcomes of Mycoplasma pneumoniae pneumonia. Front Immunol 2023; 14:1302702. [PMID: 38169689 PMCID: PMC10758472 DOI: 10.3389/fimmu.2023.1302702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Mycoplasma pneumoniae pneumonia (MPP) may lead to various significant outcomes, such as necrotizing pneumonia(NP) and refractory MPP (RMPP). We investigated the potential of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with MPP. Methods and materials This was a prospective study of patients with MPP who were admitted to our hospital from 2019 to 2021. Demographic and clinical data were collected from patient records and associated with the development of NP and RMPP and other outcome measures. Results Of the 1,401 patients with MPP included in the study, 30 (2.1%) developed NP. The NLR was an independent predictor of NP (odds ratio 1.153, 95% confidence interval 1.022-1.300, P=0.021). The probability of NP was greater in patients with a high NLR (≥1.9) than in those with a low NLR (<1.9) (P<0.001). The NLR was also an independent predictor of RMPP (odds ratio 1.246, 95% confidence interval 1.102-1.408, P<0.005). Patients with a high NLR were more likely to develop NP and RMPP and require intensive care, and had longer total fever duration, longer hospital stays, and higher hospitalization expenses than those with a low NLR (all P<0.005). Discussion The NLR can serve as a predictor of poor prognosis in patients with MPP. It can predict the occurrence of NP, RMPP, and other poor outcomes. The use of this indicator would allow the simple and rapid prediction of prognosis in the early stages of MPP, enabling the implementation of appropriate treatment strategies.
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Affiliation(s)
- Dan Li
- Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haiyan Gu
- Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Chen
- Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ruxi Wu
- Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yazhou Jiang
- Department of Pediatrics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, Jiangsu, China
| | - Xia Huang
- Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Feng Liu
- Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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16
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Chen C, Chen Y, Gao Q, Wei Q. Association of systemic immune inflammatory index with all-cause and cause-specific mortality among individuals with type 2 diabetes. BMC Cardiovasc Disord 2023; 23:596. [PMID: 38057733 PMCID: PMC10702126 DOI: 10.1186/s12872-023-03638-5] [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: 08/18/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The evidence regarding the association between the systemic immune inflammatory index (SII) and mortality among individuals with diabetes is limited. This study aims to evaluate the associations between SII and all-cause and cause-specific mortality among individuals with diabetes. METHODS The study included 8,668 participants with diabetes from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 with follow-up until 31 December 2019. The calculation of SII in this study was performed using the following formula: the neutrophil-to-lymphocyte ratio multiplied by the platelet count (10^9 cells/µL). RESULTS The study documented 2,463 deaths over 68,542 person-years, including 853 deaths from CVD and 424 from cancer. An increase in SII was significantly associated with higher all-cause and CVD mortality risk after multivariate adjustment. For each standard deviation increment in natural log transformed SII (lnSII), all-cause mortality increased by 17%, and CVD mortality increased by 34% (both P < 0.001). Additionally, the association between SII and all-cause mortality was U-shaped, with the inflection point at 6.02. The association between SII and CVD mortality was non-linear and J-shaped, where the risk increased significantly when lnSII exceeded 6.22. Furthermore, the association between SII and CVD mortality was attenuated in female and hyperlipidemia patients. CONCLUSION In this study, we observed a significant positive association between the SII and both all-cause and CVD mortality in patients with diabetes. Additionally, it was discovered that this association exhibited a non-linear pattern. These findings suggest that maintaining SII within an optimal range may play a critical role in mitigating the risk of mortality.
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Affiliation(s)
- Chaoyang Chen
- Department of Cardiology, Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Yuwen Chen
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiyue Gao
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qucheng Wei
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Chen Y, Guan M, Wang R, Wang X. Relationship between advanced lung cancer inflammation index and long-term all-cause, cardiovascular, and cancer mortality among type 2 diabetes mellitus patients: NHANES, 1999-2018. Front Endocrinol (Lausanne) 2023; 14:1298345. [PMID: 38111710 PMCID: PMC10726345 DOI: 10.3389/fendo.2023.1298345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) was a major global health threat. As a chronic low-grade inflammatory disease, the prognosis of diabetes was associated with inflammation. The advanced lung cancer inflammation index (ALI) served as a comprehensive index to assess inflammation. This study aimed to estimate the association between ALI and all-cause, cardiovascular disease (CVD), and cancer mortality in T2DM patients. Methods We extracted cohort data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2018 for analysis. The weighted Kaplan-Meier analysis and multivariate-adjusted Cox analysis were utilized to evaluate the relationship between ALI and all-cause, CVD, and cancer mortality in T2DM patients. Restricted cubic spline (RCS) analysis was employed to assess their non-linear relationship. Stratified analysis and interaction analysis were conducted to enhance the robustness of the results. Results The study incorporated a total of 3,888 patients. An increase in ALI was associated with a reduced risk of all-cause and CVD mortality in T2DM patients, but not related to cancer mortality. There were J-shaped and L-shaped non-linear relationships between ALI and all-cause, CVD mortality in T2DM patients, respectively. The inflection points were 90.20 and 93.06, respectively. For values below the inflection point, every 10U increase in ALI, both all-cause and CVD mortality risk decreased by 9%. Beyond the inflection point, all-cause mortality rose by 3%, while CVD mortality remained unaffected. Gender-stratified RCS analysis indicated a linear negative relationship between CVD mortality and ALI in female T2DM patients, whereas the trend in males aligned with the overall population. Conclusion Our research initially identified a significant correlation between increased ALI levels with decreased all-cause and CVD mortality in T2DM patients. There were J-shaped and L-shaped non-linear relationships between ALI and all-cause, CVD mortality in T2DM patients, respectively. For female patients, there was a linear negative relation between CVD mortality and ALI, whereas the trend in males aligned with the overall population. These findings suggested that maintaining ALI (for example, control body weight and keep albumin in the normal range) within a certain range in the clinical settings was crucial for improving all-cause and CVD mortality in T2DM patients.
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Affiliation(s)
- Yaying Chen
- Department of Physical Examination Center, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, Fujian, China
| | - Mengqian Guan
- Fuzhou International Travel Health Care Center, Fuzhou, China
| | - Ruiqi Wang
- Department of Gastroenterology, Xiamen Humanity Hospital of Fujian Medical University, Xiamen, Fujian, China
| | - Xuewen Wang
- Department of Histology and Embryology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
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Guo C, Lin Y, Wu S, Li H, Wu M, Wang F. Association of the dietary inflammation index (DII) with the prevalence of chronic kidney disease in patients with type-2 diabetes mellitus. Ren Fail 2023; 45:2277828. [PMID: 37994461 PMCID: PMC11011236 DOI: 10.1080/0886022x.2023.2277828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023] Open
Abstract
Chronic kidney disease (CKD) is a major complication of diabetes mellitus (DM). Inflammation is an essential component in the process of CKD progression in patients with DM. Diet is a significant determinant of systemic inflammation levels. However, the association between the dietary inflammatory index (DII) and CKD in individuals with DM remains largely unknown; therefore, the aim of this study was to explore whether the DII is linked to the prevalence of CKD in patients with DM. The research method was as follows: first, data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were obtained. There were 7,974 participants in our study. These individuals were then classified into three groups according to DII tertiles (T1-T3), with each group consisting of 2,658 participants. Logistic regression analysis was employed to examine whether there was a connection between the DII and CKD. We observed a significant association between the DII and the prevalence of CKD in individuals with DM. After full adjustment for age, sex, ethnicity, smoking, drinking, body mass index (BMI), triglyceride (TG), total cholesterol (TC), metabolic equivalents (METs), energy intake, hypoglycemic medications, hypertension, and cardiovascular disease (CVD), the group with a higher DII had a greater frequency of CKD (T2 group: OR: 1.40; 95% CI: 1.10-1.76; p = 0.006; T3 group: OR: 1.67; 95% CI: 1.29-2.17; p < 0.001). The implementation of an anti-inflammatory diet could serve as an intervention strategy for patients with DM to prevent the onset of CKD.
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Affiliation(s)
- Chunhua Guo
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Yong Lin
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Senchao Wu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Huaqing Li
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Meng Wu
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Fuzhen Wang
- Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
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Scutca AC, Nicoară DM, Mang N, Jugănaru I, Brad GF, Mărginean O. Correlation between Neutrophil-to-Lymphocyte Ratio and Cerebral Edema in Children with Severe Diabetic Ketoacidosis. Biomedicines 2023; 11:2976. [PMID: 38001976 PMCID: PMC10669654 DOI: 10.3390/biomedicines11112976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Diabetic ketoacidosis (DKA), a common onset modality of type 1 diabetes mellitus (T1DM), can lead, in rare instances, to the development of cerebral edema, which is the leading cause of mortality in T1DM. Aside from the identification of several demographic and clinical risk factors for cerebral edema, attention has also been drawn to the possible link between systemic inflammation and neuroinflammation. This single-center retrospective study of 98 children with severe DKA aimed to investigate the possible relationship between neutrophil-to-lymphocyte ratio NLR) levels and the presence of cerebral edema. Patients were classified into three groups: alert (n = 28), subclinical cerebral edema (n = 59), and overt cerebral edema (n = 11). Lower blood pH and elevated NLR and blood urea were correlated with the presence of cerebral edema (p < 0.001). After a multivariable risk adjustment for possible confounding factors, such as age, pH, corrected sodium, and BUN, the NLR remained positively associated with cerebral edema (p = 0.045). As such, NLR may be an additional instrument to help practitioners target patients with a higher risk of severe cerebral edema. These patients would benefit from more rigorous neurologic surveillance, enabling the prompt identification of early signs of cerebral edema.
