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Hofherr A, Liarte Marin E, Musial B, Seth A, Slidel T, Conway J, Baker D, Hansen PB, Challis B, Bartesaghi S, Bhat M, Pecoits-Filho R, Tu X, Selvarajah V, Woollard K, Heerspink HJ. Inhibition of Interleukin-33 to Reduce Glomerular Endothelial Inflammation in Diabetic Kidney Disease. Kidney Int Rep 2024; 9:1876-1891. [PMID: 38899206 PMCID: PMC11184260 DOI: 10.1016/j.ekir.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Inflammation is a significant contributor to cardiorenal morbidity and mortality in diabetic kidney disease (DKD). The pathophysiological mechanisms linking systemic, subacute inflammation and local, kidney injury-initiated immune maladaptation is partially understood. Methods Here, we explored the expression of proinflammatory cytokines in patients with DKD; investigated mouse models of type 1 and type 2 diabetes (T2D); evaluated glomerular signaling in vitro; performed post hoc analyses of systemic and urinary markers of inflammation; and initiated a phase 2b clinical study (FRONTIER-1; NCT04170543). Results Transcriptomic profiling of kidney biopsies from patients with DKD revealed significant glomerular upregulation of interleukin-33 (IL-33). Inhibition of IL-33 signaling reduced glomerular damage and albuminuria in the uninephrectomized db/db mouse model (T2D/DKD). On a cellular level, inhibiting IL-33 improved glomerular endothelial health by decreasing cellular inflammation and reducing release of proinflammatory cytokines. Therefore, FRONTIER-1 was designed to test the safety and efficacy of the IL-33-targeted monoclonal antibody tozorakimab in patients with DKD. So far, 578 patients are enrolled in FRONTIER-1. The baseline inflammation status of participants (N > 146) was assessed in blood and urine. Comparison to independent reference cohorts (N > 200) validated the distribution of urinary tumor necrosis factor receptor 1 (TNFR1) and C-C motif chemokine ligand 2 (CCL2). Treatment with dapagliflozin for 6 weeks did not alter these biomarkers significantly. Conclusion We show that blocking the IL-33 pathway may mitigate glomerular endothelial inflammation in DKD. The findings from the FRONTIER-1 study will provide valuable insights into the therapeutic potential of IL-33 inhibition in DKD.
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Affiliation(s)
- Alexis Hofherr
- Research and Early Clinical Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Elena Liarte Marin
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Barbara Musial
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Asha Seth
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Tim Slidel
- Bioinformatics, Oncology R&D, AstraZeneca, Cambridge, UK
| | - James Conway
- Bioinformatics, Oncology R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - David Baker
- Bioscience Metabolism, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Pernille B.L. Hansen
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Benjamin Challis
- Translational Science and Experimental Medicine, Research and Early Clinical Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Stefano Bartesaghi
- Translational Science and Experimental Medicine, Research and Early Clinical Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Maria Bhat
- Translational Science and Experimental Medicine, Research and Early Clinical Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- School of Medicine, Pontificia Universidade de Catolica do Parana, Curitiba, Brazil
- The George Institute for Global Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Xiao Tu
- Research and Early Clinical Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, Maryland, USA
| | - Viknesh Selvarajah
- Research and Early Clinical Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Kevin Woollard
- Bioscience Renal, Research and Early Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Hiddo J.L. Heerspink
- The George Institute for Global Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Zeng G, Lin Y, Xie P, Lin J, He Y, Wei J. Relationship of the Neutrophil-Lymphocyte Ratio with All-Cause and Cardiovascular Mortality in Patients with Diabetic Kidney Disease: A Prospective Cohort Study of NHANES Study. J Multidiscip Healthc 2024; 17:2461-2473. [PMID: 38799017 PMCID: PMC11127657 DOI: 10.2147/jmdh.s465317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
Background To investigate the association between the NLR and the risk of all-cause and cardiovascular mortality in US adults with diabetic kidney disease (DKD). Methods The data utilized for this analysis were sourced from ten National Health and Nutrition Examination Survey cycles (1999-2018) with mortality data (up to 31 December 2019) via linkage to the National Death Index. The optimum NLR threshold for predicting survival outcomes was determined through the maximally selected rank statistics. Restricted cubic spline (RCS), weighted Cox proportional hazard regression, stratified analyses, and time-dependent receiver-operating characteristic curve (ROC) were employed to delineate the prospective correlations of the NLR with both all-cause and cardiovascular mortality. Results In this investigation, a cohort comprising 2581 patients diagnosed with DKD was examined, encompassing 624 individuals with a higher NLR (≥3.07) and 1957 subjects with a lower NLR (<3.07). Over a median follow-up of 79 months (interquartile range, 44-128 months), 1103 deaths occurred, including 397 from cardiovascular causes and 706 from non-cardiovascular causes. The RCS analysis elucidated the positive linear correlation (both nonlinear P > 0.05). In the multivariable analyses, each one-unit increase in the NLR value was correlated with a 51% increased risk of all-cause mortality (1.51(1.28, 1.77)) and a 71% increased risk of cardiovascular mortality (1.71(1.32, 2.21)). The results were largely consistent across stratified analyses encompassing variables such as age, sex, race/ethnicity, marital status, family income, education levels, BMI, drinking status, smoking status, hypertension, CVD, and anti-infective drugs (P for interaction >0.05 for all). Time-dependent ROC analyses underscored the NLR's credible predictive efficacy for both short-term and extended durations in forecasting both all-cause and cardiovascular mortality. Conclusion The findings emphasize the promising use of the NLR in stratifying and prognosticating the risk of mortality in DKD in clinical practice.
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Affiliation(s)
- Guixing Zeng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Yujie Lin
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Peirui Xie
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, People’s Republic of China
| | - Jiarong Lin
- Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, People’s Republic of China
| | - Yaxing He
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, People’s Republic of China
| | - Junping Wei
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
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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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Mahapatro A, Nobakht S, Mukesh S, Daryagasht AA, Korsapati AR, Jain SM, Soltani Moghadam S, Moosavi R, Javid M, Hassanipour S, Prabhu SV, Keivanlou MH, Amini-Salehi E, Nayak SS. Evaluating biomarkers for contrast-induced nephropathy following coronary interventions: an umbrella review on meta-analyses. Eur J Med Res 2024; 29:210. [PMID: 38561791 PMCID: PMC10983745 DOI: 10.1186/s40001-024-01782-y] [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: 01/16/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN. METHODS A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares. RESULTS Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86-9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85-6.65), 3.58 (95% CI 2.75-4.66), and 2.85 (95% CI 2.13-3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17-0.37), ES: 0.25 (95% CI 0.13-0.50), ES: 0.26 (95% CI 0.17-0.41), and ES: 0.39 (0.28-0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P < 0.05). CONCLUSION NGAL demonstrated superior diagnostic performance, exhibiting the highest AUC, positive likelihood ratio, and diagnostic odds ratio among biomarkers for CIN, followed by cystatin-C, and uKIM-1. These findings underscore the potential clinical utility of NGAL, cystatin-C and uKIM-1 in predicting and assessing CIN.
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Affiliation(s)
| | - Sara Nobakht
- Guilan University of Medical Sciences, Rasht, Iran
| | - Sindu Mukesh
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | | | | | - Shika M Jain
- MVJ Medical College and Research Hospital, Bengaluru, India
| | | | | | - Mona Javid
- Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.
| | | | | | | | - Sandeep S Nayak
- Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport CT, USA
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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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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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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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Ban TH, Choi BS, Yoon SA, Kim Y, Jin K, Kim GH, Lee YK, Oh KH, Lee SH, Jung JY, Park HC, Ahn SY, Ko GJ, Kwon YJ, Hong YA. Clinical significance of neutrophil-to-lymphocyte ratio on the risk of abdominal aortic calcification and decreased bone mineral density in patients with end-stage kidney disease. PLoS One 2023; 18:e0286612. [PMID: 37878613 PMCID: PMC10599515 DOI: 10.1371/journal.pone.0286612] [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: 05/17/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023] Open
Abstract
Inflammation plays a major role in the pathogenesis of chronic kidney disease (CKD), but the relationship between systemic inflammation and CKD-mineral bone disease is unclear. We aimed to investigate whether the neutrophil-to-lymphocyte ratio (NLR) is related to abdominal aortic calcification (AAC) and bone mineral density (BMD) in dialysis patients. In this cross-sectional analysis using baseline data of a multicenter cohort, a total of 759 patients were divided into three groups according to NLR level, and the associations between NLR and Kauppila AAC score (AACS) and BMD were assessed. The highest tertile NLR group had more males, alcohol consumers, higher diabetes prevalence, and higher comorbidity index than the lowest tertile NLR group. Fasting glucose and C-reactive protein levels were higher, while serum albumin, serum iron, and lipid profiles except triglycerides were lower in the highest tertile group. AACS was significantly higher in the highest tertile group than in the lowest and middle tertile groups (p = 0.017), but the mean areal BMD and T-score of the lumbar spine and femur were not different between groups. NLR level was positively correlated with AACS in all aortic wall segments except L1 and L3 anterior. In multivariable logistic regression analysis, the highest tertile NLR group was independently associated with AAC (odds ratio 2.876, 95% confidence interval 1.250-6.619, p = 0.013) but was not associated with osteoporosis in the lumbar spine and femur after adjusting for confounding factors. The NLR can be used as a potential indicator of AAC in dialysis patients.
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Affiliation(s)
- Tae Hyun Ban
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum Soon Choi
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Ae Yoon
- Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yaerim Kim
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Kyubok Jin
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Gheun-Ho Kim
- Division of Nephrology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Ki Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Lee
- Division of Nephrology, Department of Internal Medicine, Kyunghee University Hospital at Gangdong, College of Medicine, Kyunghee University, Seoul, Republic of Korea
| | - Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Hyeong Cheon Park
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gang-Jee Ko
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Kwon
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yu Ah Hong
- Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Naif S, Majed R, Mohieldin E, Hanan A, Lamis A, Maha A. Neutrophil-Lymphocyte Ratios in Dry Age-Related Macular Degeneration. Ocul Immunol Inflamm 2023; 31:1647-1652. [PMID: 35830215 DOI: 10.1080/09273948.2022.2092752] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
Inflammation plays a role in the etiopathogenesis of age-related macular degeneration (AMD). A retrospective case-control study was conducted to assess the significance of the neutrophil-lymphocyte ratio (NLR) as a systemic inflammatory indicator in dry AMD. Clinical diagnosis and complete blood count (CBC) results were extracted from medical records for patients with dry AMD and age/sex-matched controls. This study included 90 patients diagnosed with dry AMD and 270 controls without AMD. There were no significant differences in the CBC results between the cases and controls. Patients with dry AMD had a slightly higher mean NLR than controls; however, this increase was not significant (P = .13). In the NLR model, age and sex were significant factors affecting the NLR values in the dry AMD group (P = .03 and 0.01, respectively). The NLR alone cannot predict dry AMD. Therefore, exploring other routine laboratory measurements may shed light on early disease prediction and prevention.
