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Mahajan M, Prasad MK, Ashok C, Guria RT, Marandi S, Vidyapati, Subrat S, Chowdhury A. The Correlation of the Neutrophil-to-Lymphocyte Ratio With Microvascular Complications in Patients With Diabetes Mellitus. Cureus 2023; 15:e44601. [PMID: 37799262 PMCID: PMC10548773 DOI: 10.7759/cureus.44601] [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] [Accepted: 09/02/2023] [Indexed: 10/07/2023] Open
Abstract
Background High neutrophil-to-lymphocyte ratio (NLR) may be used as a reliable measure of vascular complications and an indicator of poor outcomes in cases of diabetes mellitus (DM). Methods A prospective analytical cross-sectional observational study was conducted at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India. A total of 100 patients with DM who met the inclusion and exclusion criteria were included in the study. A pre-tested and semi-structured questionnaire was given to the patients. IBM SPSS software version 26 (IBM Corp., Armonk, NY, USA) and MedCalc trial version 20.114 (MedCalc Software Ltd., Ostend, Belgium) were used for data analysis. Logistic regression analysis was performed to determine the association of the NLR with microvascular complications. Results In our study, the male-to-female ratio was 1.78:1 (male: 64 (n)%, female: 36 (n)%). The mean age of our study population was 56.28 ± 13.24 years. Of 58 patients with microvascular complications, 34 had a high NLR, and 24 patients had a normal NLR. Of 42 patients without microvascular complications, only 14 had a high NLR, and the remaining 28 patients had a normal NLR (p = 0.012). Logistic regression was performed to analyze the association between the NLR and microvascular complications, which demonstrated a significant association (odds ratio (OR): 2.833, 95% confidence interval (CI): 1.238-6.481; p = 0.013). Conclusions Our study demonstrated the higher odds of having microvascular complications among diabetics with a high NLR compared with non-diabetics. Therefore, the NLR may be used as a measure of microvascular complications in the diabetic population.
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Affiliation(s)
- Mayank Mahajan
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | | | - Chanchal Ashok
- Pathology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Rishi Tuhin Guria
- Internal Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Sujeet Marandi
- Internal Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Vidyapati
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
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Obata S, Matsumoto R, Kakinoki M, Sawada O, Sawada T, Saishin Y, Yanagi T, Maruo Y, Ohji M. Blood neutrophil-to-lymphocyte ratio as a risk factor in treatment for retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2023; 261:951-957. [PMID: 36378339 DOI: 10.1007/s00417-022-05902-4] [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: 05/24/2022] [Revised: 09/26/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the blood neutrophil-to-lymphocyte ratio (NLR) as a risk factor for retinopathy of prematurity (ROP) development or treatment. METHODS Retrospective cohort study. Infants who underwent ROP screening at Shiga University of Medical Science Hospital and Omihachiman Community Medical Center between April 2010 and December 2021 were included in this study. Screening criteria were gestational age (GA) < 32 weeks or birth weight (BW) < 1500 g. Multivariate logistic regression analysis was applied to investigate whether the NLR constituted an independent risk factor for ROP development or treatment. The objective variable was ROP development or treatment, and the explanatory variables were GA, BW, NLR, maternal infection or clinical chorioamnionitis and corticosteroid use by the mother. Maternal infection or clinical chorioamnionitis and corticosteroid use by the mother was included in the explanatory variables to adjust for factors affecting the NLR. RESULTS In total, 220 infants met the inclusion criteria, of whom 125 developed ROP, whereas 95 infants did not display ROP. GA was significantly associated with ROP development (odds ratio (OR): 0.41, p < 0.001); however, the NLR was not significantly associated with ROP development (OR: 1.0, p = 0.74). Thirty-eight infants received treatment for ROP, whereas 182 infants had no such treatment. BW and the NLR were significantly associated with ROP treatment (OR: 1.6 and 0.66, p < 0.001 and 0.003, respectively). CONCLUSION The NLR was not a risk factor for ROP development but was a risk factor for ROP treatment.