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Affiliation(s)
- Alexandra-Cristina Scutca
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (N.M.); (I.J.); (G.-F.B.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Delia-Maria Nicoară
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (N.M.); (I.J.); (G.-F.B.); (O.M.)
| | - Niculina Mang
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (N.M.); (I.J.); (G.-F.B.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Iulius Jugănaru
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (N.M.); (I.J.); (G.-F.B.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
- Research Center for Disturbances of Growth and Development in Children BELIVE, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Giorgiana-Flavia Brad
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (N.M.); (I.J.); (G.-F.B.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania; (A.-C.S.); (N.M.); (I.J.); (G.-F.B.); (O.M.)
- Department of Pediatrics I, Children’s Emergency Hospital “Louis Turcanu”, 300011 Timisoara, Romania
- Research Center for Disturbances of Growth and Development in Children BELIVE, ‘Victor Babeş’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
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20
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Essawi K, Dobie G, Shaabi MF, Hakami W, Saboor M, Madkhali AM, Hamami AAH, Allallah WH, Akhter MS, Mobarki AA, Hamali HA. Comparative Analysis of Red Blood Cells, White Blood Cells, Platelet Count, and Indices in Type 2 Diabetes Mellitus Patients and Normal Controls: Association and Clinical Implications. Diabetes Metab Syndr Obes 2023; 16:3123-3132. [PMID: 37822802 PMCID: PMC10563775 DOI: 10.2147/dmso.s422373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
Background Diabetes mellitus (DM) is a major health burden affecting 537 million adults worldwide, characterized by chronic metabolic disorder and various complications. This case control study aimed to assess the impact of type 2 diabetes mellitus (T2DM), including hyperglycemia levels, on hematological parameters and complete blood count (CBC) derived parameters. Methods A total of 250 known diabetic patients from the Jazan Diabetic Center, Saudi Arabia, between January 2021 and December 2022, along with 175 healthy adult controls were recruited from Jazan Hospital's blood donation center. Demographic characteristics, medical histories, and relevant factors such as gender, age, BMI, treatment, disease duration, and comorbidities were collected with informed consent. Results The results of the red blood cell (RBC) count, RBC indices, and mean platelet volume showed significant differences between patients and controls, while the white cell (WBC) and platelet count were comparable between the two groups. CBC-derived parameters, especially neutrophil/lymphocyte ratio (NLR), and platelet/neutrophil ratio (PNR) exhibited significant differences. Conclusion CBC and derived parameters serve as inexpensive tools for T2DM patients monitoring, indicating early blood cell alterations and potential development of anemia. Further studies are needed to explore their role in predicting T2DM pathogenesis and progression, aiming to reduce severe complications, mortality and morbidity.
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Affiliation(s)
- Khaled Essawi
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Gasim Dobie
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Misk F Shaabi
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Waleed Hakami
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Muhammad Saboor
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Aymen M Madkhali
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah A H Hamami
- Department of Laboratory & Blood Bank, Prince Mohammed bin Nasser Hospital, Ministry of Health, Jazan, Saudi Arabia
| | - Wael H Allallah
- Department of Laboratory & Blood Bank, Prince Mohammed bin Nasser Hospital, Ministry of Health, Jazan, Saudi Arabia
| | - Mohammad S Akhter
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Abdullah A Mobarki
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Hassan A Hamali
- Department of Medical Laboratory Technology, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
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21
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Andrés-Blasco I, Gallego-Martínez A, Machado X, Cruz-Espinosa J, Di Lauro S, Casaroli-Marano R, Alegre-Ituarte V, Arévalo JF, Pinazo-Durán MD. Oxidative Stress, Inflammatory, Angiogenic, and Apoptotic molecules in Proliferative Diabetic Retinopathy and Diabetic Macular Edema Patients. Int J Mol Sci 2023; 24:ijms24098227. [PMID: 37175931 PMCID: PMC10179600 DOI: 10.3390/ijms24098227] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/30/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The aim of this study is to evaluate molecules involved in oxidative stress (OS), inflammation, angiogenesis, and apoptosis, and discern which of these are more likely to be implicated in proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) by investigating the correlation between them in the plasma (PLS) and vitreous body (VIT), as well as examining data obtained from ophthalmological examinations. Type 2 diabetic (T2DM) patients with PDR/DME (PDRG/DMEG; n = 112) and non-DM subjects as the surrogate controls (SCG n = 48) were selected according to the inclusion/exclusion criteria and programming for vitrectomy, either due to having PDR/DME or macular hole (MH)/epiretinal membrane (ERM)/rhegmatogenous retinal detachment. Blood samples were collected and processed to determine the glycemic profile, total cholesterol, and C reactive protein, as well as the malondialdehyde (MDA), 4-hydroxynonenal (4HNE), superoxide dismutase (SOD), and catalase (CAT) levels and total antioxidant capacity (TAC). In addition, interleukin 6 (IL6), vascular endothelial growth factor (VEGF), and caspase 3 (CAS3) were assayed. The VITs were collected and processed to measure the expression levels of all the abovementioned molecules. Statistical analyses were conducted using the R Core Team (2022) program, including group comparisons and correlation analyses. Compared with the SCG, our findings support the presence of molecules involved in OS, inflammation, angiogenesis, and apoptosis in the PLS and VIT samples from T2DM. In PLS from PDRG, there was a decrease in the antioxidant load (p < 0.001) and an increase in pro-angiogenic molecules (p < 0.001), but an increase in pro-oxidants (p < 0.001) and a decline in antioxidants (p < 0.001) intravitreally. In PLS from DMEG, pro-oxidants and pro-inflammatory molecules were augmented (p < 0.001) and the antioxidant capacity diminished (p < 0.001), but the pro-oxidants increased (p < 0.001) and antioxidants decreased (p < 0.001) intravitreally. Furthermore, we found a positive correlation between the PLS-CAT and the VIT-SOD levels (rho = 0.5; p < 0.01) in PDRG, and a negative correlation between the PSD-4HNE and the VIT-TAC levels (rho = 0.5; p < 0.01) in DMEG. Integrative data of retinal imaging variables showed a positive correlation between the central subfield foveal thickness (CSFT) and the VIT-SOD levels (rho = 0.5; p < 0.01), and a negative correlation between the CSFT and the VIT-4HNE levels (rho = 0.4; p < 0.01) in PDRG. In DMEG, the CSFT displayed a negative correlation with the VIT-CAT (rho = 0.5; p < 0.01). Exploring the relationship of the abovementioned potential biomarkers between PLS and VIT may help detecting early molecular changes in PDR/DME, which can be used to identify patients at high risk of progression, as well as to monitor therapeutic outcomes in the diabetic retina.