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Affiliation(s)
- Sannan Naif
- Department of Clinical Laboratory Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Biomedical Research, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Ramadan Majed
- Department of Biomedical Research, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Elsayid Mohieldin
- Department of Clinical Laboratory Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Biomedical Research, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Alghamdi Hanan
- Department of Clinical Laboratory Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Alghamdi Lamis
- Department of Clinical Laboratory Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Alqahtani Maha
- Department of Clinical Laboratory Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Pathology and Laboratory Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
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Dong G, Gan M, Xu S, Xie Y, Zhou M, Wu L. The neutrophil-lymphocyte ratio as a risk factor for all-cause and cardiovascular mortality among individuals with diabetes: evidence from the NHANES 2003-2016. Cardiovasc Diabetol 2023; 22:267. [PMID: 37775767 PMCID: PMC10541705 DOI: 10.1186/s12933-023-01998-y] [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: 06/25/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Evidence regarding the neutrophil-lymphocyte ratio (NLR) and mortality risk in diabetes patients is scarce. This study investigated the relationship of the NLR with all-cause and cardiovascular mortality risk in diabetes patients. METHODS Diabetes patients (n = 3251) from seven National Health and Nutrition Examination Survey (NHANES) cycles (2003-2016) were included in this study. The cause of death and mortality status of the participants were obtained from National Death Index records. Restricted cubic spline (RCS) was used to visualize the association of the NLR with mortality risk. The maximally selected rank statistics method (MSRSM) was used to determine the optimal NLR cutoff value corresponding to the most significant association with survival outcomes. Weighted multivariable Cox regression models and subgroup analyses were adopted to assess the association of the NLR with all-cause and cardiovascular mortality. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to evaluate the accuracy of the NLR in predicting survival outcomes. RESULTS During a median follow-up of 91 months (interquartile range, 55-131 months), 896 (27.5%) of the 3251 diabetes patients died, including 261 (8.0%) with cardiovascular deaths and 635 (19.5%) with noncardiovascular deaths. The RCS regression analysis showed a positive linear association between the NLR and all-cause and cardiovascular mortality (both p > 0.05 for nonlinearity) in diabetes patients. Participants were divided into higher (> 3.48) and lower (≤ 3.48) NLR groups according to the MSRSM. In the multivariable-adjusted model, compared with participants with a lower NLR, those with a higher NLR had a significantly higher risk of both all-cause (HR 2.03, 95% confidence interval (CI) 1.64-2.51, p < 0.0001) and cardiovascular mortality (HR 2.76, 95% CI 1.84-4.14, p < 0.0001). The association was consistent in subgroup analyses based on age, sex, smoking status, drinking status, and hypertension, with no significant interaction between the aforementioned characteristics and the NLR (p interaction > 0.05). The time-dependent ROC curve showed that the areas under the curve of the 1-, 3-, 5-, and 10-year survival rates were 0.72, 0.66, 0.64, and 0.64 for all-cause mortality and 0.69, 0.71, 0.69 and 0.65, respectively, for cardiovascular mortality. CONCLUSION An elevated NLR is independently associated with increased all-cause and cardiovascular mortality in diabetes patients.
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Affiliation(s)
- Gaiying Dong
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Man Gan
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Shilin Xu
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Yanlin Xie
- Department of Medical Ultrasound, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Ming Zhou
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Liangliang Wu
- Department of Hematology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.
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Adane T, Melku M, Worku YB, Fasil A, Aynalem M, Kelem A, Getawa S. The Association between Neutrophil-to-Lymphocyte Ratio and Glycemic Control in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Diabetes Res 2023; 2023:3117396. [PMID: 37305430 PMCID: PMC10257553 DOI: 10.1155/2023/3117396] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/18/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
Background Glycated hemoglobin (HbA1c) is a commonly used clinical marker to monitor the control of type 2 diabetes mellitus patients (T2DM). However, it is unable to identify the ongoing inflammatory changes in the body. These factors could be easily identified and monitored by the neutrophil-to-lymphocyte ratio (NLR). Therefore, this study is aimed at investigating the relationship between NLR and glycemic control in T2DM. Method A comprehensive search of eligible studies was performed in various databases published until July 2021. A random effect model was used to estimate the standardized mean difference (SMD). A metaregression, subgroup, and sensitivity analysis were conducted to search for potential sources of heterogeneity. Result A total of 13 studies were included in this study. Accordingly, the SMD of the NLR values between the poor and good glycemic control groups was 0.79 (95% CI, 0.46-1.12). Our study also showed that high NLR was significantly associated with poor glycemic control in T2DM patients (OR = 1.50, 95% CI: 1.30-1.93). Conclusion The results of this study suggest an association between high NLR values and an elevated HbA1C in T2DM patients. Therefore, NLR should be considered a marker of glycemic control in addition to HbA1c in T2DM patients.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yilkal Belete Worku
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Fasil
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melak Aynalem
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amanuel Kelem
- Department of Medical Laboratory Sciences, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Cetın N, Kocaturk E, Tufan AK, Kıraz ZK, Alatas O. Immature granulocytes as biomarkers of inflammation in children with predialysis chronic kidney disease. Pediatr Nephrol 2023; 38:219-225. [PMID: 35445974 DOI: 10.1007/s00467-022-05530-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic inflammation in patients with predialysis chronic kidney disease (CKD) is quite common. We aimed to investigate the relationship of the percentage of immature granulocytes (IG%) and immature granulocyte count (IGC) with inflammation in children with predialysis CKD. METHODS The data from children with stage 2-4 CKD and a control group of healthy children were evaluated retrospectively. A highly-sensitive C-reactive protein (hs-CRP) level above 5 mg/dL was considered the presence of inflammation. The IGCs were calculated in the white cell differential channel of the Sysmex XN-9000 using the fluorescent flow cytometry method. The IG% was expressed as percentage of total leucocyte concentration. RESULTS The data from 57 patients (30 stage 2 CKD, 15 stage 3 CKD, 12 stage 4 CKD) and 46 controls were analyzed. hs-CRP levels, IG%, IGC, white blood cell (WBC) and neutrophil counts, and neutrophil-to-lymphocyte ratio (NLR) were higher in patients than the control group (p < 0.000, p < 0.000, p < 0.000, p = 0.001, p = 0.002, p < 0.000, respectively). Both IG% and IGC were positively correlated with hs-CRP, WBC and neutrophil counts, and NLR (r = 0.485, p < 0.000; r = 0.379, p = 0.004; r = 0.543, p < 0.000; r = 0.628, p < 0.000 for IG%; r = 0.379, p = 0.004; r = 0.351, p = 0.007; r = 0.525, p < 0.000; r = 0.601, p < 0.000 for IGC, respectively). A ROC analysis of the relationship between IGC, IG%, and inflammation showed IGC and IG% had predictive value for the presence of inflammation (cut-off value: 0.035 × 106/mL, AUC: 0.799 ± 0.061, sensitivity: 74.2%, specifity: 63%, p < 0.001 for IGC; cut-off value: 0.45%, AUC: 0.838 ± 0.056, sensitivity: 70.8%, specifity: 67.3%, p = 0.001 for IG%). CONCLUSIONS Immature granulocytes may be used as a biomarker of inflammation in children with predialysis CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Nuran Cetın
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, TR-26480, Eskisehir, Turkey.
| | - Evin Kocaturk
- Department of Medical Biochemistry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Aslı Kavaz Tufan
- Department of Pediatric Nephrology, Faculty of Medicine, Eskisehir Osmangazi University, TR-26480, Eskisehir, Turkey
| | - Zeynep Kusku Kıraz
- Department of Medical Biochemistry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ozkan Alatas
- Department of Medical Biochemistry, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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Gurmu MZ, Genet S, Gizaw ST, Feyisa TO, Gnanasekaran N. Neutrophil-lymphocyte ratio as an inflammatory biomarker of diabetic nephropathy among type 2 diabetes mellitus patients: A comparative cross-sectional study. SAGE Open Med 2022; 10:20503121221140231. [PMID: 36505969 PMCID: PMC9729998 DOI: 10.1177/20503121221140231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This study aimed to determine the neutrophil-lymphocyte ratio (NLR) as an inflammatory biomarker among type 2 diabetes mellitus (T2DM) patients with diabetic nephropathy (DN). Methods A comparative cross-sectional study design was conducted on 199 T2DM patients attending Bole 17 Health Center, Addis Ababa, Ethiopia. The urine albumin test was done by the MICRAL-II test strip. Fasting blood sugar was measured by a glucometer. Complete blood count was analyzed using an automated hematology analyzer (HUMAN GmbH, Wiesbaden, Hesse, Germany). The student's t-test, a chi-square test, and Pearson correlation were applied to analyze the data. Results Out of the 199 diabetes mellitus patients, 45 (22.6%) and 154 (77.4%) were found with DN and without DN, respectively. Interestingly, the mean NLR value (2.66 ± 0.49) was found significantly higher in diabetic patients with DN compared to the mean NLR (1.65 ± 0.20) in diabetes patients without DN (p < 0.0001). The NLR showed positive significant correlation with variables such as age (r = 0.162, p = 0.023), duration of disease (r = 0.52, p < 0.0001), absolute neutrophil count (r = 0.712, p < 0.0001), total white blood cell count (r = 0.162, p = 0.022), systolic blood pressure (r = 0.338, p < 0.0001), and diastolic blood pressure (r = 0.731, p < 0.0001). On the other hand, negatively significant correlation was found between NLR and absolute lymphocyte count (r = -0.770, p < 0.000). Conclusion The NLR was significantly increased in T2DM patients with DN, suggesting that inflammation and endothelial dysfunction could be an integral part of the pathogenesis of DN, and therefore, this ratio may be considered as a predictor and a prognostic biomarker of DN.
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Affiliation(s)
- Mesfin Zewude Gurmu
- Department of Biomedical Science, College of Health Sciences, Arsi University, Asela, Ethiopia
| | - Solomon Genet
- Department of Medical Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia,Solomon Genet, Associate Professor of Medical Biochemistry, Department of Medical Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia.
| | - Solomon Tebeje Gizaw
- Department of Medical Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Teka Obsa Feyisa
- Department of Medical Biochemistry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Netasan Gnanasekaran
- Department of Medical Biochemistry, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
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Martínez-Alberquilla I, Gasull X, Pérez-Luna P, Seco-Mera R, Ruiz-Alcocer J, Crooke A. Neutrophils and neutrophil extracellular trap components: Emerging biomarkers and therapeutic targets for age-related eye diseases. Ageing Res Rev 2022; 74:101553. [PMID: 34971794 DOI: 10.1016/j.arr.2021.101553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/17/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
Age-related eye diseases, including dry eye, glaucoma, age-related macular degeneration, and diabetic retinopathy, represent a major global health issue based on their increasing prevalence and disabling action. Unraveling the molecular mechanisms underlying these diseases will provide novel opportunities to reduce the burden of age-related eye diseases and improve eye health, contributing to sustainable development goals achievement. The impairment of neutrophil extracellular traps formation/degradation processes seems to be one of these mechanisms. These traps formed by a meshwork of DNA and neutrophil cytosolic granule proteins may exacerbate the inflammatory response promoting chronic inflammation, a pivotal cause of age-related diseases. In this review, we describe current findings that suggest the role of neutrophils and their traps in the pathogenesis of the above-mentioned age-related eye diseases. Furthermore, we discuss why these cells and their constituents could be biomarkers and therapeutic targets for dry eye, glaucoma, age-related macular degeneration, and diabetic retinopathy. We also examine the therapeutic potential of some neutrophil function modulators and provide several recommendations for future research in age-related eye diseases.