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Affiliation(s)
- Shumpei Obata
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan.
| | - Riko Matsumoto
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Masashi Kakinoki
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Osamu Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Tomoko Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Yoshitsugu Saishin
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Takahide Yanagi
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
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Maresin 1 Alleviates Diabetic Kidney Disease via LGR6-Mediated cAMP-SOD2-ROS Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:7177889. [PMID: 35498124 PMCID: PMC9042615 DOI: 10.1155/2022/7177889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022]
Abstract
Background. Chronic hyperglycemia-induced inflammation is recognized as the most important pathophysiological process in diabetic kidney disease (DKD). As maresin 1 (MaR1) is an extensive anti-inflammatory lipid mediator, the present study investigated the protective role of MaR1 in the pathogenesis of DKD and its clinical relevance. Methods. Serum MaR1 concentrations were analyzed in 104 subjects with normal glucose tolerant, type 2 diabetes (T2DM), or DKD. Streptozotocin (STZ) together with high fat diet was used to induce male C57BL/6 J mice into diabetic mice which were treated with MaR1. Human renal tubule epithelial cells (HK-2 cells) were treated by high glucose for glucotoxicity cell model and transfected with LGR6 siRNA for knockdown with MaR1 added,and detected oxidative stress and inflammatory related factors. Results. Serum MaR1 concentrations were significant decreased in T2DM with or without kidney disease compared with normal participant and were lowest in patients with DKD. Serum MaR1 concentrations were negatively correlated with hemoglobin A1c (HbA1c), duration of diabetes, urinary albumin to creatinine ratio (UACR), neutrophil, and neutrophil-lymphocyte ratio and were positively correlated with high-density lipoprotein-cholesterol (HDL-C) and estimated glomerular filtration rate (eGFR). In mouse model, MaR1 injection alleviated hyperglycemia, UACR and the pathological progression of DKD. Interestingly, the renal expression of LGR6 was down-regulated in DKD and high glucose treated HK-2 cells but up-regulated by MaR1 treatment. Mechanistically, MaR1 alleviated inflammation via LGR6-mediated cAMP-SOD2 antioxidant pathway in DKD mice and high glucose treated HK-2 cells. Conclusions. Our study demonstrates that decreased serum MaR1 levels were correlated with the development of DKD. MaR1 could alleviate DKD and glucotoxicity-induced inflammation via LGR6-mediated cAMP-SOD2 antioxidant pathway. Thus, our present findings identify MaR1 as a predictor and a potential therapeutic target for DKD.
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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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Association between neutrophil–lymphocyte ratio on arterial stiffness in type-2 diabetes mellitus patients: a part of DiORS Study. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00965-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Rias YA, Kurniawan AL, Chang CW, Gordon CJ, Tsai HT. Synergistic Effects of Regular Walking and Alkaline Electrolyzed Water on Decreasing Inflammation and Oxidative Stress, and Increasing Quality of Life in Individuals with Type 2 Diabetes: A Community Based Randomized Controlled Trial. Antioxidants (Basel) 2020; 9:E946. [PMID: 33019646 PMCID: PMC7599474 DOI: 10.3390/antiox9100946] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/17/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023] Open
Abstract
Alkaline electrolyzed water (AEW) and walking are strongly recommended for ameliorating oxidative stress and inflammation. Nevertheless, there is a lack of information on the combination of both on alleviating inflammation, oxidative stress, and improving the quality of life (QoL). We investigated the synergistic effects of drinking AEW and walking on advanced glycation end products (AGEs), advanced oxidation protein products (AOPPs), malondialdehyde (MDA), white blood cells (WBCs), neutrophil-lymphocyte ratio (NLR) and QoL. In total, 81 eligible patients with type 2 diabetes (T2DM) were randomly allocated via single blind to four groups: consumed 2 L/day of AEW (n = 20), instructed to walk for 150 min/week (n = 20), received a combination of AEW and walking (n = 20), and continue their habitual diet and activity (n = 21). Data were collected and analyzed before and after 8 weeks of intervention. Our results showed a significant interaction between the group and time, with both AEW and walking independently and synergistically ameliorating AGEs, AOPPs, MDA, NLR and WBCs levels. Moreover, the AEW group had a higher physical and total QoL score. The walking group and the combined group had higher scores in physical, mental and total QoL compared to the control group. The synergistic effect of AEW and regular walking are an advisable treatment for patients with T2DM.