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Affiliation(s)
- Irene Andrés-Blasco
- Cellular and Molecular Ophthalmo-Biology Group, Department of Surgery, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO, 46017 Valencia, Spain
- Spanish Net of Inflammatory Diseases and Immunopathology of Organs and Systems (REI/RICORS), Institute of Health Carlos III, Ministry of Science and Innovation, 28029 Madrid, Spain
| | - Alex Gallego-Martínez
- Cellular and Molecular Ophthalmo-Biology Group, Department of Surgery, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO, 46017 Valencia, Spain
| | - Ximena Machado
- Cellular and Molecular Ophthalmo-Biology Group, Department of Surgery, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO, 46017 Valencia, Spain
| | | | - Salvatore Di Lauro
- Department of Ophthalmology, University Clinic Hospital, 47003 Valladolid, Spain
| | - Ricardo Casaroli-Marano
- Spanish Net of Inflammatory Diseases and Immunopathology of Organs and Systems (REI/RICORS), Institute of Health Carlos III, Ministry of Science and Innovation, 28029 Madrid, Spain
- Spanish Net of Ophthalmic Pathology Research OFTARED, Institute of Health Carlos III, Ministry of Science and Innovation, 28029 Madrid, Spain
- Department of Ophthalmology, Clinic Hospital, 08036 Barcelona, Spain
| | - Víctor Alegre-Ituarte
- Cellular and Molecular Ophthalmo-Biology Group, Department of Surgery, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO, 46017 Valencia, Spain
- Department of Ophthalmology, University Hospital Dr. Peset, 46017 Valencia, Spain
| | - José Fernando Arévalo
- Spanish Net of Inflammatory Diseases and Immunopathology of Organs and Systems (REI/RICORS), Institute of Health Carlos III, Ministry of Science and Innovation, 28029 Madrid, Spain
- Wilmer at Johns Hopkins Bayview Medical Center, Baltimore, MA 21224, USA
| | - María Dolores Pinazo-Durán
- Cellular and Molecular Ophthalmo-Biology Group, Department of Surgery, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO, 46017 Valencia, Spain
- Spanish Net of Inflammatory Diseases and Immunopathology of Organs and Systems (REI/RICORS), Institute of Health Carlos III, Ministry of Science and Innovation, 28029 Madrid, Spain
- Spanish Net of Ophthalmic Pathology Research OFTARED, Institute of Health Carlos III, Ministry of Science and Innovation, 28029 Madrid, Spain
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Subramani M, Anbarasan M, Shanmugam D, Muthumani LN, Vasudevan P. Role of neutrophil-lymphocyte ratio as a prognostic marker for type 2 diabetic nephropathy among Indians. Bioinformation 2023; 19:375-379. [PMID: 37822815 PMCID: PMC10563576 DOI: 10.6026/97320630019375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/30/2023] [Accepted: 04/30/2023] [Indexed: 10/13/2023] Open
Abstract
Diabetic nephropathy/diabetic kidney disease (DKD) is one of the leading causes of renal failure. Early identification of the development or progression of diabetic nephropathy using appropriate screening and diagnostic tools is very important in order to provide timely and proper management. Inflammation plays a crucial role in development and progression of diabetic nephropathy. The aim of this study was to evaluate the relationship of inflammatory markers (neutrophil-to-lymphocyte ratio-NLR) as an early indicator to prevent the progression of diabetic kidney disease. A total of 158 patients with type 2 diabetes mellitus were distributed into three groups according urinary albumin-to-creatinine ratio. Levels of inflammatory markers neutrophil-to-lymphocyte ratio was recorded and compared among the three groups. Significant differences were detected between the groups in terms of neutrophil-to-lymphocyte ratio (p = 0.000).Characteristic curve analysis of inflammatory markers and microalbuminuria prediction demonstrated an area under curve (AUC) of 0.869 for neutrophil-to-lymphocyte ratio (p = 0.000). A NLR cut-off point of 2.2 has 72.3 % sensitivity and 78.1 % specificity, which suggested sufficient accuracy. Increased neutrophil-to-lymphocyte ratio was significantly correlated with diabetic nephropathy progression and increased neutrophil-to-lymphocyte ratio can be considered as an early indicator and a prognostic risk marker of diabetic nephropathy.
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Affiliation(s)
- Murugan Subramani
- Department of General Medicine, K.A.P Viswanatham Govt Medical College, Trichy - 17
| | - Mudali Anbarasan
- Department of General Medicine, K.A.P Viswanatham Govt Medical College, Trichy - 17
| | | | | | - Pradeep Vasudevan
- Department of General Medicine, K.A.P Viswanatham Govt Medical College, Trichy - 17
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23
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Rafaqat S, Rafaqat S. Role of hematological parameters in pathogenesis of diabetes mellitus: A review of the literature. World J Hematol 2023; 10:25-41. [DOI: 10.5315/wjh.v10.i3.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/03/2023] [Accepted: 03/09/2023] [Indexed: 03/22/2023] Open
Abstract
Diabetes mellitus (DM) is characterized by hyperglycemia and abnormalities in insulin secretion and activity. There are numerous hematological parameters; however, this review article only focuses on red blood cells, hemoglobin, hematocrit, red blood cell indices, platelet count, white blood cells, lymphocytes, neutrophils, monocytes, eosinophils, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio, which play an essential role in the pathogenesis of DM. Also, this review article aims to report the relationship between these hematological parameters and the development of DM. In con-clusion, this article shows that increased levels of platelets, red blood cells, hematocrit, lymphocytes, eosinophils, neutrophils, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio and decreased levels of hemoglobin are involved in the pathogenesis of DM. However, the role of basophils in DM is unknown yet.
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Affiliation(s)
- Sana Rafaqat
- Department of Biotechnology, Lahore College for Women University, Lahore 5400, Pakistan
| | - Saira Rafaqat
- Department of Zoology, Lahore College for Women University, Lahore 5400, Pakistan
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24
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Moh MC, Low S, Shao YM, Subramaniam T, Sum CF, Lim SC. Association between neutrophil/lymphocyte ratio and kidney impairment in type 2 diabetes mellitus: A role of extracellular water/total body water ratio. Diabetes Res Clin Pract 2023; 199:110634. [PMID: 36948421 DOI: 10.1016/j.diabres.2023.110634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/26/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
AIMS We explored the predictive utility of baseline neutrophil/lymphocyte ratio (NLR), which reflects a systemic inflammatory tone, in kidney impairment in type 2 diabetes mellitus (T2DM); and investigated the effect of extracellular water/total body water (ECW/TBW) ratio on the relationship. METHODS This longitudinal study included 1,224 T2DM adults recruited from a single centre. Cox regression analyses examined the association between NLR and progressive kidney function decline or albuminuria progression. Improvements in risk discrimination were assessed using Harrell's concordance-statistics. The mediatory role of ECW/TBW ratio estimated by bioelectrical impedance was evaluated. RESULTS Higher baseline NLR levels were observed in cases with kidney function decline or albuminuria progression over a median 2-year follow-up. NLR independently predicted progressive kidney function decline (hazard ratio:1.39, 95% CI:1.21-1.60, P < 0.001) or albuminuria progression (hazard ratio:1.34, 95% CI:1.08-1.68, P = 0.009). Addition of NLR to a base model comprising demographics, T2DM duration, metabolic and renal parameters, and medications significantly improved the risk discrimination of kidney function decline (P = 0.022) but not albuminuria progression. ECW/TBW ratio accounted for 19.7% of the total effect between NLR and kidney function loss. CONCLUSIONS Increased NLR reflecting systemic inflammation is associated with progressive kidney function decline in T2DM, partially explained by dysregulated body fluid balance.
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Affiliation(s)
- Mei Chung Moh
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Serena Low
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore
| | - Yi-Ming Shao
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Tavintharan Subramaniam
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore
| | - Chee Fang Sum
- Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore
| | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore; Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore; Saw Swee Hock School of Public Health, National University Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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25
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Ren X, Kang N, Yu X, Li X, Tang Y, Wu J. Prevalence and association of diabetic nephropathy in newly diagnosed Chinese patients with diabetes in the Hebei province: A single-center case-control study. Medicine (Baltimore) 2023; 102:e32911. [PMID: 36930094 PMCID: PMC10019112 DOI: 10.1097/md.0000000000032911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/19/2023] [Indexed: 03/18/2023] Open
Abstract
Diabetes is a chronic disease and has huge pressure on patients and the medical system, especially for patients with diabetic complications, for example, diabetic nephropathy. Diabetic nephropathy is a diabetic complication associated with damage to the kidney. To improve the quality of life of patients with diabetes, it is necessary to understand the factors that are associated with diabetic nephropathy. The objective of the study was to find the prevalence of diabetic nephropathy in newly diagnosed patients with diabetes and to develop the association between clinicopathological parameters and diabetic nephropathy. In a case-control study, demographics, anthropometric, and clinicopathological parameters of a total of 305 newly diagnosed patients with diabetes (the fasting blood glucose ≥ 7.0 mM/L and/or glycosylated hemoglobin ≥ 6.5 mM/L) in Hebei province were included in the analysis. If the urine albumin to creatinine ratio was ≥ 30 (microalbuminuria) then patients were considered diabetic nephropathy. Among enrolled patients, 206 (68%) were males and 99 (32%) were females and they were 46 to 71 years old. Demographic variables and health-related behaviors were the same among patients with diabetes either with nephropathy (case group, n = 135) or patients without nephropathy (control group, n = 170, P > .05 for all). The prevalence of diabetic nephropathy was 44%. Female to male ratio was 1:1.7 in the case group. Patients with diabetic nephropathy had higher body weight (P < .0001), waist circumference (P = .0006), and body mass index (P = .0002) than those of patients without nephropathy. Abnormal urinary globulin (P = .041, odd ratio (OR): 1.1231) was associated with diabetic nephropathy. Aspartate transaminase (P = .0651, OR: 0.8541), alkaline phosphatase (P = .0661, OR: 0.8122), hypertension (P = .0821, OR: 0.8214), and blood urea nitrogen (P = .0842, OR: 0.9411) were not significantly associated with diabetic neuropathy. However, they are near the statistical cutoff value. The prevalence of diabetic nephropathy in newly diagnosed diabetic patients of Hebei province is higher than those of the other provinces. Urinary globulin excretion had a weak association with the presence of nephropathy defined by urinary albumin excretion in patients with diabetes. The presence of other diabetic complications is also an essential parameter for diabetic nephropathy. Males are more susceptible to diabetic nephropathy than females if diabetic (Evidence Level: V; Technical Efficacy: Stage 3).