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Affiliation(s)
- Irene Martínez-Alberquilla
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain; Clinical and Experimental Eye Research Group, UCM 971009, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Xavier Gasull
- Neurophysiology Laboratory, Department of Biomedicine, Medical School, Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia Pérez-Luna
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Rubén Seco-Mera
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Ruiz-Alcocer
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain; Clinical and Experimental Eye Research Group, UCM 971009, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Almudena Crooke
- Department of Biochemistry and Molecular Biology, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain; Clinical and Experimental Eye Research Group, UCM 971009, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain.
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15
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Ming J, Sana SRGL, Deng X. Identification of copper-related biomarkers and potential molecule mechanism in diabetic nephropathy. Front Endocrinol (Lausanne) 2022; 13:978601. [PMID: 36329882 PMCID: PMC9623046 DOI: 10.3389/fendo.2022.978601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) is a chronic microvascular complication in patients with diabetes mellitus, which is the leading cause of end-stage renal disease. However, the role of copper-related genes (CRGs) in DN development remains unclear. MATERIALS AND METHODS CRGs were acquired from the GeneCards and NCBI databases. Based on the GSE96804 and GSE111154 datasets from the GEO repository, we identified hub CRGs for DN progression by taking the intersection of differentially expressed CRGs (DECRGs) and genes in the key module from Weighted Gene Co-expression Network Analysis. The Maximal Clique Centrality algorithm was used to identify the key CRGs from hub CRGs. Transcriptional factors (TFs) and microRNAs (miRNAs) targeting hub CRGs were acquired from publicly available databases. The CIBERSORT algorithm was used to perform comparative immune cell infiltration analysis between normal and DN samples. RESULTS Eighty-two DECRGs were identified between normal and DN samples, as were 10 hub CRGs, namely PTGS2, DUSP1, JUN, FOS, S100A8, S100A12, NAIP, CLEC4E, CXCR1, and CXCR2. Thirty-nine TFs and 165 miRNAs potentially targeted these 10 hub CRGs. PTGS2 was identified as the key CRG and FOS as the most significant gene among all of DECRGs. RELA was identified as the hub TF interacting with PTGS2 by taking the intersection of potential TFs from the ChEA and JASPAR public databases. let-7b-5p was identified as the hub miRNA targeting PTGS2 by taking the intersection of miRNAs from the miRwalk, RNA22, RNAInter, TargetMiner, miRTarBase, and ENCORI databases. Similarly, CREB1, E2F1, and RELA were revealed as hub TFs for FOS, and miR-338-3p as the hub miRNA. Finally, compared with those in healthy samples, there are more infiltrating memory B cells, M1 macrophages, M2 macrophages, and resting mast cells and fewer infiltrating activated mast cells and neutrophils in DN samples (all p< 0.05). CONCLUSION The 10 identified hub copper-related genes provide insight into the mechanisms of DN development. It is beneficial to examine and understand the interaction between hub CRGs and potential regulatory molecules in DN. This knowledge may provide a novel theoretical foundation for the development of diagnostic biomarkers and copper-related therapy targets in DN.
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Affiliation(s)
- Jie Ming
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Si Ri Gu Leng Sana
- Department of Anaesthesiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- *Correspondence: Si Ri Gu Leng Sana,
| | - Xijin Deng
- Department of Anaesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Zeng J, Chen M, Feng Q, Wan H, Wang J, Yang F, Cao H. The Platelet-to-Lymphocyte Ratio Predicts Diabetic Retinopathy in Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2022; 15:3617-3626. [PMID: 36444389 PMCID: PMC9700435 DOI: 10.2147/dmso.s378284] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION As a severe and specific neurovascular complication of type 2 diabetes mellitus (T2DM), diabetic retinopathy (DR) remains the leading cause of vision loss and preventable blindness in adults aged 20 to 74. The pathogenesis of DR is not completely understood, however, studies indicate that chronic inflammation plays a significant role. Emerging evidence suggests that the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), and the monocyte-to-lymphocyte ratio (MLR) are novel potential inflammatory response markers. The purpose of this study was to investigate the relationships between the NLR, PLR, MLR, and DR. PATIENTS AND METHODS 290 patients who had been diagnosed with T2DM participated in the study. Patients were categorized into three groups: 142 control subjects with T2DM, 124 subjects with nonproliferative diabetic retinopathy (NPDR), and 24 patients with proliferative diabetic retinopathy (PDR). Characteristics, laboratory data, as well as NLR, PLR and MLR levels of the study groups were compared. RESULTS In patients with DR, the median NLR, PLR, and MLR were significantly higher than in patients without DR (p = 0.012, p < 0.001, and p = 0.043, respectively). In the post hoc analysis, there was no correlation between the severity of retinopathy and the increase in NLR or PLR. Multiple logistic regression revealed that the PLR was an independent risk factor for DR (odds ratio [OR]: 1.020, 95% confidence interval [CI]: 1.010-1.029 p = 0.026). Based on the receiver operating characteristic (ROC) curve, the cutoff value of PLR as an indicator for diagnosing DR was estimated to be 129.65, with a sensitivity and specificity of 53.4% and 76.1%, respectively, and an area under the curve of 0.668 (95% CI: 0.605-0.730, p < 0.001). CONCLUSION Our findings suggest that PLR may be an independent risk factor for evaluating DR in type 2 diabetes patients.
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Affiliation(s)
- Jing Zeng
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Min Chen
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Qiu Feng
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Haiyan Wan
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Jianbo Wang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Medical Record, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Fan Yang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
| | - Hongyi Cao
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, People’s Republic of China
- Correspondence: Hongyi Cao; Fan Yang, Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Endocrinology and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), No. 33, Mashi Street, Wenjiang District, Chengdu, Sichuan, 611130, People’s Republic of China, Tel +86 13730683979, Fax +86 028-82713097, Email ;
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Reyhan AH, Karadağ AS, Çınar ŞŞ. Assessing the role of systemic inflammation in the etiopathogenesis of advanced stage keratoconus. Indian J Ophthalmol 2021; 69:2658-2662. [PMID: 34571609 PMCID: PMC8597491 DOI: 10.4103/ijo.ijo_3403_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/23/2021] [Accepted: 06/13/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE It was aimed to compare the levels of inflammation-related parameters, such as neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR), in patients with advanced keratoconus (KC) and healthy controls. Also, we evaluated the relationships between these parameters and several corneal topography values used in the KC diagnostic index. METHODS Forty patients with advanced and 40 healthy volunteers were included in this study. In the KC group, 20 patients were nonprogressive KC and 20 patients were progressive KC. In all participating individuals, we evaluated detailed ophthalmologic examination findings and complete blood count data, while corneal topographic measurements were also recorded in patients with KC. RESULTS The mean NLR value was 2.3 ± 1.19 in the progressive KC group; nonprogressive KC values were 1.99 ± 1.69 and 1.81 ± 0.72 in the control group. Mean PLR value was 113.24 ± 48.44 in the progressive KC group, nonprogressive KC values were 96.47 ± 31.04 and 104.09 ± 35.14 in the control group. No statistically significant difference was found between patients with progressive KC, nonprogressive KC, and healthy volunteers in terms of mean NLR and PLR values (P > 0.05). NLR values were found to demonstrate significant positive correlations with the corneal topography parameters, Symmetry Index front (r = 0.278, P = 0.025), KC Vertex front (r = 0.247, P = 0.048), and Baiocchi Calossi Versaci front (r = 0.273, P = 0.028); there was no significant relationship between corneal topography parameters and PLR values. CONCLUSION Although there was no significant difference between the progressive KC, nonprogressive KC, and control groups in inflammation parameters such as NLR and PLR, a positive correlation was observed between the NLR value and some corneal topography findings used in the diagnosis of KC. The role of inflammation in the etiology of KC can be better understood by clinical studies and laboratory tests conducted with prospective studies involving a higher number of patients.
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Affiliation(s)
- Ali H Reyhan
- Department of Opthalmology, Kilis state Hospital, Kilis, Turkey
| | - Ayşe Sevgi Karadağ
- Department of Ophthalmology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Şerife Şule Çınar
- Department of Ophthalmology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
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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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Chen Y, Chai Q, Wang Q, Zhang Z, Shan Y, Lu D, Liu M, Wu W. Neutrophil-to-lymphocyte ratio is associated with coronary microvascular dysfunction in type 2 diabetes mellitus patients. Diabetes Res Clin Pract 2021; 178:108983. [PMID: 34311023 DOI: 10.1016/j.diabres.2021.108983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
AIMS Our study is aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and coronary microvascular dysfunction (CMD) in type 2 diabetes mellitus (T2DM) patients. METHODS We retrospect the consecutive medical files of 160 T2DM patients and recorded their clinical information and laboratory findings. Patients were divided into CMD group (n = 87) and non-CMD group (n = 73). We compared the NLR values of the two groups. Meanwhile we also observed the prevalence of CMD at different NLR levels. Then, logistic regression and ROC analysis were performed. RESULTS NLR value of CMD group was significantly lower than non-CMD group (2.01 ± 0.74 vs 2.53 ± 0.69, P<0.001). Prevalence of CMD in low (NLR ≤ 1.53, n = 30), medium (1.53 < NLR ≤ 2.20, n = 53) and high (NLR > 2.20, n = 77) group were 90%, 61.1%, and 39.2% respectively. The prevalence of CMD significantly increased as NLR level decreased. After adjusting potential related factors, NLR was still significantly correlated with CMD (OR = 0.295, 95 %CI:0.162-0.539, P < 0.001). The area under ROC curve (AUC) was 0.707 (95 %CI:0.627-0.786, P < 0.001). CONCLUSIONS Our results showed that NLR is associated with CMD in T2DM patients, and the prevalence of CMD may increase as NLR level decrease.
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Affiliation(s)
- Yangwen Chen
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Qian Chai
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Qian Wang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Ziying Zhang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Yongyan Shan
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Dexue Lu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Meili Liu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China
| | - Weihua Wu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, People's Republic of China.
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He P, He LJ, Huang C, Hu JP, Sun SR. Neutrophil-to-Lymphocyte Ratio and Treatment Failure in Peritoneal Dialysis-Associated Peritonitis. Front Med (Lausanne) 2021; 8:699502. [PMID: 34381800 PMCID: PMC8350030 DOI: 10.3389/fmed.2021.699502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: We sought to explore if there is an association between neutrophil-to-lymphocyte ratio (NLR) and treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP). Methods: Our cohort involved 337 episodes of PDAP experienced by 202 patients who were undergoing continuous ambulatory peritoneal dialysis at a single center from 1 July 2013 to 30 June 2018. The exposures were log-transformed NLR and a categorical variable grouped by the tertiles of NLR levels (T1, <3.75; T2, 3.75–6.53; and T3, >6.53) at baseline. Generalized estimating equation (GEE) and restricted cubic spline (RCS) analyses were done to determine the association between NLR and treatment failure, defined as catheter removal or all-cause mortality during therapy. Results: After adjusting for other potential predictors, the log-transformed NLR exhibited an incremental relationship with the risk of treatment failure (odds ratio, 1.82; 95% confidence interval, 1.05–3.15). RCS analyses showed that the relationship was positively and linearly correlated (P for nonlinearity = 0.104). As a three-level categorical variable, in reference to T1, the T3 of NLR showed a 3.41-fold increased venture of treatment failure in fully adjusted model. Subgroup analyses suggested that the prognostic relevance of NLR in PDAP was particularly significant in gram-negative peritonitis. Conclusions: A greater level of NLR at baseline was remarkably associated with a higher incidence of treatment failure among PDAP episodes regardless of other potential risk factors.