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Affiliation(s)
- Yohanes Andy Rias
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan;
- Faculty of Health and Medicine, College of Nursing, Institut Ilmu Kesehatan Bhakti Wiyata, Kediri 64114, Indonesia
| | - Adi Lukas Kurniawan
- Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, 365 Ming-te Road, Beitou District, Taipei 112, Taiwan;
| | - Ching Wen Chang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei 11031, Taiwan;
| | - Christopher James Gordon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown 2050, Australia;
| | - Hsiu Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan;
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
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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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8
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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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Kim M, Kim BH, Jang MH, Kim JM, Kim EH, Jeon YK, Kim SS, Kim IJ. High neutrophil-to-lymphocyte ratio is associated with relapse in Graves' disease after antithyroid drug therapy. Endocrine 2020; 67:406-411. [PMID: 31749116 DOI: 10.1007/s12020-019-02137-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/09/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Antithyroid drugs (ATDs) are effective in controlling hyperthyroidism due to Graves' disease (GD); however, long-term remission rates are low. The neutrophil-to-lymphocyte ratio (NLR) is a useful prognostic marker in many inflammatory diseases. We aimed to evaluate whether NLR can be used as a prognostic marker for relapse in patients with GD after ATD therapy. METHODS This retrospective cohort study included 108 patients with newly diagnosed GD who achieved remission after ATD therapy and were followed-up for >12 months after ATD discontinuation. The primary outcome was relapse-free survival (RFS). RESULTS Patients were classified into two groups according to baseline NLR: low NLR group with NLR < 1.14 (n = 59; 55%) and high NLR group with NLR ≥ 1.14 (n = 49; 45%). During the median follow-up of 6.5 years, disease relapse after a year of ATD withdrawal occurred in 23 (21%) patients. The patients with high NLR had poorer RFS than those with low NLR, and RFS curves were significantly different between the two groups (p = 0.002). In multivariate analysis, a high NLR (OR = 4.22, p = 0.016) was an independent prognostic factor for relapse in patients with GD after adjusting for age, sex, goiter, orbitopathy, thyroid hormone levels, thyrotropin binding inhibiting immunoglobulin titer, and the duration of ATD therapy. CONCLUSIONS This study showed that NLR can be an early and cost-effective prognostic biomarker for relapse in patients with GD after ATD therapy. Further studies are needed to validate the prognostic role of NLR in GD.