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Affiliation(s)
- Xiaoya Ren
- Department of Endocrinology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Ninglin Kang
- Department of Endocrinology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Xianghui Yu
- Department of Endocrinology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Xiaolei Li
- Department of Endocrinology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Yange Tang
- Department of Endocrinology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Jie Wu
- Department of Endocrinology, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China
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Reppo I, Jakobson M, Volke V. Effects of Semaglutide and Empagliflozin on Inflammatory Markers in Patients with Type 2 Diabetes. Int J Mol Sci 2023; 24:ijms24065714. [PMID: 36982786 PMCID: PMC10054691 DOI: 10.3390/ijms24065714] [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: 12/21/2022] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
Low-grade inflammation is associated with complications of type 2 diabetes. Glucagon-like peptide-1 receptor agonists and sodium-glucose transporter-2 inhibitors have shown cardioprotective effects that are independent of their glucose-lowering effects. Cardio-protection could be mediated by the anti-inflammatory effects of these medications, but there is currently limited evidence to support this hypothesis. We conducted a prospective clinical study in patients with type 2 diabetes requiring treatment intensification. Ten patients were assigned to receive empagliflozin 10 mg and 10 patients to receive s/c semaglutide (titrated to 1 mg once a week) in a non-randomised manner. All parameters were measured at baseline and after 3 months. Fasting plasma glucose and glycated haemoglobin improved significantly in both treatment groups, with no between-group differences. Body weight and body mass index reduced significantly more in the semaglutide group, whereas waist circumference decreased only in the empagliflozin group. There was a trend for high-sensitivity CRP reduction in both treatment groups that did not reach statistical significance. Interleukin-6 and the neutrophil-to-lymphocyte ratio did not change in either group. Ferritin and uric acid decreased significantly only in the empagliflozin group, and ceruloplasmin decreased significantly only in the semaglutide group. Though there were clinically meaningful improvements in diabetes control in both treatment arms, we could detect only minor changes in some inflammatory markers.
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Affiliation(s)
- Ingrid Reppo
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia
- Endocrinology Unit, Tartu University Hospital, 50406 Tartu, Estonia
| | - Maili Jakobson
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia
| | - Vallo Volke
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia
- Endocrinology Unit, Tartu University Hospital, 50406 Tartu, Estonia
- Correspondence:
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Associations between Systemic Immune-Inflammation Index and Diabetes Mellitus Secondary to Pancreatic Ductal Adenocarcinoma. J Clin Med 2023; 12:jcm12030756. [PMID: 36769405 PMCID: PMC9917636 DOI: 10.3390/jcm12030756] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There is a high prevalence of diabetes mellitus (DM) in patients with pancreatic ductal adenocarcinoma (PDAC). An inflammatory response is considered as a potential mechanism involved in the process. The systemic immune-inflammation (SII) index is an integrated and novel inflammatory indicator developed in recent years. The purpose of this study was to determine the relationship between the SII and DM secondary to PDAC. METHOD Patients with a confirmed diagnosis of PDAC were analyzed in this cross-sectional study. Anthropometric measures, glucose-related data (including fasting glucose, 2 h OGTT, glycated hemoglobin, fasting insulin, and fasting c-peptide), tumor characteristics (tumor volumes, location and stages), and the periphery blood inflammatory index (white blood cell count, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and SII) were recorded. The inflammation index was analyzed for its association with glucose-related parameters. Multivariable logistic regression analysis was used to analyze the association between SII levels and DM secondary to PDAC. RESULTS Blood cell results showed that the white blood cell count, neutrophils, lymphocytes, monocytes, platelets, the neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were higher in patients with diabetes. It was worth noting that SII significantly increased in patients with diabetes secondary to PDAC (4.41 vs. 3.19, p < 0.0001). Multivariable logistic regression analysis showed that SII (OR: 2.024, 95%CI: 1.297, 3.157, p = 0.002) and age (OR: 1.043, 95%CI: 1.01, 1.077, p = 0.011) were the risk factors for DM secondary to PDAC after adjusting for covariates. According to Spearmen correlation analysis, SII was positively correlated with fasting glucose (r = 0.345, p < 0.0001), 2 h OGTT (r = 0.383, p < 0.0001), HbA1c (r = 0.211, p = 0.005), fasting insulin (r = 0.435, p < 0.0001), fasting C-peptide (r = 0.420, p < 0.0001), and HOMA2-IR (r = 0.491, p < 0.0001). CONCLUSIONS In conclusion, SII is significantly increased among patients with DM secondary to PDAC and is associated with the DM in patients with PDAC (OR: 2.382, 95% CI: 1.157, 4.903, p = 0.019). Additionally, SII is significantly correlated with insulin resistance. We are the first to investigate the relationship between SII and diabetes secondary to PDAC and further confirm the role of an inflammatory response in this process. More studies need to be designed to clarify how inflammatory responses participate.
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Omrani-Nava V, Moosazadeh M, Bahar A, Hedayatizadeh-Omran A, Ahmadi A, Alizadeh-Navaei R. Neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios, any association with metabolic syndrome? CASPIAN JOURNAL OF INTERNAL MEDICINE 2023; 14:567-571. [PMID: 37520875 PMCID: PMC10379793 DOI: 10.22088/cjim.14.3.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 08/01/2023]
Abstract
Background Metabolic syndrome is a critical health concern associated with an elevated risk of chronic health problems including cardiovascular disease and diabetes. There are shreds of evidence that novel inflammatory ratios including neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios serve as prognostic biomarkers for metabolic syndrome (MetS). This hypothesis was investigated in a cohort of the Iranian population. Methods selection of MetS + subjects was based on the National Cholesterol Education Program Adult Treatment Panel III criteria 3 (NCEP ATP 3). The control group consisted of participants negative for any of the five MetS criteria. Demographic and laboratory data were extracted from the Tabari cohort study. Results A total of 1930 subjects including 965 Mets positive and 965 MetS criteria negative participants were evaluated. Diabetes (84.8%), hypertension (48.9%), hypertriglyceridemia (81.7%), low HDL cholesterol (70.3%), and high waist circumference (78.9%) were observed in patients. There were no differences between NLR (1.66±0.71 vs. 1.69±0.72 P=0.42), LMR (11.23±3.13 vs. 11.30±11.99, P= 0.86) and PLR (113.85±68.67 vs 114.11±35.85, P=0.91) between case and control groups, respectively. Logistic regression analysis revealed no association between ratios and MetS risk even after adjusting for potential confounders including age, gender, living place, and BMI. Conclusion In a relatively large population from Northern Iran, no association was observed between CBC-derived inflammatory ratios and the presence of MetS.
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Affiliation(s)
- Versa Omrani-Nava
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Adeleh Bahar
- Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Hedayatizadeh-Omran
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdolrahim Ahmadi
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Li L, Shen Q, Rao S. Association of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Diabetic Kidney Disease in Chinese Patients with Type 2 Diabetes: A Cross-Sectional Study. Ther Clin Risk Manag 2022; 18:1157-1166. [PMID: 36597513 PMCID: PMC9805708 DOI: 10.2147/tcrm.s393135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been extensively studied in a variety of diseases. However, research on their relationship with diabetic kidney disease (DKD) is limited. The aim of our study was to investigate the association between these two indicators and renal function in Chinese patients with type 2 diabetes and assess whether they can serve as predictors of DKD. Methods This cross-sectional study enrolled 655 Chinese patients with type 2 diabetes. Subjects were divided into three groups according to the urinary albumin-to-creatinine ratio (UACR). The differences in the NLR and PLR among the groups and their correlation with renal function were analyzed. Logistic regression analysis was used to analyze independent risk factors for DKD, and receiver operating characteristic (ROC) curves were used to assess the predictive values of the NLR and PLR for the disease. Results The NLR and PLR were significantly different among the three groups, and they increased with increasing levels of albuminuria. Pearson's correlation analysis showed that the NLR and PLR were positively correlated with the UACR but negatively correlated with the estimated glomerular filtration rate (eGFR) (p<0.001). Logistic regression analysis showed that these two indicators were independent risk factors for DKD (p<0.001). The results of ROC curve analysis suggested that the NLR (AUC=0.794; 95% CI, 0.760-0.827; p<0.001) and PLR (AUC=0.665; 95% CI, 0.623-0.706, p<0.001) had important diagnostic value for DKD. Conclusion The NLR and PLR were closely associated with renal function among Chinese patients with type 2 diabetes, and high NLR and PLR values may serve as predictors of DKD.
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Affiliation(s)
- Lan Li
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Qing Shen
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China,Correspondence: Qing Shen, Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Chongqing, 400016, People’s Republic of China, Tel +86 13508304817, Fax +86 023 89012019, Email
| | - Sijie Rao
- Department of Nephrology, The Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, People’s Republic of China
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Assessment of C-Reactive Protein, Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients at Different Stages of Chronic Kidney Disease. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Abstract
Background: Low-grade chronic inflammation is an important feature of chronic kidney disease (CKD).
Aim: To determine the values of C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with different stages of CKD and to examine how they change depending on the progression of renal damage.