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Affiliation(s)
- Peng He
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Li-Jie He
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Chen Huang
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jin-Ping Hu
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Shi-Ren Sun
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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21
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Chen M, Zhu Y, Wang J, Wang G, Wu Y. The Predictive Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Levels of Diabetic Peripheral Neuropathy. J Pain Res 2021; 14:2049-2058. [PMID: 34267549 PMCID: PMC8275189 DOI: 10.2147/jpr.s304595] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/20/2021] [Indexed: 12/14/2022] Open
Abstract
Objective This study was designed to assess the levels of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in diabetes patients to determine their prognostic value in predicting the disease of diabetic peripheral neuropathy (DPN). Methods We recruited 225 diabetes cases from the department of endocrinology of Anhui Provincial Hospital from August 2018 to October 2019. A total of 103 patients without diabetic peripheral neuropathy (DPN) were followed up for 18 months, and the number of patients of newly diagnosed DPN was counted. According to the results of neuroelectrophysiological examination, these patients were divided into the diabetes mellitus (DM) without DPN group and the DM with DPN group. The general information and results of blood samples were collected. The collected data were compared between groups, and the receiver operating characteristic curve (ROC) was drawn. The follow-up data were compared between groups and Binary Logistic regression analysis was performed. Results Patients with DPN shared distinct characteristics. For example, the patients were older, and had higher levels of inflammatory indicators (ie, levels of PLR and NLR), and lower level of indirect bilirubin, compared with patients without DPN. According to the receiver operating characteristic curve analysis, for type 1 diabetes, PLR showed the highest area under the curve (0.753). For type 2 diabetes, NLR showed the highest AUC of 0.602. For the follow-up results, patients with newly diagnosed DPN bad higher NLR level. Conclusion If patients of type 1 and type 2 diabetes are combined with elevated level of PLR and NLR, respectively, they are more likely complicated with DPN. NLR and PLR could be used as predictors to help clinicians screening for DPN in different types of diabetes. For type 1 diabetes, if patients who were without DPN had higher NLR level, the risk of developing DPN in the future will be greatly increased.
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Affiliation(s)
- Meiqiao Chen
- Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, 230001, People's Republic of China
| | - Yuyou Zhu
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, 230001, People's Republic of China
| | - Jumei Wang
- Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, 230001, People's Republic of China
| | - Guoping Wang
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, 230001, People's Republic of China
| | - Yuanbo Wu
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, 230001, People's Republic of China
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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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Eroglu FC, Gediz BS, Ozturk M, Kazancı B. Association Between Dry Eye Disease and Newly Diagnosed Obsessive-Compulsive Disorder. Cornea 2021; 40:817-821. [PMID: 33859092 DOI: 10.1097/ico.0000000000002724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the association between dry eye disease and patients with newly diagnosed obsessive-compulsive disorder (OCD). METHODS Thirty treatment-naive patients with OCD and 30 healthy controls were included in this prospective study. The Ocular Surface Disease Index, tear breakup time, Schirmer I test, corneal and conjunctival staining grade (Oxford scale), and neutrophil-to-leucocyte ratio values were obtained for all participants. RESULTS The comparison of the patients with OCD and healthy controls showed significantly higher values in Ocular Surface Disease Index (34.8 vs. 20.8, P = 0.001), corneal Oxford scoring (0.9 vs. 0.6, P = 0.02), and conjunctival Oxford scoring (0.8 vs. 0.5, P = 0.04), with consistently lower values in the Schirmer I test (15.7 vs. 18.8, P = 0.043) and tear breakup time (9.1 vs. 12.9, P = 0.001). The mean neutrophil-to-leucocyte ratio values were significantly higher in the OCD group compared with the controls (2.4 ± 0.9 vs. 1.6 ± 0.4, respectively; P = 0.001). CONCLUSIONS Our study showed a relation between dry eye disease and patients with newly diagnosed OCD who were not using any psychiatric drug. Our findings suggest that inflammation, which plays an important role in the pathogenesis of both diseases, may be responsible for this relationship.
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Affiliation(s)
- Fatma Corak Eroglu
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey; and
| | - Berrak Sekeryapan Gediz
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey; and
| | - Mehmet Ozturk
- Department of Psychiatry, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| | - Burcu Kazancı
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey; and
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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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Vural E, Hazar L. Assessment of Inflammation Biomarkers in Diabetic Macular Edema Treated with Intravitreal Dexamethasone Implant. J Ocul Pharmacol Ther 2021; 37:430-437. [PMID: 33961524 DOI: 10.1089/jop.2020.0130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose: To evaluate inflammation biomarkers in diabetic macular edema (DME) treated with intravitreal dexamethasone implant (Ozurdex®). Methods: This retrospective single-center study investigated 64 eyes of 64 patients with DME who were nonresponsive to prior antivascular endothelial growth factor and treated with intravitreal Ozurdex. The neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), and platelet/lymphocyte ratio were calculated. Visual acuity and optical coherence tomography markers, including hyper-reflective dots and subretinal fluid (SRF), were determined, and central retinal thickness was also evaluated monthly for 3 months. Results: The average age was 64.06 ± 7.81 (48-84) years. The baseline NLR and MLR were significantly higher in patients with better visual outcomes (P = 0.029 and P = 0.048, respectively). Better anatomical outcomes were observed in the presence of SRF (P = 0.027). No significant differences were observed in the rates of the presence of SRF and hyper-reflective points about the better functional outcome (P > 0.05). Conclusions: SRF as an imaging biomarker, and NLR and MLR as blood biomarkers, stand out as markers of inflammation and were found to be associated with better response to Ozurdex implantation in DME.
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Affiliation(s)
- Esra Vural
- Department of Ophthalmology, Kayseri City Hospital, Kayseri, Turkey
| | - Leyla Hazar
- Department of Ophthalmology, Dicle University School of Medicine, Diyarbakır, Turkey
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Wu X, Ma C, Sun D, Zhang G, Wang J, Zhang E. Inflammatory Indicators and Hematological Indices in Contrast-Induced Nephropathy Among Patients Receiving Coronary Intervention: A Systematic Review and Meta-Analysis. Angiology 2021; 72:867-877. [PMID: 33719591 DOI: 10.1177/00033197211000492] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Strong inflammatory indicators such as C-reactive protein (CRP), high-sensitivity CRP (hsCRP), and hematological indices, including platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), hematocrit (HCT), and red blood cell distribution width (RDW), may be related with contrast-induced nephropathy (CIN). Our meta-analysis aimed at exploring the relationship between these indicators and CIN incidence among patients undergoing coronary intervention. Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, Google Scholar, Clinical Trials, and Science Direct from their inception to June 3, 2020. Meta-analysis was performed on pooled eligible studies. Finally, 26 studies involving 29 454 patients were included. Pooled analysis revealed that patients with higher CRP (odds ratio [OR] = 1.06, 95% CI: 1.01-1.12, P = .02), hsCRP (OR = 1.03, 95% CI: 1.01-1.06, P = .004), NLR (OR = 1.11, 95% CI: 1.01-1.20, P = .02), RDW (OR = 1.35, 95% CI: 1.19-1.53, P < .001), and lower HCT (OR = 0.94, 95% CI: 0.92-0.97, P = .003) all exhibited significantly higher CIN rates, but there was no significant association between PLR and CIN risk (OR = 1.12, 95% CI: 0.99-1.26, P = .07). Pre-angiography CRP/hsCRP and some hematological indices are associated with CIN.
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Affiliation(s)
- Xiaoyan Wu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Ma
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Daqing Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Guojing Zhang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinmiao Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Enyuan Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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Wang S, Shen T, Xi B, Shen Z, Zhang X. Vitamin D affects the neutrophil-to-lymphocyte ratio in patients with type 2 diabetes mellitus. J Diabetes Investig 2021; 12:254-265. [PMID: 32593190 PMCID: PMC7858138 DOI: 10.1111/jdi.13338] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS/INTRODUCTION Chronic inflammation is an underlying feature of type 2 diabetes mellitus. Hypovitaminosis D is associated with type 2 diabetes mellitus, but whether it contributes to chronic inflammation is unclear. We examined the effects of vitamin D on various immune markers to evaluate its contribution to systemic inflammation in type 2 diabetes mellitus. MATERIALS AND METHODS We retrospectively analyzed data from type 2 diabetes mellitus patients, people with prediabetes and control patients without diabetes (n = 9,746). Demographic and clinical variables were evaluated using descriptive statistics and generalized linear regression. A stratified analysis based on total serum vitamin D was also carried out. RESULTS Neutrophil count was a significant predictor of 1,5-anhydroglucitol and glycated hemoglobin (HbA1c) in patients with prediabetes (1,5-anhydroglucitol: β = -0.719, P < 0.001 and HbA1c: β = -0.006, P = 0.002) and patients with diabetes (1,5-anhydroglucitol: β = 0.207, P = 0.004 and HbA1c: β = -0.067, P = 0.010). Lymphocyte count was a significant predictor of HbA1c in patients without diabetes (β = 0.056, P < 0.001) and patients with prediabetes (β = 0.038, P < 0.001). The neutrophil-to-lymphocyte ratio (NLR) was a significant predictor of HbA1c in patients without diabetes (β = -0.001, P = 0.032). No immune markers differed significantly based on vitamin D level among patients without diabetes (P> 0.05 for all). Among patients with prediabetes, those who were vitamin D-deficient had the highest NLR (P = 0.040). Among patients with diabetes, those who were vitamin D-deficient had the highest neutrophil count (P = 0.001), lowest lymphocyte count (P = 0.016) and highest NLR (P < 0.001). CONCLUSIONS The NLR is strongly influenced by serum vitamin D level. Given the high prevalence of hypovitaminosis D and elevated NLR among chronic disease patients and the elderly, our results suggest that clinical interpretation of NLR as a predictive marker of type 2 diabetes mellitus-related inflammation should consider vitamin D level, age and pre-existing morbidity.
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Affiliation(s)
- Si‐Yang Wang
- Department of GeriatricsShanghai Xuhui Central HospitalShanghaiChina
| | - Ting‐Ting Shen
- Department of GeriatricsZhongshan‐Xuhui Hospital Affiliated to Fudan UniversityShanghaiChina
| | - Bei‐Li Xi
- Department of GeriatricsShanghai Xuhui Central HospitalShanghaiChina
| | - Zhan Shen
- Department of GeriatricsShanghai Xuhui Central HospitalShanghaiChina
| | - Xian Zhang
- Department of GeriatricsShanghai Xuhui Central HospitalShanghaiChina
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Yin X, Xin M, Ding S, Gao F, Wu F, Wang J, Chen J, Jiang L, Wu X, Wang X, Liu J, Zhang J, He S. Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension. BMC Surg 2021; 21:3. [PMID: 33397333 PMCID: PMC7780205 DOI: 10.1186/s12893-020-01009-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/13/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. METHODS A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. RESULTS We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). CONCLUSION For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.
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Affiliation(s)
- Xiaoqiang Yin
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Mei Xin
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Feng Gao
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Fan Wu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jian Wang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jie Chen
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Li Jiang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Xiaochen Wu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Xianying Wang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jingzhen Liu
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China
| | - Jinbao Zhang
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China.
- North Sichuan Medical College, Nanchong, Sichuan, China.
| | - Siyi He
- Department of Cardiovascular Surgery, Jinniu District, General Hospital of Western Theater Command, Rongdu Avenue No.270, Chengdu, 610083, Sichuan, China.
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Li P, Xia C, Liu P, Peng Z, Huang H, Wu J, He Z. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease (ESRD). BMC Nephrol 2020; 21:511. [PMID: 33238906 PMCID: PMC7690201 DOI: 10.1186/s12882-020-02174-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 11/17/2020] [Indexed: 12/22/2022] Open
Abstract
Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to be associated with inflammation in end-stage renal disease (ESRD) receiving dialysis. However, the value of NLR and PLR in non-dialysis patients with ESRD remains unclear. Methods Among 611 non-dialysis patients with ESRD in The First Affiliated Hospital of University of South China (2012–2018), we compared NLR and PLR in patients with high-sensitivity C-reactive protein (hs-CRP) levels of ≤3 mg/L vs. > 3 mg/L. Correlation of NLR and PLR to hs-CRP, PCT, ferritin were analyzed. Receiver operating characteristics (ROC) analysis was used for estimating sensitivity and specificity of NLR and PLR. Results NLR was higher in the patients with high hs-CRP levels (> 3 mg/L), compared to patients with low hs-CRP levels (≤ 3 mg/L) [5.74 (3.54–9.01) vs. 3.96 (2.86–5.85), p < 0.0001]. Additionally, PLR was higher in high hs-CRP group than in low group [175.28 (116.67–252.26) vs. 140.65 (110.51–235.17), p = 0.022]. In the current study, NLR and PLR were both positively correlated with hs-CRP (rs = 0.377, p = 0.000 for NLR; rs = 0.161, p = 0.001 for PLR), PCT, leukocytes, neutrophils, platelets, and age. NLR or PLR with a cut-off value of 5.07 or 163.80 indicated sensitivity and specificity were 65.67 and 66.37% (AUC = 0.69) or 57.21 and 57.52% (AUC = 0.55), respectively. Conclusions NLR or PLR was positively correlated with hs-CRP in non-dialysis patients with ESRD. NLR might be better for identifying inflammation than PLR in this population.
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Affiliation(s)
- Peiyuan Li
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, Hengyang, 421001, PR China
| | - Chenqi Xia
- Department of Nephrology, The First Affiliated Hospital of University of South China, Hengyang, Hunan Province, 421001, PR China
| | - Peng Liu
- Department of Nephrology, The First Affiliated Hospital of University of South China, Hengyang, Hunan Province, 421001, PR China
| | - Zhong Peng
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, Hengyang, 421001, PR China
| | - Hong Huang
- Institute of Clinical Medicine, The First Affiliated Hospital of University of South China, Hengyang, 421001, PR China
| | - Juan Wu
- Department of Gastroenterology, The First Affiliated Hospital of University of South China, Hengyang, 421001, PR China
| | - Zhangxiu He
- Department of Nephrology, The First Affiliated Hospital of University of South China, Hengyang, Hunan Province, 421001, PR China.
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Yu Y, Lin Q, Ye D, Wang Y, He B, Li Y, Huang G, Zhou Z, Xiao Y. Neutrophil count as a reliable marker for diabetic kidney disease in autoimmune diabetes. BMC Endocr Disord 2020; 20:158. [PMID: 33092580 PMCID: PMC7580021 DOI: 10.1186/s12902-020-00597-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 07/15/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A growing body of evidence supports neutrophils as having an active role in the development of diabetic kidney disease (DKD). However, the clinical relevance of neutrophils and DKD in autoimmune diabetes remains unknown. This study aimed to investigate the relationship between circulating neutrophils and DKD in autoimmune diabetes. METHODS Patients with type 1 diabetes (T1D, n = 226) and latent autoimmune diabetes in adults (LADA, n = 79) were enrolled and stratified according to the urinary albumin to creatinine ratio (ACR). Circulating levels of white blood cells (WBCs), including neutrophils, were measured in a central laboratory, and the neutrophil-to-lymphocyte ratio (NLR) was calculated. The risk factors associated with DKD were analysed by logistic regression. RESULTS In T1D and LADA patients, the peripheral neutrophil counts increased in parallel with DKD advancement. The neutrophil counts in the patients with macroalbuminuria were significantly higher than those in the patients with normoalbuminuria for each type of diabetes. Furthermore, neutrophil counts positively correlated with ACR in T1D. In addition, neutrophils were independently associated with DKD in T1D in the logistic regression analysis, when various well-known risk factors, including age, gender, disease duration, hypertension, dyslipidemia and smoking status, were adjusted. CONCLUSIONS Neutrophil counts are closely associated with DKD in patients with autoimmune diabetes, suggesting that neutrophil-mediated inflammation may be involved in the pathogenesis of DKD in patients with autoimmune diabetes.
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Affiliation(s)
- Yao Yu
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Qiuqiu Lin
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Dewei Ye
- Joint Laboratory between Guangdong and Hong Kong on Metabolic Diseases, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yanfei Wang
- Department of Endocrinology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Binbin He
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Yanhua Li
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Gan Huang
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Zhiguang Zhou
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Yang Xiao
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China.
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Yang Y, Lai C, Yan F, Wang J. Clinical Significance of MRI Contrast Enhancement of the Oculomotor Nerve in Ischemic Isolated Oculomotor Nerve Palsy. J Clin Neurol 2020; 16:653-658. [PMID: 33029972 PMCID: PMC7541971 DOI: 10.3988/jcn.2020.16.4.653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose Contrast enhancement of the oculomotor nerve in MRI was recently noticed in patients with clinical ischemic isolated oculomotor nerve palsy (iIONP). The opinions about whether this is a sign of inflammation and whether or not to administer steroids vary between doctors. The study aimed to determine the associations between this enhancement and vascular-disease risk factors (VRFs) and inflammatory factors in iIONP patients. Methods The study recruited patients who had experienced iIONP during the previous 2 years. They were divided into groups A and B based on whether or not they exhibited an enhanced oculomotor nerve in MRI of the cavernous sinus using thin-section, fat-suppressed, and contrast-enhanced sequences. VRFs, inflammatory factors, and improvement scores were compared between the two groups. Results Most (71.1%) of the 45 included iIONP patients had enhanced oculomotor nerves in MRI. VRFs, periorbital pain, elevated C-reactive protein and erythrocyte sedimentation rate, the neutrophil-to-lymphocyte ratio, and the platelet-to-lymphocyte ratio were not significantly associated with the enhancement. Four of the five patients in group A exhibited an elevated cerebrospinal fluid (CSF) IgG synthesis rate. The improvement score of eight patients who received 80 mg of methylprednisolone in addition to the routine therapy was not significantly different from the scores of the other patients (p=0.485). Conclusions More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level.
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Affiliation(s)
- Yan Yang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chuntao Lai
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Fei Yan
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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Sekeryapan Gediz B, Ozturk M, Kilinc Hekimsoy H, Yuksel EG, Ozdamar Erol Y. Choroidal Vascularity Index as a Potential Inflammatory Biomarker for Obsessive Compulsive Disorder. Ocul Immunol Inflamm 2020; 30:428-432. [DOI: 10.1080/09273948.2020.1800052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Berrak Sekeryapan Gediz
- Ophthalmology Department, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ozturk
- Psychiatry Department, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hilal Kilinc Hekimsoy
- Ophthalmology Department, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Emine Gokcen Yuksel
- Ophthalmology Department, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Yasemin Ozdamar Erol
- Ophthalmology Department, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Yenibertiz D, Ozyurek BA, Erdogan Y. Is Onodera's prognostic nutritional index (OPNI) a prognostic factor in small cell lung cancer (SCLC)? THE CLINICAL RESPIRATORY JOURNAL 2020; 14:689-694. [PMID: 32170830 DOI: 10.1111/crj.13185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/04/2020] [Accepted: 03/08/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION We aimed to evaluate the prognostic value of Onodera's prognostic nutritional index (OPNI) in patients with Small-cell lung cancer (SCLC). MATERIALS AND METHODS This study retrospectively examined 109 patients diagnosed with SCLC between January 2008 and October 2018 in our hospital. Patients were divided into two groups according to the median of OPNI values. RESULTS A significant difference was observed between the groups in terms of neutrophil percentage, lymphocyte count, lymphocyte percentage, C-reactive protein (CRP), albumin, lactat dehidrogenase (LDH) and neutrophil to lymphocyte ratio (NLR) (P < 0.05). LDH, CRP, neutrophil percentage and NLR (P = 0.008, P < 0.001, P = 0.001, P < 0.001, respectively) were significantly higher and albumin, lymphocyte count and lymphocyte percentage (P < 0.001, P < 0.001, P = 0.001, respectively) were significantly lower in the low OPNI group. Survival analyses have shown that mortality rates and lifespan are similar in the two groups. CONCLUSION The OPNI may be a helpful tool for determining the prognosis in SCLC.
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Affiliation(s)
- Derya Yenibertiz
- Department of Chest Disease, University of Health Sciences Ankara Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Berna Akinci Ozyurek
- Department of Chest Disease, University of Health Sciences Ankara Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Yurdanur Erdogan
- Department of Chest Disease, University of Health Sciences Ankara Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
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Guo S, Wang M, Yu Y, Yang Y, Zeng F, Sun F, Li Q, He M, Li Y, Wen J, Gong W, Zhang Z. The association of erythrocyte sedimentation rate, high-sensitivity C-reactive protein and diabetic kidney disease in patients with type 2 diabetes. BMC Endocr Disord 2020; 20:103. [PMID: 32660469 PMCID: PMC7358197 DOI: 10.1186/s12902-020-00584-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To evaluate the association between high-sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR), and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional study was conducted in 1210 patients with T2DM, among whom 265 had DKD. The severity of DKD was assessed by estimated-glomerular filtration rate (eGFR) and urinary albumin creatinine ratio (ACR). The relationship between ESR, hsCRP and DKD was analyzed by multivariate logistic analysis. The relationship between ESR and eGFR, ESR or ACR was analyzed by multivariate linear regression. RESULTS ESR (23.0 [12.0 ~ 41.5] mm/h versus 12.0 [7.0 ~ 22.0] mm/h, P < 0.001) and hsCRP (3.60 [2.20 ~ 7.65] versus 2.90 [1.80 ~ 5.60] mg/L mg/L, P < 0.01) values were significantly higher in patients with DKD than those without. Patients with higher ESR or hsCRP had lower eGFR and higher ACR. After adjusted for gender, age, hemoglobin, plasma proteins, HbA1c, lipid profiles, and the usage of renin-angiotensin system inhibitors, ESR but not hsCRP was independently associated with the rate and severity of DKD in patients with T2DM. CONCLUSION ESR was independently associated with the rate and severity of DKD in patients with T2DM.
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Affiliation(s)
- Shizhe Guo
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Meng Wang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Yifei Yu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Yeping Yang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Fangfang Zeng
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Fei Sun
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Qin Li
- Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Min He
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Yiming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Jie Wen
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
- Department of Endocrinology, Jing'an District Center Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Gong
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China.
| | - Zhaoyun Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China.