Materials and methods: A cross-sectional descriptive comparative study included 157 subjects at different stages of CKD which was assessed based on glomerular filtration rate (GFR) calculated according to the MDRD equation. CRP was analyzed by an immunoturbidimetric method. NLR and PLR were calculated by a mathematical calculation after a blood count was performed.
Results: The present study showed an increase in serum creatinine, CRP, and NLR values with progression of renal failure. There was a statistically significant difference in the creatinine and CRP concentrations between groups with different stages of CKD (p <0.001 for all comparisons). A significant positive correlation was found between NLR and CRP, while negative, significant correlations were observed between NLR and eGFR as well as between PLR and eGFR. There was a slight increase in PLR value with the progression of renal impairment, but the correlation between PLR and CRP was not significant.
Conclusion: These results suggest that NLR, together with CRP, may serve as an indicator of systemic low-grade inflammation progression in patients with CKD. Larger prospective studies are required to observe the possibility of using NLR as a surrogate marker for CRP in patients with CKD.
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Zhong Z, Zhang H, Xu T, Hao J, Chen X, Sun S, Yang J, Sun J, Lin H, Guo H. Identification and verification of immune-related biomarkers and immune infiltration in diabetic heart failure. Front Cardiovasc Med 2022; 9:931066. [PMID: 36465455 PMCID: PMC9712450 DOI: 10.3389/fcvm.2022.931066] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/31/2022] [Indexed: 10/25/2023] Open
Abstract
PURPOSE Diabetic heart failure (DHF) or cardiomyopathy is a common complication of diabetes; however, the underlying mechanism is not clear. In the present study, the authors searched for differentially expressed genes associated with DHF and the molecular types of immune cells based on bioinformatics. METHODS The RNA expression dataset of DHF was obtained from the NCBI Gene Expression Omnibus (GEO) database. After preprocessing the data, the differentially expressed genes (DEGs) between the DHF group and the non-diabetic heart failure (NHF) group were screened and intersected with immune-related genes (IRGs) in the ImmPort database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed using the DAVID tool. The ssGSEA algorithm was used to evaluate immune infiltration of the heart tissue in each group. In addition, the protein-protein interaction (PPI) network and miRNA-mRNA network were constructed using the STRING online website and Cytoscape program. Finally, validation analysis was performed using animal models. RESULTS Eight immune-related core genes were identified. GO and KEGG showed that core genes were mainly enriched in angiogenesis and cytokine-cytokine receptor interaction. Immune infiltration results showed that activated dendritic cells, central memory CD4 T cells, central memory CD8 T cells, myeloid-derived suppressor cells (MDSCs), neutrophils, and regulatory T cells may be involved in DHF. Neutrophils may play a key role in the pathogenesis of HF in diabetes. CONCLUSION Immune-related core genes and immune infiltrating cells provide a new perspective on the pathogenesis of DHF.
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Affiliation(s)
- Zuoquan Zhong
- Department of Cardiology, Shaoxing People’s Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China
| | - Hanlin Zhang
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ting Xu
- Department of Cardiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinjin Hao
- Department of Cardiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xing Chen
- Department of Respiratory Medicine, Shaoxing People’s Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China
| | - Shimin Sun
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinjin Yang
- Department of Cardiology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Sun
- The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hui Lin
- Department of Cardiovascular, Lihuili Hospital Affiliated to Ningbo University, Ningbo, Zhejiang, China
| | - Hangyuan Guo
- Department of Cardiology, Shaoxing People’s Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China
- College of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
- Shaoxing People’s Hospital, Shaoxing Key Laboratory of Cardio-Cerebral Vascular Disease Rehabilitation Technology Research, Shaoxing, Zhejiang, China
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Seo IH, Lee YJ. Usefulness of Complete Blood Count (CBC) to Assess Cardiovascular and Metabolic Diseases in Clinical Settings: A Comprehensive Literature Review. Biomedicines 2022; 10:2697. [PMID: 36359216 PMCID: PMC9687310 DOI: 10.3390/biomedicines10112697] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 08/03/2023] Open
Abstract
Complete blood count (CBC) is one of the most common blood tests requested by clinicians and evaluates the total numbers and characteristics of cell components in the blood. Recently, many investigations have suggested that the risk of cancer, cardiovascular disease (CVD), arteriosclerosis, type 2 diabetes (T2DM), and metabolic syndrome can be predicted using CBC components. This review introduces that white blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), hemoglobin (Hb), mean corpuscular volume (MCV), red cell distribution width (RDW), platelet count, mean platelet volume (MPV), and platelet-to-lymphocyte ratio (PLR) are useful markers to predict CVD and metabolic diseases. Furthermore, we would like to support various uses of CBC by organizing pathophysiology that can explain the relationship between CBC components and diseases.
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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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Chen G, Tan C, Liu X, Chen Y. Association Between the Neutrophil-To-Lymphocyte Ratio and Diabetes Secondary to Exocrine Pancreatic Disorders. Front Endocrinol (Lausanne) 2022; 13:957129. [PMID: 35937787 PMCID: PMC9352859 DOI: 10.3389/fendo.2022.957129] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/22/2022] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes mellitus among patients with exocrine pancreatic disorders is commonly known to be associated with chronic inflammation, including chronic pancreatitis and pancreatic ductal adenocarcinoma (PDAC). The neutrophil-to-lymphocyte ratio (NLR) is a novel marker that indicates the presence of various chronic inflammatory diseases, including type 2 diabetes (T2DM). However, no studies have examined the relationship between the NLR value and diabetes secondary to exocrine pancreatic disorders. Aim To determine whether the NLR value is associated with diabetes secondary to exocrine pancreatic disorders. Methods The medical data of subjects with confirmed pancreatic disease who were admitted to the Department of Pancreatic Surgery of our institution from August 2017 to October 2021 were obtained from the database and retrospectively analyzed. Anthropometric measures, laboratory data, including HbA1c, fasting insulin, and fasting C-peptide levels and the inflammatory index (white blood cell count, NLR, platelet-to-lymphocyte ration, monocyte-to-lymphocyte ratio) were recorded. The NLR is the ratio of neutrophils to lymphocytes. A homeostasis model (HOMA-B and HOMA-IR) was used to measure beta-cell dysfunction and insulin resistance. Results The NLR values of the diabetes secondary to exocrine pancreatic disorders group were significantly higher than those of the nondiabetic group (P=0.001). In multivariate logistic regression, after adjusting for covariates, high NLR values were found to be an independent risk factor for diabetes secondary to exocrine pancreatic disorders (OR: 1.37, 95% CI: 1.138-1.649, P=0.001). According to Spearman correlation analysis, the NLR was significantly correlated with fasting plasma glucose levels (P<0.0001) and HOMA2-IR values (P=0.02). Conclusion The NLR inflammation marker was significantly higher in subjects with diabetes secondary to exocrine pancreatic disorders and was associated with insulin resistance. NLR values may be reliable predictive markers for diabetes among patients with exocrine pancreatic disorders.
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Affiliation(s)
| | | | | | - Yonghua Chen
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China
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Almășan O, Leucuța DC, Hedeșiu M. Blood Cell Count Inflammatory Markers as Prognostic Indicators of Periodontitis: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:992. [PMID: 35743775 PMCID: PMC9225277 DOI: 10.3390/jpm12060992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Our study aimed to assess the association between the neutrophil to lymphocyte ratio (NLR), platelet to leukocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), red cell distribution width (RDW), and systemic immune inflammation index (SII) and periodontitis. (2) Methods: We searched PubMed, Embase, Scopus, Web of Science, and LILACS databases, identifying observational studies. The Newcastle Ottawa scale was used to evaluate the quality of the included studies. The principal summary outcome measure in our random effects meta-analysis was the mean difference (MD). (3) Results: After screening 682 search results, a total of 10 studies including 3164 subjects were selected for quantitative assessment. We found a higher mean NLR, PLR, and LMR in the periodontitis group compared to the control group (0.41 (95% CI 0.12-0.7), p = 0.006; 7.43 (95% CI 0.31-14.54), p = 0.04; 2.05 (95% CI 0.27-3.83), p = 0.024). No differences were observed for RDW. (4) Conclusions: We found an association between NLR, LMR, and PLR and periodontitis, which might be thought of as emerging blood cell count inflammatory biomarkers that could shed light on the link between periodontitis and systemic disbalances, as well as for periodontitis prognosis and grading.