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Akase T, Kawamoto R, Ninomiya D, Kikuchi A, Kumagi T. Neutrophil-to-lymphocyte ratio is a predictor of renal dysfunction in Japanese patients with type 2 diabetes. Diabetes Metab Syndr 2020; 14:481-487. [PMID: 32388325 DOI: 10.1016/j.dsx.2020.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Neutrophil-to-lymphocyte ratio (NLR) has been widely evaluated as a biomarker in various medical and surgical prognoses, but its usefulness in diabetic kidney disease is not yet known. METHODS This prospective observational study included outpatients, comprised of 184 men aged 73 ± 11 (mean ± standard deviation) years and 174 women aged 76 ± 10 years at baseline, from a rural hospital. We examined the relationship between baseline NLR calculated by analyzing the differential leukocyte counts in the complete blood count and the 2-year estimated glomerular filtration rate (eGFR) decline rate (i.e. 2-year eGFR-baseline eGFR) ∗100/baseline eGFR. Rapid eGFR decline rate was defined as a value < -25%. RESULTS Multiple linear regression analysis using rapid eGFR decline rates as objective variables, adjusted for confounding factors as explanatory variables, showed that NLR (β = 0.138, p = 0.007) as well as presence of antidyslipidemic medication, hemoglobinA1c, and urinary albumin excretion stage were significantly and independently associated with a rapid eGFR decline rate. The multivariate-adjusted odds ratios (95% confidence interval) of the 2nd and 3rd tertiles of baseline NLR for rapid eGFR decline rate were 3.62 (0.70-18.7) and 8.03 (1.54-41.9), respectively. Multivariate-adjusted mean eGFR (95% confidence interval) values after 2 years categorized by tertile of baseline NLR were: 1st, 63.9 (61.8-66.1); 2nd, 60.8 (58.7-62.9); and 3rd, 58.9 (56.8-61.0). CONCLUSIONS These results suggest that baseline NLR might be a useful biomarker for renal function decline in outpatients with diabetes.
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Affiliation(s)
- Taichi Akase
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan; Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Ryuichi Kawamoto
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan; Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Daisuke Ninomiya
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan; Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Asuka Kikuchi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan; Department of Internal Medicine, Seiyo Municipal Nomura Hospital, Japan.
| | - Teru Kumagi
- Department of Community Medicine, Ehime University Graduate School of Medicine, Japan.
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Huang X, Qin Z, Xu M, Zhang F, Jiang X, Hua F, Tao L. Neutrophil: lymphocyte ratio is positively associated with subclinical diabetic cardiomyopathy. BMC Endocr Disord 2020; 20:99. [PMID: 32605653 PMCID: PMC7329473 DOI: 10.1186/s12902-020-00571-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Subclinical diabetic cardiomyopathy (DCM) occurs frequently in asymptomatic subjects with Type 2 diabetes mellitus (T2DM). The direct association between the immune system and DCM with effective biomarkers has been demonstrated in previous studies. METHODS Five hundred seven subjects with T2DM were recruited from April 2018 to October 2019 and divided into T2DM with cardiac dysfunction (DCM) group and T2DM without cardiac dysfunction (non-DCM) group. The relationship between the quartiles of Neutrophil: lymphocyte ratio (NLR) and subclinical DCM was evaluated by using adjusted logistic regression models.(covariates: age, sex, BMI, duration of diabetes, and hyperlipidemia). RESULTS Blood NLR was significantly upregulated in DCM group compared to non-DCM group (P = 0.05). Then the adjusted odds ratio (95% CI) of the highest NLR quartile was 14.32 (2.92-70.31) compared with the lowest quartile of NLR after multiple adjusted (P < 0.001). However, there was no significant relation between neutrophil and lymphocyte counts and the occurrence of DCM in T2DM patients. CONCLUSIONS This study demonstrated that NLR was associated with the occurrence of subclinical DCM, suggesting that NLR may be a biomarker for predicting DCM with effectiveness and accuracy. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR1900027080) . Registered 30 October 2019. Retrospectively registered: www.medresman.org.
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Affiliation(s)
- Xiaoli Huang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Zihan Qin
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Min Xu
- Department of Echocardiography, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Xiaohong Jiang
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Fei Hua
- Department of Endocrinology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
| | - Lichan Tao
- Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou City, 213003 China
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Assulyn T, Khamisy-Farah R, Nseir W, Bashkin A, Farah R. Neutrophil-to-lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. J Clin Lab Anal 2020; 34:e23259. [PMID: 32096579 PMCID: PMC7370726 DOI: 10.1002/jcla.23259] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIM Chronic inflammation has an important role in the development and progression of type 2 diabetes through immunologic inflammatory mechanisms. Simple new inexpensive inflammatory markers may contribute to the detection of microalbuminuria. Aim of our study is to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and red blood cell distribution width (RDW) for microalbuminuria in type 2 diabetic patients for possible application as prognostic factors for the prediction of microalbuminuria and the progression of disease in patients with diabetes. METHODS A total of 168 patients with type 2 diabetes mellitus were classified into gender- and BMI-matched three groups according to hemoglobin A1c and microalbuminuria: Group A: 53 patients with controlled diabetes, Group B: 57 patients with uncontrolled diabetes, both without microalbuminuria, and Group C: 58 patients with uncontrolled diabetes with microalbuminuria. Levels of NLR, MPV, and RDW between the study groups were examined and compared. RESULTS A significant difference in NLR was found between Group C and groups A and B (P < .001, P = .005, respectively). A statistically significant difference in RDW was found between groups B and C (P = .014). Receiver operating characteristic curve analysis of inflammatory markers and microalbuminuria prediction showed an area under curve (AUC) of 0.675 for NLR (CI 0.58-0.76, P < .001) and 0.614 for RDW (CI 0.52-0.70, P = .013). NLR value of 2.54 has 39.7% sensitivity, 78.8% specificity, and 45% positive predictive value (PPV). RDW value of 14.44 has 37.9% sensitivity, 76% specificity, and 41.5% PPV. CONCLUSIONS Neutrophil-to-lymphocyte ratio and RDW have PPV for microalbuminuria in diabetic patients.
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Affiliation(s)
| | - Rola Khamisy-Farah
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Clalit Health Services, Akko, Israel
| | - William Nseir
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Department of Internal Medicine A, Baruch Padeh Medical Center, Poriya, Israel
| | - Amir Bashkin
- Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Raymond Farah
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Department of Internal Medicine B, Ziv Medical Center, Safed, Israel
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Al-Osami MH, Awadh NI, Khalid KB, Awadh AI. Neutrophil/lymphocyte and platelet/lymphocyte ratios as potential markers of disease activity in patients with Ankylosing spondylitis: a case-control study. Adv Rheumatol 2020; 60:13. [DOI: 10.1186/s42358-020-0113-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 01/19/2020] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
The neutrophil/ lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have the potential to be inflammatory markers that reflect the activity of many inflammatory diseases. The aim of this study was to evaluate the NLR and PLR as potential markers of disease activity in patients with ankylosing spondylitis.
Methods
The study involved 132 patients with ankylosing spondylitis and 81 healthy controls matched in terms of age and gender. Their sociodemographic data, disease activity scores using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), and white blood cell, neutrophil, lymphocyte and platelet counts were recorded. The patients with ankylosing spondylitis were further divided according to their BASDAI scores into patients with inactive disease (BASDAI < 4) and patients with active disease (BASDAI ≥4). The correlations between the NLR, PLR and disease activity were analysed.
Results
There was a statistically significant difference in the NLR and PLR between the active and inactive ankylosing spondylitis patients (2.31 ± 1.23 vs. 1.77 ± 0.73, p = 0.002), (142.04 ± 70.98 vs. 119.24 ± 32.49, p < 0.001, respectively). However, there was no significant difference in both the NLR and PLR between the healthy control group and ankylosing spondylitis patients (p > 0.05). In addition, the PLR was significantly higher in both the active and inactive groups compared to those in the healthy control group (142.04 ± 70.98 vs. 99.32 ± 33.97, p = 0.014), (119.24 ± 32.49 vs. 99.32 ± 33.97, p = 0.019). The BASDAI scores were positively correlated with the PLR (r = 0.219, p = 0.012) and the NLR, but they were not statistically significant with the later (r = 0.170, p = 0.051). Based on the ROC curve, the best NLR cut-off value for predicting severe disease activity in ankylosing spondylitis patients was 1.66, with a sensitivity of 61.8% and a specificity of 50.6%, whereas the best PLR cut-off value was 95.9, with a sensitivity of 70.9% and a specificity of 55.5%.
Conclusion
The PLR may be used as a useful marker in the assessment and monitoring of disease activity in AS together with acute phase reactants such as the ESR.
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Uçar M, Soyupek S, Oksay T, Özorak A, Akkoç A, Topçuoğlu M, Demir M, Koşar A. Can we Predict Preoperative Tumor Aggressivity with Hemogram Parameters in Renal Cell Carcinoma? a Novel Calculation Method. J Med Syst 2019; 44:19. [PMID: 31823081 DOI: 10.1007/s10916-019-1491-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/17/2019] [Indexed: 12/01/2022]
Abstract
We aim to investigate the prognostic significance of the hemoglobin X lymphocyte / neutrophil ratio (HLNR) and hemoglobin x lymphocyte / platelet ratio (HLPR) with tumor aggressivity in patients with renal cell carcinoma. We retrospectively analyzed 127 patients' data who had diagnosed as renal cell carcinoma between 2008 and 2019 in Suleyman Demirel University Hospital. Tumor and patient characteristics, hemoglobin, neutrophil, lymphocyte, platelet values HLNR and HLPR were calculated in preoperative hemogram parameters. The relationship between tumor pathological stage, Fuhrman nuclear grade and tumor necrosis with HLPR and HLNR analyzed with statistically. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLNR. P values are 0.003, 0.012 and 0.015 respectively. HLNR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. There was a negative correlation between pathologic stage, Fuhrman nuclear grade and tumor necrosis with HLPR. P values are 0.001, 0.014 and 0.047 respectively. HLPR was lower in patients with high pathologic stage, high Fuhrman nuclear grade and accompanying tumor necrosis positiveness. High pathological stage, high Fuhrman nuclear grade and existence of tumor necrosis are associates with preoperative low HLNR and low HLPR in renal cell carcinoma patients. They can be used as prognostic markers in patients with renal mass preoperatively.
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Affiliation(s)
- Murat Uçar
- Alanya Alaaddin Keykubat University, School of Medicine, Antalya, Turkey.
| | - Sedat Soyupek
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Taylan Oksay
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Alper Özorak
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Ali Akkoç
- Alanya Alaaddin Keykubat University, School of Medicine, Antalya, Turkey
| | - Murat Topçuoğlu
- Alanya Alaaddin Keykubat University, School of Medicine, Antalya, Turkey
| | - Murat Demir
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
| | - Alim Koşar
- Süleyman Demirel University, School of Medicine, Isparta, Turkey
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Tagawa M, Nishimoto M, Kokubu M, Matsui M, Eriguchi M, Samejima KI, Akai Y, Tsuruya K. Acute kidney injury as an independent predictor of infection and malignancy: the NARA-AKI cohort study. J Nephrol 2019; 32:967-975. [PMID: 31617159 DOI: 10.1007/s40620-019-00662-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with higher mortality and cardiovascular events. However, association between AKI and non-cardiac events such as infection or malignancy is largely unknown. METHODS This is a retrospective cohort study. Inclusion criteria were adults who underwent non-cardiac surgery from 2007 to 2011 at Nara Medical University Hospital. Exclusion criteria were urological surgery, obstetric surgery, missing creatinine values peri-operatively, and pre-operative dialysis. The end of observation period was at the end of 2015 or loss to follow-up. A predictor was AKI defined by KDIGO criteria within 1-week post-operatively. Outcomes were hospitalization for infection or diagnoses of malignancy. Associations between AKI and outcomes were examined by Cox regression models. RESULTS Among 6692 subjects, 445 (6.6%) developed AKI. During median follow-up of 4.0 years, there were 485 hospitalizations for infection and 1138 diagnoses of malignancy (2.0 and 5.1 events/100 patient-years, respectively). After adjustment for potential confounders, AKI was independently associated with hospitalization for infection and diagnoses of malignancy (Hazard ratio [95% confidence interval]: 1.64 [1.23-2.20] and 1.31 [1.06-1.61], respectively). Excluding recurrence of malignancy from outcomes and analyses limited to those who recover renal function by the time of discharge yielded similar results. Absolute lymphocyte counts were significantly lower and neutrophil-to-lymphocyte ratios were significantly higher among those with AKI. CONCLUSIONS AKI was significantly associated with hospitalization for infection and development of malignancy during long-term follow-up. Those with AKI might be in persistent immunosuppressed state.
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Affiliation(s)
- Miho Tagawa
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 6348521, Japan.
| | - Masatoshi Nishimoto
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 6348521, Japan
| | - Maiko Kokubu
- Department of Nephrology, Nara Prefecture General Medical Center, 2-897-5, Shichijo-nishi-machi, Nara, Nara, 6308581, Japan
| | - Masaru Matsui
- Department of Nephrology, Nara Prefecture General Medical Center, 2-897-5, Shichijo-nishi-machi, Nara, Nara, 6308581, Japan
| | - Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 6348521, Japan
| | - Ken-Ichi Samejima
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 6348521, Japan
| | - Yasuhiro Akai
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 6348521, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 6348521, Japan
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Kutlugun AA, Ebinc FA, Ozturk MT, Efe FK, Karadag İ, Eser M, Unsal O, Karakaya S. Association of neutrophil-to-lymphocyte ratio and microalbuminuria in patients with normal eGFR. ACTA ACUST UNITED AC 2019; 56:21-26. [PMID: 28945608 DOI: 10.1515/rjim-2017-0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Indexed: 12/15/2022]
Abstract
AIMS The aim of this study was to evaluate the association between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and microalbuminuria in patients with normal estimated glomerular filtration rate (eGFR). METHODS 174 patients who had eGFR ≥ 60 mL/min/1.73 m2 were studied. Patients were divided into two groups according to the urinary albumin excretion as microalbuminuric group (n = 105) and normoalbuminuric group (n = 69). NLR and PLR levels were calculated. RESULTS NLR was significantly higher (p < 0.05) in microalbuminuric patients (1.91 ± 0.70) compared with normoalbuminuric patients (1.63 ± 0.53). A positive correlation was found between urine albumin excretion and NLR in the whole study group (r = 0.214, p < 0.005). CONCLUSIONS Higher NLR levels were found in microalbuminuric patients with normal eGFR. Also a significant positive correlation was observed between albuminuria and NLR.
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Affiliation(s)
- Aysun Aybal Kutlugun
- Department of Nephrology, Keçioren Education and Research Hospital, Ankara, Turkey
| | - Fatma Ayerden Ebinc
- Department of Nephrology, Keçioren Education and Research Hospital, Ankara, Turkey
| | - Mujgan Tek Ozturk
- Department of Cardiology, Keçioren Education and Research Hospital, Ankara, Turkey
| | - Fatma Kaplan Efe
- Department of Internal Medicine, Keçioren Education and Research Hospital, Ankara, Turkey
| | - İbrahim Karadag
- Department of Internal Medicine, Keçioren Education and Research Hospital, Ankara, Turkey
| | - Murat Eser
- Department of Internal Medicine, Keçioren Education and Research Hospital, Ankara, Turkey
| | - Oktay Unsal
- Department of Internal Medicine, Keçioren Education and Research Hospital, Ankara, Turkey
| | - Serdar Karakaya
- Department of Internal Medicine, Keçioren Education and Research Hospital, Ankara, Turkey
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Howard R, Scheiner A, Kanetsky PA, Egan KM. Sociodemographic and lifestyle factors associated with the neutrophil-to-lymphocyte ratio. Ann Epidemiol 2019; 38:11-21.e6. [PMID: 31481293 DOI: 10.1016/j.annepidem.2019.07.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/18/2019] [Accepted: 07/24/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation with established prognostic value in patients with cancer. Although high NLR is associated with poorer clinical outcomes, factors that influence the magnitude of NLR independently of disease are poorly understood. METHODS We identified 48,023 adults who participated in the National Health and Nutrition Examination Survey (1999-2016). Demographic, socioeconomic, and lifestyle factors associated with the magnitude of NLR after adjusting for comorbidities including heart disease, cancer, diabetes, and hypertension, and medications including aspirin, were identified. Effect modification by comorbidity status and demographics was explored. RESULTS Female gender, age less than 60 years, and non-Hispanic black race/ethnicity were associated with lower NLR. Marital statuses of widowed, separated, or never married demonstrated increased NLR as compared with those who were currently married. Never-smoking and moderate alcohol consumption were associated with lower NLR. Participation in physical activity was associated with decreased NLR after adjustment for potential confounders, primarily among non-Hispanic whites. CONCLUSIONS Multiple demographic and lifestyle factors are independently associated with NLR. Sex, age, race, marital status, body mass index, physical activity, smoking history, and alcohol consumption should all be routinely collected and adjusted for to improve the accuracy of assessment of the prognostic power of NLR.
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Affiliation(s)
- Rachel Howard
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
| | - Aaron Scheiner
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kathleen M Egan
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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The relationship of blood neutrophil-to-lymphocyte ratio with nutrition markers and health outcomes in hemodialysis patients. Int Urol Nephrol 2019; 51:1239-1247. [PMID: 31089947 DOI: 10.1007/s11255-019-02166-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 04/30/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adverse outcomes in hemodialysis patients have been attributed, in part, to the pro-inflammatory state prevalent in this population. This study examines the relationship between blood neutrophil-to-lymphocyte ratio (NLR) with nutrition markers and health outcomes in hemodialysis (HD) patients. DESIGN This is a 12-month prospective cohort study that recruited 77 participants from May to Jun 2017. SETTINGS AND SUBJECTS Patients receiving maintenance hemodialysis. MAIN OUTCOMES Hospitalization, transplants and mortality. RESULTS Of the 77 participants, 63.8% were hospitalized, 10 (13%) died of cardiovascular diseases and 6 (7.8%) had a kidney transplant. Spearman correlations using baseline values showed an inverse significant correlation between the total number of hospitalizations and BMI kg/m2 (BMI rho = - 0.37, P <0.001); a significant inverse correlation between NLR and albumin (rho = - 0.22, P = 0.028); and a significant direct correlation between baseline NLR and BMI kg/m2 (rho = 0.22, P = 0.028). Participants were grouped by their NLR value into quartiles for outcomes analysis: quartile 1 (NLR ≤ 1.75), quartile 2 (NLR 1.76-2.6), quartile 3 (NLR 2.7-3.9) and quartile 4 (NLR ≥ 4). The percentage of patients with the lowest level of inflammation (NLR ≤ 1.75) was greater for not hospitalized patients than for hospitalized (39.3% vs 16.3%, P = 0.025) and not hospitalized participants had higher BMI kg/m2 (mean ± SD) at baseline compared to those hospitalized (29.11 ± 5.4 vs 26.22 ± 5.34, P = 0.026). In a multivariate cox regression analysis, participants in the lowest quartile (NLR ≤ 1.75) were compared to the rest on hospitalization, mortality and transplant. Years in dialysis, BMI kg/m2 and NLR ≤ 1.75 were significant predictors of hospitalization after adjustment (P = 0.021, P = 0.005, P = 0.039; respectively) and we observed an association of low NLR with a hazard ratio (HR 0.44, 95% CI 0.20-0.96, P = 0.039), BMI (HR 0.90, 95% CI 0.85-0.97, P = 0.005) and years in dialysis (HR 0.90, 95% CI 0.83-0.98, P = 0.021) for hospitalization in overall participants. In a further analysis comparing the effect of low NLR in the subgroup of diabetic vs non-diabetics, it was observed that BMI kg/m2 was a significant predictor for hospitalization in the non-diabetic subgroup (P = 0.040) but not significant in the case of diabetics (P = 0.128) after adjustments. Years in dialysis and NLR ≤ 1.75 were significant predictors of hospitalizations in the subgroup of diabetic before and after adjustment (P = 0.049, P = 0.044; respectively). Having a low NLR decreased 73% the risk for hospitalization (HR 0.27 95% CI 0.07-0.96, P = 0.044) in this subgroup. Survival and hospitalization curves were analyzed by comparing all participants and the diabetic subgroup, in the lowest inflammation quartile vs the rest (NLR ≤ 1.75 vs NLR > 1.75). Participants with NLR ≤ 1.75 had 100% survival rate (log-rank test, P = 0.059) and lower hospitalization rate (log-rank test, P = 0.025); participants with diabetes had lower hospitalization rate (log-rank test, P = 0.039). CONCLUSION NLR at baseline was associated with nutritional markers (albumin, BMI). Low NLR at baseline was a predictor of lower risk for hospitalizations in HD patients with diabetes.
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Icel E, Ucak T, Karakurt Y, Yilmaz H, Tasli NG, Turk A. The Relation of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio with High Axial Myopia. Ocul Immunol Inflamm 2019; 28:396-401. [PMID: 30994377 DOI: 10.1080/09273948.2019.1588334] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose: To investigate the relation between high axial myopia and neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) values.Methods: Seventy-nine cases were enrolled, 50 myopic and 29 emmetropic. All participants were assigned into three groups: Group I (high myopia with no retinal involvement), Group II (high myopia with retinal involvement) and Group III (control). NLR and PLR values calculated from blood tests were compared among the groups.Results: Mean NLR levels were 2.23 ± 0.78 in Group I, 2.36 ± 1.06 in Group II, and 1.57 ± 0.33 in Group III. Mean PLR levels were 114.62 ± 23.21 in Group I, 145.16 ± 52.36 in Group II, and 91.42 ± 18.73 in Group III. NLR and PLR values in the high myopia groups were significantly higher than in the control group.Conclusion: NLR and PLR values in cases with high axial myopia were higher than in the emmetropic group. Higher inflammation in the degenerative myopic group in particular may be related to pathological chorioretinal changes.