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Affiliation(s)
- Oana Almășan
- Prosthetic Dentistry and Dental Materials Department, Iuliu Hațieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Daniel-Corneliu Leucuța
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Mihaela Hedeșiu
- Department of Oral and Maxillofacial Surgery and Radiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
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Mishra S, M. P. G, Rahman W. Clinical and diagnostic significance of blood leukocyte ratios in young patients with stage III grade C periodontitis. Acta Odontol Scand 2022; 80:161-168. [PMID: 34436974 DOI: 10.1080/00016357.2021.1969035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Blood leukocyte ratios have been recently proposed as simple, rapid, cheap and easily accessible biomarkers of systemic inflammation. However, little is known about the relationship of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) with periodontitis, which might not only serve as the potential biomarkers of systemic inflammation but also aid in diagnosis/screening of severe periodontitis. Hence, the purpose of this study was to evaluate the differences in the serum levels of these leukocyte ratios in healthy subjects and patients with generalized stage III Grade C periodontitis, and their applicability in identifying patients with the risk of developing severe periodontitis. MATERIAL AND METHODS The subjects were categorized into case and control group. Clinical parameters including Plaque index (PI), modified Gingival Index (mGI), Mean ratio of bleeding sites, Probing Pocket depth (PPD) and the clinical attachment loss (CAL) were assessed in both the groups. Venous blood samples were collected from subjects from both groups for the biochemical analysis and blood leukocyte ratios- NLR, PLR and LMR were calculated. The values were then subjected to statistical analysis. RESULTS The results showed significantly higher NLR and lower LMR values in patients with generalized stage III grade C periodontitis. Both the blood leukocyte ratios were moderately associated with increasing clinical parameters of periodontal disease. However, the values of PLR, although found to be higher in the periodontitis group, did not make a significant difference when compared with periodontally healthy subjects. The cut-off value of >2.15 for NLR and <7.16 for LMR fairly predicted the risk of severe periodontitis in young adults. CONCLUSIONS NLR and LMR can provide a new insight into the relationship between periodontitis and systemic diseases and can be of potential diagnostic value in identifying patients with severe periodontitis of younger age group.
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Affiliation(s)
- Supriya Mishra
- Department of Periodontics, Government Dental College and Hospital, Raipur, India
| | - Gazala M. P.
- Department of Periodontics, Government Dental College and Hospital, Raipur, India
| | - Waheda Rahman
- Department of Periodontics, Government Dental College and Hospital, Raipur, India
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Wan H, Wang Y, Zhang H, Zhang K, Chen Y, Chen C, Zhang W, Xia F, Wang N, Lu Y. Chronic lead exposure induces fatty liver disease associated with the variations of gut microbiota. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 232:113257. [PMID: 35104782 DOI: 10.1016/j.ecoenv.2022.113257] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 05/02/2023]
Abstract
BACKGROUND Lead (Pb) has been suggested as an endocrine-disrupting chemical. However, few studies have investigated the association between chronic Pb exposure and fatty liver disease. OBJECTIVES We aimed to investigate the association of chronic Pb exposure with fatty liver disease and whether the variations of the gut microbiota involve in the mechanism of the fatty liver disease induced by chronic Pb exposure. METHODS We conducted a cross-sectional study of 3066 rural participants in East China. Blood lead level (BLL) was detected, and abdominal ultrasonography was used to diagnose hepatic steatosis. Both the definition of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) were used. Wistar rats were randomly divided into two groups and each group was exposed to 0 or 0.05% w/v Pb through drinking water for 28 weeks. The relevant parameters of hepatic lipid metabolism and gut microbiota were analyzed. RESULTS In humans, after adjusting for potential confounders, the odds of having NAFLD and MAFLD were significantly increased by 54% and 52% in the participants in the fourth BLL quartile (OR 1.54, 95% CI 1.24, 1.91 and OR 1.52, 95% CI 1.22, 1.89). In the rats, chronic Pb exposure induced the increased visceral fat, hepatic steatosis, and dysbiosis of the gut microbiota, including the decrease of richness, diversity, evenness and phylogenetic diversity of the gut microbiota and the significant alternations of the gut microbiota composition, particularly, the decrease of the relative abundance of Coprococcus and Oscillospira at the genus level. CONCLUSIONS Chronic Pb exposure could induce fatty liver disease, which may be associated with the variations of the gut microbiota.
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Affiliation(s)
- Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Institute and Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Haojie Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kun Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Institute and Department of Endocrinology and Metabolism, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Institute and Department of Endocrinology and Metabolism, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Wang J, Liu F, Kong R, Han X. Association Between Globulin and Diabetic Nephropathy in Type2 Diabetes Mellitus Patients: A Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:890273. [PMID: 35898464 PMCID: PMC9311329 DOI: 10.3389/fendo.2022.890273] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/03/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND With the development of economy, the living standard of people all over the world has been greatly improved, and the incidence of diabetes is also increasing. Many people with diabetes also develop other complications that reduce their quality of life. Diabetic nephropathy is a common complication of type2 diabetes. Understanding the related factors of diabetic nephropathy is greatly significant to control the occurrence of diabetic nephropathy and improve patient's life quality. DATA AND METHODS Data were collected from 2009 to 2018 in NHANES. Curve fitting graph was performed to investigate the association between globulin (GLB) and diabetic nephropathy(DN). Four logistic regression models were conducted to control the potential confounding factors. Subgroup analysis was carried out to assess the stability of results. RESULTS GLB was positively correlated with the occurrence of DN after controlling for potential confounders. Higher GLB was associated with an increased risk of diabetic nephropathy [odds ratio(OR), 1.10; 95% confidence interval (CI), 1.07-1.13, P < 0.001]. CONCLUSIONS In this cross-sectional study, GLB was significant positively correlated with the occurrence of DN in patients with type2 diabetes mellitus.
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Vartak T, Godson C, Brennan E. Therapeutic potential of pro-resolving mediators in diabetic kidney disease. Adv Drug Deliv Rev 2021; 178:113965. [PMID: 34508793 DOI: 10.1016/j.addr.2021.113965] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/26/2021] [Accepted: 09/05/2021] [Indexed: 02/06/2023]
Abstract
Renal microvascular disease associated with diabetes [Diabetic kidney disease - DKD] is the leading cause of chronic kidney disease. In DKD, glomerular basement membrane thickening, mesangial expansion, endothelial dysfunction, podocyte cell loss and renal tubule injury contribute to progressive glomerulosclerosis and tubulointerstitial fibrosis. Chronic inflammation is recognized as a major pathogenic mechanism for DKD, with resident and circulating immune cells interacting with local kidney cell populations to provoke an inflammatory response. The onset of inflammation is driven by the release of well described proinflammatory mediators, and this is typically followed by a resolution phase. Inflammation resolution is achieved through the bioactions of endogenous specialized pro-resolving lipid mediators (SPMs). As our understanding of SPMs advances 'resolution pharmacology' based approaches using these molecules are being explored in DKD.
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Affiliation(s)
- Tanwi Vartak
- Diabetes Complications Research Centre, Conway Institute and School of Medicine, University College Dublin, Dublin, Ireland
| | - Catherine Godson
- Diabetes Complications Research Centre, Conway Institute and School of Medicine, University College Dublin, Dublin, Ireland
| | - Eoin Brennan
- Diabetes Complications Research Centre, Conway Institute and School of Medicine, University College Dublin, Dublin, Ireland.
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Relationship between Epicardial Fat Tissue Thickness and CRP and Neutrophil-Lymphocyte Ratio in Metabolic Syndrome Patients Over 65 Years. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2021; 55:405-411. [PMID: 34712084 PMCID: PMC8526237 DOI: 10.14744/semb.2021.91455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/07/2021] [Indexed: 01/05/2023]
Abstract
Objective: There are no data evaluating the association of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) with epicardial fat tissue thickness (EFTT) in elderly metabolic syndrome (MS) patients. In this study, we aimed to investigate the relationship of EFTT with CRP and NLR in patients with MS over 65 years. Methods: A cross-sectional study was performed. Fifty patients (patient group) with MS and 25 subjects (control group) without MS were allocated in the study. All parameters were compared in patient and control groups. The correlations between NLR, CRP, and EFTT were evaluated. Results: White blood cell and neutrophil levels were higher in MS group (p=0.020 and p=0.019, respectively). Both transverse and longitudinal EFTT were increased in MS patients (p<0.001). There was a significant correlation between the EFTT and NLR but not with CRP in the MS group (r=0.4, p=0.003). Conclusion: Our study showed that both longitudinal and transverse EFTT are associated with NLR in patients older than 65 years with MS. In geriatric MS patients, higher NLR level may be an indicator of increased visceral fat around the myocardium.
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Prediction and Risk Factors for Prognosis of Cirrhotic Patients with Hepatic Encephalopathy. Gastroenterol Res Pract 2021; 2021:5623601. [PMID: 34712321 PMCID: PMC8546404 DOI: 10.1155/2021/5623601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aims Hepatic encephalopathy (HE) is characterized by recurrence and poor quality of life. Acute-on-chronic liver failure (ACLF) mainly occurs in patients with chronic liver diseases and often presents with HE. Several predictive models have been proposed to predict the outcomes of these patients. Our study is aimed at identifying associated risk factors and the prognostic accuracies of predictive models in HE patients with or without ACLF. Methods Patients with liver cirrhosis were retrospectively enrolled. Risk factors were evaluated by multivariate regression analyses. The predictive capabilities of models were calculated using the receiver operating characteristic (ROC) curve analyses and compared by the DeLong tests. Outcomes were defined as in-hospital mortality, HE severity, and ACLF occurrence. Results In multivariate regression analyses, serum biomarkers neutrophil and total bilirubin (TBIL) were independently correlated with in-hospital death. Alanine aminotransferase (ALT) and blood urea nitrogen (BUN) were independent serum biomarkers associated with HE severity. Hemoglobin, TBIL, BUN, and international normalized ratio (INR) were significant indicators associated with ACLF incidence. For prediction of in-hospital mortality, Child-Pugh was superior to the others in the whole patients, while NLR showed the best capability in the ACLF group. Conclusion In cirrhotic patients present with HE, BUN is a risk factor associated with HE severity and ACLF incidence. Child-Pugh and NLR scores may be effective prognosticators in patients with HE.