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Affiliation(s)
- Erel Icel
- Faculty of Medicine, Department of Ophthalmology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Turgay Ucak
- Faculty of Medicine, Department of Ophthalmology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Yücel Karakurt
- Faculty of Medicine, Department of Ophthalmology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Hayati Yilmaz
- Faculty of Medicine, Department of Ophthalmology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Nurdan Gamze Tasli
- Faculty of Medicine, Department of Ophthalmology, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Adem Turk
- Faculty of Medicine, Department of Ophthalmology, Karadeniz Technical University, Trabzon, Turkey
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Mattared AM, Esheba NE, Elshora OA, Mohamed WS. Mean platelet volume and neutrophil to lymphocyte ratio in prediction of early diabetic nephropathy in type 2 diabetics. Diabetes Metab Syndr 2019; 13:1469-1473. [PMID: 31336508 DOI: 10.1016/j.dsx.2019.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Affiliation(s)
| | - Noha E Esheba
- Internal Medicine Department, Faculty of Medicine, Tanta University, Egypt
| | - Ola A Elshora
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Egypt.
| | - Waleed S Mohamed
- Internal Medicine Department, Faculty of Medicine, Tanta University, Egypt.
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Association of neutrophil-to-lymphocyte ratio with early renal dysfunction and albuminuria among diabetic patients. Int Urol Nephrol 2019; 51:483-490. [PMID: 30607775 DOI: 10.1007/s11255-018-02065-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/24/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Neutrophil-to-lymphocyte ratio (NLR) was widely studied as a prognostic marker in various medical and surgical specialties, but its significance in diabetic kidney disease is not yet established. METHODS The subjects comprised 199 men aged 73 ± 11 (mean ± standard deviation) years and 187 women aged 77 ± 10 years from a rural hospital. We examined the relationship between NLR calculated by analyzing differential leukocyte count in complete blood picture and renal function evaluated by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study Group equation and urinary albumin excretion (UAE). RESULTS NLR was negatively related to eGFR and positively related to UAE. Multiple linear regression analysis using eGFR and UAE as an objective variables, adjusted for confounding factors as explanatory variables showed that NLR (β = - 0.101, p = 0.009) as well as age, body mass index, serum uric acid, and presence of uric acid lowing medication were significantly and independently associated with eGFR, and NLR (β = 0.113, p = 0.031) as well as prevalence of cardiovascular disease, systolic blood pressure, presence of antihypertensive medication, presence of antilipidemic medication, and eGFR were significantly and independently associated with UAE. The multivariate-adjusted odds ratios (95% confidence interval) of NLR for stage 3a (eGFR < 60 mL/min/1.73 m2), stage 3b (eGFR < 45 mL/min/1.73 m2), and microalbuminuria (UAE ≥ 30 mg/g Cr) were 1.90 (1.02-3.56) and 2.99 (1.28-6.98), and 1.77 (1.04-3.01), respectively. Next, to examine the consistency of the observed association between NLR and eGFR, we performed subgroup analyses. There was a significant interaction (p = 0.006) only between the two groups regarding antihypertensive medication (absence: β = - 0.272, p < 0.001 and presence: β = - 0.029, p = 0.564). CONCLUSIONS Our data suggested that NLR might be important as a potential factor for evaluating patients with a higher degree of albuminuria among diabetic outpatients.
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The association of neutrophil to lymphocyte ratio, mean platelet volume, and platelet distribution width with diabetic retinopathy and nephropathy: a meta-analysis. Biosci Rep 2018; 38:BSR20180172. [PMID: 29581246 PMCID: PMC6019380 DOI: 10.1042/bsr20180172] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/13/2018] [Accepted: 03/26/2018] [Indexed: 01/02/2023] Open
Abstract
The aim of the present study was to investigate the correlation of neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet distribution width (PDW) with diabetic nephropathy (DN) and diabetic retinopathy (DR). We searched for eligible studies from PubMed, Embase, Web of Science, and CNKI up to 1 December 2017. Standardized mean difference (SMD) was calculated with a confidence interval (CI) of 95%. A total of 48 studies were included in our meta-analysis. Compared with patients with type Ⅱ diabetes mellitus (T2DM) and without DR, NLR, MPV, and PDW were higher in patients with DR (SMD = 0.77; 95% CI: 0.49-1.05; P<0.001; SMD = 0.68; 95% CI: 0.36-0.99; P<0.001; SMD = 0.52; 95% CI: 0.28-0.76; P<0.01). Compared with patients with T2DM and without DN, NLR, MPV, and PDW were higher in patients with DN (SMD = 0.63; 95% CI: 0.43-0.83; P<0.001; SMD = 0.81; 95% CI: 0.36-1.25; P<0.001; SMD = 0.70; 95% CI: 0.50-0.90; P<0.001). We also found that MPV was strongly associated with the severity of DR, and NLR was closely related to the degree of DN. Our findings indicated that NLR, MPV, and PDW could be recommended as inexpensive diagnostic biomarkers for DN and DR. However, considering several limitations in the present study, further high-quality clinical studies should be performed to investigate the relationship of NLR, MPV, and PDW to DN and DR.
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Neutrophil-to-lymphocyte ratio as prognostic indicator in gastrointestinal cancers: a systematic review and meta-analysis. Oncotarget 2018; 8:32171-32189. [PMID: 28418870 PMCID: PMC5458276 DOI: 10.18632/oncotarget.16291] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/20/2017] [Indexed: 12/12/2022] Open
Abstract
An accurate, time efficient, and inexpensive prognostic indicator is needed to reduce cost and assist with clinical decision making for cancer management. The neutrophil-to-lymphocyte ratio (NLR), which is derived from common serum testing, has been explored in a variety of cancers. We sought to determine its prognostic value in gastrointestinal cancers and performed a meta-analysis of published studies using the Meta-analysis Of Observational Studies in Epidemiology guidelines. Included were randomized control trials and observational studies that analyzed humans with gastrointestinal cancers that included NLR and hazard ratios (HR) with overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), and/or cancer-specific survival (CSS). We analyzed 144 studies comprising 45,905 patients, two-thirds of which were published after 2014. The mean, median, and mode cutoffs for NLR reporting OS from multivariate models were 3.4, 3.0, 5.0 (±IQR 2.5-5.0), respectively. Overall, NLR greater than the cutoff was associated with a HR for OS of 1.63 (95% CI, 1.53-1.73; P < 0.001). This association was observed in all subgroups based on tumor site, stage, and geographic region. HR for elevated NLR for DFS, PFS, and CSS were 1.70 (95% CI, 1.52-1.91, P < 0.001), 1.64 (95% CI, 1.36-1.97, P < 0.001), and 1.83 (95% CI, 1.50-2.23, P < 0.001), respectively. Available evidence suggests that NLR greater than the cutoff reduces OS, independent of geographic location, gastrointestinal cancer type, or stage of cancer. Furthermore, DFS, PFS, and CSS also have worse outcomes with elevated NLR.
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Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: A retrospective observational study. PLoS One 2018; 13:e0190411. [PMID: 29293605 PMCID: PMC5749807 DOI: 10.1371/journal.pone.0190411] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022] Open
Abstract
Recent studies have suggested that neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein-to-albumin ratio (CAR) are emerging markers of disease activity and prognosis in patients with chronic inflammatory diseases, cardiovascular diseases, or malignancies. Therefore, we investigated the clinical significance and prognostic value of the NLR and CAR in adult patients with polymyositis and dermatomyositis. The medical records of 197 patients with newly diagnosed polymyositis/dermatomyositis between August 2003 and November 2016 were retrospectively reviewed. Survival and causes of death were recorded during an average 33-month observational period. Clinical and laboratory findings were compared between survivors and non-survivors. Using receiver operating characteristic curves, the NLR and CAR cut-off values for predicting survival were calculated. Univariate and multivariate analyses using Cox proportional hazard models were performed to identify factors associated with survival. Twenty-six patients (13.2%) died during the study period, and the 5-year survival-rate was estimated to be 82%. The non-survivor group exhibited older age and a higher prevalence of interstitial lung disease (ILD), acute interstitial pneumonia, and acute exacerbation of ILD compared to that in the survivor group. NLR and CAR values were significantly higher in the non-survivors and in patients with polymyositis/dermatomyositis-associated ILD, and the death rates increased across NLR and CAR quartiles. Furthermore, when stratified according to the NLR or CAR optimal cut-off values, patients with a high NLR (>4.775) or high CAR (>0.0735) had a significantly lower survival rate than patients with low NLR or CAR, respectively. In addition, old age (>50 years), the presence of acute interstitial pneumonia, hypoproteinemia (serum protein <5.5 g/dL), and high NLR (but not high CAR) were independent predictors for mortality. The results indicate that a high NLR is independently associated with worse overall survival. Thus, the baseline NLR level may be a simple, cost-effective prognostic marker in patients with polymyositis/dermatomyositis.
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Winter L, Wong LA, Jerums G, Seah JM, Clarke M, Tan SM, Coughlan MT, MacIsaac RJ, Ekinci EI. Use of Readily Accessible Inflammatory Markers to Predict Diabetic Kidney Disease. Front Endocrinol (Lausanne) 2018; 9:225. [PMID: 29910771 PMCID: PMC5992400 DOI: 10.3389/fendo.2018.00225] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
Diabetic kidney disease is a common complication of type 1 and type 2 diabetes and is the primary cause of end-stage renal disease in developed countries. Early detection of diabetic kidney disease will facilitate early intervention aimed at reducing the rate of progression to end-stage renal disease. Diabetic kidney disease has been traditionally classified based on the presence of albuminuria. More recently estimated glomerular filtration rate has also been incorporated into the staging of diabetic kidney disease. While albuminuric diabetic kidney disease is well described, the phenotype of non-albuminuric diabetic kidney disease is now widely accepted. An association between markers of inflammation and diabetic kidney disease has previously been demonstrated. Effector molecules of the innate immune system including C-reactive protein, interleukin-6, and tumor necrosis factor-α are increased in patients with diabetic kidney disease. Furthermore, renal infiltration of neutrophils, macrophages, and lymphocytes are observed in renal biopsies of patients with diabetic kidney disease. Similarly high serum neutrophil and low serum lymphocyte counts have been shown to be associated with diabetic kidney disease. The neutrophil-lymphocyte ratio is considered a robust measure of systemic inflammation and is associated with the presence of inflammatory conditions including the metabolic syndrome and insulin resistance. Cross-sectional studies have demonstrated a link between high levels of the above inflammatory biomarkers and diabetic kidney disease. Further longitudinal studies will be required to determine if these readily available inflammatory biomarkers can accurately predict the presence and prognosis of diabetic kidney disease, above and beyond albuminuria, and estimated glomerular filtration rate.
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Affiliation(s)
- Lauren Winter
- Endocrine Centre of Excellence, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lydia A. Wong
- Endocrine Centre of Excellence, Austin Health, Melbourne, VIC, Australia
| | - George Jerums
- Endocrine Centre of Excellence, Austin Health, Melbourne, VIC, Australia
| | - Jas-mine Seah
- Endocrine Centre of Excellence, Austin Health, Melbourne, VIC, Australia
| | - Michele Clarke
- Endocrine Centre of Excellence, Austin Health, Melbourne, VIC, Australia
| | - Sih Min Tan
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Melinda T. Coughlan
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richard J. MacIsaac
- Department of Endocrinology and Diabetes, St Vincent’s Health, Melbourne, VIC, Australia
- Department of Medicine, St Vincent’s Health, University of Melbourne, Melbourne, VIC, Australia
| | - Elif I. Ekinci
- Endocrine Centre of Excellence, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia
- *Correspondence: Elif I. Ekinci,
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