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Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as novel risk markers for diabetic nephropathy in patients with type 2 diabetes. Heliyon 2021; 7:e07564. [PMID: 34368476 PMCID: PMC8326730 DOI: 10.1016/j.heliyon.2021.e07564] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/30/2021] [Accepted: 07/09/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Diabetes mellitus causes serious complications such as diabetic nephropathy. Diabetic nephropathy is now the most common reason of chronic kidney disease. Inflammation plays a crucial role in development and progression of diabetic nephropathy. The aim of this study was to evaluate the relationship of Inflammatory markers (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio) with diabetic nephropathy in Syrian patients. Materials and methods A total of 158 patients with type 2 diabetes mellitus were distributed into three groups according to urinary albumin-to-creatinine ratio: Group A, type 2 diabetic patients with normoalbuminuria (urinary albumin-to-creatinine ratio <30 mg/g); Group B, type 2 diabetic patients with microalbuminuria (urinary albumin-to-creatinine ratio = 30–300 mg/g); Group C, type 2 diabetic patients with macroalbuminuria (urinary albumin-to-creatinine ratio ≥300 mg/g). Levels of inflammatory markers (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio) were recorded and compared among the three groups. Results Significant differences were detected between the groups in terms of neutrophil-to-lymphocyte ratio (p = 0.000) and platelet-to-lymphocyte ratio (p = 0.000). Receiver operating characteristic curve analysis of inflammatory markers and microalbuminuria prediction demonstrated an area under curve (AUC) of 0.869 for neutrophil-to-lymphocyte ratio (confidence interval: 0.813–0.926, p = 0.000) and 0.739 for platelet-to-lymphocyte ratio (confidence interval: 0.662–0.815, p = 0.000). Conclusion Increased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were significantly correlated with diabetic nephropathy, and high neutrophil-to-lymphocyte ratio & platelet-to-lymphocyte ratio may be served as a predictor and a prognostic risk marker of diabetic nephropathy.
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Wan H, Wang B, Cui Y, Wang Y, Zhang K, Chen C, Xia F, Ye L, Wang L, Wang N, Lu Y. Low-level lead exposure promotes hepatic gluconeogenesis and contributes to the elevation of fasting glucose level. CHEMOSPHERE 2021; 276:130111. [PMID: 33691221 DOI: 10.1016/j.chemosphere.2021.130111] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/28/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Lead (Pb) is considered an endocrine-disrupting chemical. However, few studies have investigated the effects of low-level Pb exposure on plasma glucose levels. Herein, we aimed to investigate whether low-level Pb exposure causes elevated plasma glucose levels and the possible mechanisms involved. METHODS We conducted a cross-sectional study of 5747 participants from 16 sites in China. The participants underwent measurements of anthropometric factors, blood lead level (BLL) and fasting plasma glucose (FPG). Wistar rats were exposed to 0.05% Pb through drinking water or fed with a high-fat diet (HFD) for 28 weeks. The relevant parameters of glucose homeostasis, hepatic glucose production (HGP) and gene expression levels of hepatic gluconeogenesis enzymes, including phosphoenolpyruvate carboxy kinase (PEPCK), glucose-6-phosphatase (G6PC) and fructose-1,6-bisphosphatase (FBP1), were measured. In addition, gene expression levels of gluconeogenesis enzymes were also measured in HepG2 cells administered with different concentrations of lead acetate for 24 h. RESULTS In humans, after adjusting for confounders, the odds of having High_FPG (≥5.6 mmol/L) were significantly increased by 25% in the participants in the fourth BLL quartile (OR 1.25, 95% CI 1.05, 1.49). In the animals exposed to 0.05% Pb, FPG, HGP and hepatic gene expression levels of PEPCK, G6PC and FBP1 were increased. In addition, the mRNA expression levels of PEPCK, G6PC and FBP1 in HepG2 cells were also increased in response to Pb exposure. CONCLUSIONS These findings support the possibility that low-level Pb exposure may increase HGP by affecting key enzymes of hepatic gluconeogenesis, eventually resulting in impaired FPG and hyperglycemia.
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Affiliation(s)
- Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuke Cui
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kun Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Lin Ye
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Li Wang
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Institute and Department of Endocrinology and Metabolism, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China; Institute and Department of Endocrinology and Metabolism, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Association between neutrophil–lymphocyte ratio on arterial stiffness in type-2 diabetes mellitus patients: a part of DiORS Study. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00965-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cardoso CRL, Leite NC, Salles GF. Importance of hematological parameters for micro- and macrovascular outcomes in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study. Cardiovasc Diabetol 2021; 20:133. [PMID: 34229668 PMCID: PMC8261940 DOI: 10.1186/s12933-021-01324-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/23/2021] [Indexed: 12/27/2022] Open
Abstract
Background The prognostic importance of several hematological parameters has been scarcely investigated in type 2 diabetes. So, we aimed to evaluate their prognostic importance for development of complications in a cohort of type 2 diabetes. Methods In a prospective study, 689 individuals with type 2 diabetes had blood red cell, platelet and leukocyte parameters obtained at baseline. Multivariate Cox analyses examined the associations between several hematological parameters (including neutrophyl-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte, and monocyte-to-HDL ratios) and the occurrence of microvascular (retina, renal and peripheral neuropathy) and cardiovascular complications (total cardiovascular events [CVEs], and major adverse CVEs [MACEs]), and all-cause and cardiovascular mortality. Improvements in risk discrimination were assessed by C-statistics and Integrated Discrimination Improvement (IDI) index. Results During a median follow-up of 10.5 years, 212 patients had a CVE (174 MACEs), 264 patients died (131 cardiovascular deaths); 206 had a renal, 161 a retinopathy and 179 patients had a neuropathy outcome. In multivariate-adjusted analyses, the lymphocytes count and lymphocyte-to-monocyte ratio were protective (hazard ratios [HRs]: 0.77 and 0.72, respectively), whereas the neutrophyl-to-lymphocyte and platelet-to-lymphocyte ratios were associated with increased risks (HRs: 1.19 and 1.17) for all-cause mortality. For cardiovascular mortality, the monocytes count, the neutrophyl-to-lymphocyte and monocyte-to-HDL ratios were associated with increased risks and the lymphocyte-to-monocyte ratio was protective. Higher lymphocyte-to-monocyte ratio was protective for renal failure outcome. However, none of them improved risk discrimination. Conclusions Low lymphocytes count and leukocyte ratios that mainly included lymphocytes were predictors of macrovascular complications and mortality in individuals with type 2 diabetes. However, they did not improve risk prediction over traditional risk factors.
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Affiliation(s)
- Claudia R L Cardoso
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine; Universidade Federal Do Rio de Janeiro, Rua Croton, 72, Rio de Janeiro, Jacarepagua, 22750-240, Brazil.
| | - Nathalie C Leite
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine; Universidade Federal Do Rio de Janeiro, Rua Croton, 72, Rio de Janeiro, Jacarepagua, 22750-240, Brazil
| | - Gil F Salles
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine; Universidade Federal Do Rio de Janeiro, Rua Croton, 72, Rio de Janeiro, Jacarepagua, 22750-240, Brazil
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Pace NP, Vassallo J. Association Between Neutrophil-Lymphocyte Ratio and Gestational Diabetes-A Systematic Review and Meta-Analysis. J Endocr Soc 2021; 5:bvab051. [PMID: 34095691 PMCID: PMC8169042 DOI: 10.1210/jendso/bvab051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
A growing body of evidence shows that the neutrophil-lymphocyte ratio (NLR) is a surrogate index of systemic inflammation in several chronic diseases. Conflicting associations between NLR and gestational diabetes mellitus (GDM) have been reported in individual studies. This meta-analysis sought to investigate the association between NLR and GDM. The PubMed, EMBASE, and Google Scholar databases were searched to identify relevant articles. The pooled standardized mean difference with 95% CI was calculated using a random-effects model. Subgroup and meta-regression analysis were carried out to control for the effects of GDM diagnostic criteria, ethnicity, body mass index (BMI), and age. Eleven eligible articles were included, containing 1271 participants with GDM and 1504 controls. Pooled outcomes indicated a higher NLR in GDM pregnancies than in normoglycemic controls (SMD = 0.584; 95% CI, 0.339-0.830; P < .001), although extensive heterogeneity between studies was noted. Subgroup analysis revealed that the higher pooled estimate in GDM was not affected by diagnostic criteria, ethnicity, or BMI, although matching for BMI reduced heterogeneity between studies. This meta-analysis supports the higher NLR in GDM described by some individual studies.
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Affiliation(s)
- Nikolai Paul Pace
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
| | - Josanne Vassallo
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, MSD2080, Msida, Malta
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Lee S, Zhou J, Leung KSK, Wu WKK, Wong WT, Liu T, Wong ICK, Jeevaratnam K, Zhang Q, Tse G. Development of a predictive risk model for all-cause mortality in patients with diabetes in Hong Kong. BMJ Open Diabetes Res Care 2021; 9:9/1/e001950. [PMID: 34117050 PMCID: PMC8201981 DOI: 10.1136/bmjdrc-2020-001950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/09/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Patients with diabetes mellitus are risk of premature death. In this study, we developed a machine learning-driven predictive risk model for all-cause mortality among patients with type 2 diabetes mellitus using multiparametric approach with data from different domains. RESEARCH DESIGN AND METHODS This study used territory-wide data of patients with type 2 diabetes attending public hospitals or their associated ambulatory/outpatient facilities in Hong Kong between January 1, 2009 and December 31, 2009. The primary outcome is all-cause mortality. The association of risk variables and all-cause mortality was assessed using Cox proportional hazards models. Machine and deep learning approaches were used to improve overall survival prediction and were evaluated with fivefold cross validation method. RESULTS A total of 273 678 patients (mean age: 65.4±12.7 years, male: 48.2%, median follow-up: 142 (IQR=106-142) months) were included, with 91 155 deaths occurring on follow-up (33.3%; annualized mortality rate: 3.4%/year; 2.7 million patient-years). Multivariate Cox regression found the following significant predictors of all-cause mortality: age, male gender, baseline comorbidities, anemia, mean values of neutrophil-to-lymphocyte ratio, high-density lipoprotein-cholesterol, total cholesterol, triglyceride, HbA1c and fasting blood glucose (FBG), measures of variability of both HbA1c and FBG. The above parameters were incorporated into a score-based predictive risk model that had a c-statistic of 0.73 (95% CI 0.66 to 0.77), which was improved to 0.86 (0.81 to 0.90) and 0.87 (0.84 to 0.91) using random survival forests and deep survival learning models, respectively. CONCLUSIONS A multiparametric model incorporating variables from different domains predicted all-cause mortality accurately in type 2 diabetes mellitus. The predictive and modeling capabilities of machine/deep learning survival analysis achieved more accurate predictions.
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Affiliation(s)
- Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Kowloon, Hong Kong
| | | | - William Ka Kei Wu
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Tak Wong
- School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ian Chi Kei Wong
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Kowloon, Hong Kong
| | - Gary Tse
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
- Kent and Medway Medical School, Canterbury, UK
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Neutrophil-to-Lymphocyte Ratio as a Cardiovascular Risk Marker May Be Less Efficient in Women Than in Men. Biomolecules 2021; 11:biom11040528. [PMID: 33918155 PMCID: PMC8066649 DOI: 10.3390/biom11040528] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women, although traditionally, it has been considered as a male dominated disease. Chronic inflammation plays a crucial role in the development of insulin resistance, diabetes type 2 and CVD. Since studies on women were scarce, in order to improve diagnosis and treatment of CVD, there is a need to improve understanding of the role of inflammation in the development of CVD in women. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and widely available marker of inflammation, and has been studied in cardio-metabolic disorders. There is a paucity of data on sex specific differences in the lifetime course of NLR. Men and women differ to each other in sex hormones and characteristics of immune reaction and the expression of CVD. These factors can determine NLR values and their variations along the life course. In particular, menopause in women is a period associated with profound physiological and hormonal changes, and is coincidental with aging. An emergence of CV risk factors with aging, and age-related changes in the immune system, are factors that are associated with an increase in prevalence of CVD in both sexes. The aim of this review is to comprehend the available evidence on this issue, and to discuss sex specific differences in the lifetime course of NLR in the light of immune and inflammation mechanisms.
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A tongue features fusion approach to predicting prediabetes and diabetes with machine learning. J Biomed Inform 2021; 115:103693. [PMID: 33540076 DOI: 10.1016/j.jbi.2021.103693] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetics has become a serious public health burden in China. Multiple complications appear with the progression of diabetics pose a serious threat to the quality of human life and health. We can prevent the progression of prediabetics to diabetics and delay the progression to diabetics by early identification of diabetics and prediabetics and timely intervention, which have positive significance for improving public health. OBJECTIVE Using machine learning techniques, we establish the noninvasive diabetics risk prediction model based on tongue features fusion and predict the risk of prediabetics and diabetics. METHODS Applying the type TFDA-1 Tongue Diagnosis Instrument, we collect tongue images, extract tongue features including color and texture features using TDAS, and extract the advanced tongue features with ResNet-50, achieve the fusion of the two features with GA_XGBT, finally establish the noninvasive diabetics risk prediction model and evaluate the performance of testing effectiveness. RESULTS Cross-validation suggests the best performance of GA_XGBT model with fusion features, whose average CA is 0.821, the average AUROC is 0.924, the average AUPRC is 0.856, the average Precision is 0.834, the average Recall is 0.822, the average F1-score is 0.813. Test set suggests the best testing performance of GA_XGBT model, whose average CA is 0.81, the average AUROC is 0.918, the average AUPRC is 0.839, the average Precision is 0.821, the average Recall is 0.81, the average F1-score is 0.796. When we test prediabetics with GA_XGBT model, we find that the AUROC is 0.914, the Precision is 0.69, the Recall is 0.952, the F1-score is 0.8. When we test diabetics with GA_XGBT model, we find that the AUROC is 0.984, the Precision is 0.929, the Recall is 0.951, the F1-score is 0.94. CONCLUSIONS Based on tongue features, the study uses classical machine learning algorithm and deep learning algorithm to maximum the respective advantages. We combine the prior knowledge and potential features together, establish the noninvasive diabetics risk prediction model with features fusion algorithm, and detect prediabetics and diabetics noninvasively. Our study presents a feasible method for establishing the association between diabetics and the tongue image information and prove that tongue image information is a potential marker which facilitates effective early diagnosis of prediabetics and diabetics.
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Wang K, Xu W, Zha B, Shi J, Wu G, Ding H. Fibrinogen to Albumin Ratio as an Independent Risk Factor for Type 2 Diabetic Kidney Disease. Diabetes Metab Syndr Obes 2021; 14:4557-4567. [PMID: 34815682 PMCID: PMC8605489 DOI: 10.2147/dmso.s337986] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Diabetic kidney disease (DKD) is an inflammatory disease. This study aimed to investigate the association of fibrinogen to albumin ratio (FAR) with DKD. PATIENTS AND METHODS A total of 1022 type 2 diabetes mellitus (T2DM) patients with DKD and 1203 T2DM patients without DKD were enrolled in this study. Laboratory values including blood cell count, hemoglobin A1c, biochemical parameters, and fibrinogen and albumin creatinine ratio were recorded. Patients were classified according to tertile of admission FAR. Clinical parameters were compared between groups. Logistic regression, linear regression, ROC analysis and spline regression were carried out. RESULTS FAR in the DKD group was significantly higher than that in the non-DKD group. FAR had the highest odds ratio as an independent risk factor for the development of DKD and the highest area under ROC curve for predicting DKD compared with albumin (ALB) or fibrinogen (FIB) alone. Simple linear regression analyses revealed a significant and linear correlation of FAR with neutrophil and neutrophil-to-lymphocyte ratio. FAR was an independent risk factor for development of DKD. Spline regression showed that there was a significant linear association between DKD incidence and continuous FAR value when it exceeded 67.3mg/g. CONCLUSION FAR is a stronger independent predictor of DKD than FIB and ALB. FAR is an independent risk factor for DKD development when it exceeded 67.3mg/g. FAR might be one of novel diagnostic biomarkers to predict and prevent DKD progression. However, a prospective study to validate the prognostic model is still needed.
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Affiliation(s)
- Kai Wang
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Wenjun Xu
- Department of Nephrology, Zhejiang Kaihua County Hospital of Chinese Medicine, Zhejiang, People’s Republic of China
| | - Bingbing Zha
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Jindong Shi
- Department of Respiratory and Critical Care Medicine, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Guowei Wu
- Department of Nephrology, Zhejiang Kaihua County Hospital of Chinese Medicine, Zhejiang, People’s Republic of China
- Guowei Wu Department of Nephrology, Zhejiang Kaihua County Hospital of Chinese Medicine, 10 Zhongshan Road, Kaihua County, Zhejiang, 324399, People’s Republic of China Email
| | - Heyuan Ding
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of Nephrology, Zhejiang Kaihua County Hospital of Chinese Medicine, Zhejiang, People’s Republic of China
- Correspondence: Heyuan Ding Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, 801 Heqing Road, Minhang District, Shanghai, 200240, People’s Republic of China Email
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