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Affiliation(s)
- Mijin Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
| | - Min Hee Jang
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeong Mi Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eun Heui Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Mokgalaboni K, Dludla PV, Nyambuya TM, Yakobi SH, Mxinwa V, Nkambule BB. Monocyte-mediated inflammation and cardiovascular risk factors in type 2 diabetes mellitus: A systematic review and meta-analysis of pre-clinical and clinical studies. JRSM Cardiovasc Dis 2020; 9:2048004019900748. [PMID: 31984134 PMCID: PMC6961142 DOI: 10.1177/2048004019900748] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/22/2019] [Accepted: 12/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Monocyte-mediated inflammation increases the risk of developing type 2 diabetes mellitus and cardiovascular disease. This is the first systematic review and meta-analysis of studies reporting on monocyte-mediated inflammation in type 2 diabetes mellitus. METHODS This systematic review and meta-analysis was registered in the international prospective register of a systematic review: CRD42019132902. The MEDLINE, EMBASE and Google scholar electronic databases were searched, and a random-effects model was used to generate pooled standardised mean differences between patients with type 2 diabetes mellitus and healthy controls. RESULTS The clinical studies (n = 20) comprised of 1065 patients with type 2 diabetes mellitus and 1103 healthy controls. Notably, the levels of monocyte activation were higher in patients with type 2 diabetes mellitus compared to healthy controls (standardised mean difference = 0.47, 95% confidence interval (0.10, 0.84), p = 0.01) (χ2 = 65.72, I 2 = 83%, p < 0.00001). Patients with type 2 diabetes mellitus had an increased risk of cardiovascular disease compared to healthy controls (standardised mean difference = 0.37, 95% confidence interval (0.13, 0.61), p = 0.003) (χ2 = 958.77, I 2 = 95%, p < 0.00001). All included pre-clinical studies reported on the C57BL/6 mice strain, with a majority of the studies 57% of reporting on high fat diet-induced C57BL/6 mice model. The overall quality of the studies was good with a median score and range of 16 (13-19). CONCLUSION Our meta-analysis suggests that there is increased monocyte activation in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Kabelo Mokgalaboni
- School of Laboratory Medicine and Medical Sciences, College of
Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Phiwayinkosi V Dludla
- Biomedical Research and Innovation Platform, The South African
Medical Research Council, Tygerberg, South Africa
- Department of Life and Environmental Sciences, Polytechnic
University of Marche, Ancona, Italy
| | - Tawanda M Nyambuya
- School of Laboratory Medicine and Medical Sciences, College of
Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Health Sciences, Faculty of Health and Applied
Sciences, Namibia University of Science and Technology, Windhoek, Namibia
| | - Sinethemba H Yakobi
- School of Laboratory Medicine and Medical Sciences, College of
Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Vuyolwethu Mxinwa
- School of Laboratory Medicine and Medical Sciences, College of
Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bongani B Nkambule
- School of Laboratory Medicine and Medical Sciences, College of
Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Ji S, Zhang J, Fan X, Wang X, Ning X, Zhang B, Shi H, Yan H. The relationship between mean platelet volume and diabetic retinopathy: a systematic review and meta-analysis. Diabetol Metab Syndr 2019; 11:25. [PMID: 30911336 PMCID: PMC6417244 DOI: 10.1186/s13098-019-0420-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the most common diseases causing blindness in the world, and most patients are already in advanced stage. Recent years, many studies reported mean platelet volume (MPV) may be associated with development of DR, but there was no consistent conclusion reached. METHODS Literature was retrieved by formally searching PubMed, Embase, Cochrane library and Scopus and by hand searching of reference lists of related articles. Finally, a total of 14 literatures included, and Review manager 5.3 and STATA 14.0 statistical software were utilized for processing. RESULTS Meta-analysis showed that MPV values in DR were significantly higher than health controls [SMD (95% CI) = 0.92 (0.60-1.24)] and type 2 diabetes mellitus without diabetic retinopathy (T2DM without DR) [SMD (95% CI) = 0.36 (0.19-0.53)]. Subgroup analysis indicated that MPV level in proliferative diabetic retinopathy (PDR) patients was higher than T2DM without DR patients [SMD (95% CI) = 0.48 (0.28, 0.68)], but this difference didn't appear in non-proliferative diabetic retinopathy (NPDR). CONCLUSIONS The study demonstrated that increased MPV level was significant associated with the development of DR, and it might reflect the severity of DR, which could be provided to monitor development and progression of DR clinically.
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Affiliation(s)
- ShuaiFei Ji
- Department of Ophthalmology, Tangdu Hospital, the Fourth Military Medical University, Xian, 710038 Shaanxi People’s Republic of China
| | - Jie Zhang
- Department of Ophthalmology, Tangdu Hospital, the Fourth Military Medical University, Xian, 710038 Shaanxi People’s Republic of China
| | - XiuDe Fan
- Department of Infectious Diseases, First Affiliated Hospital of Xian Jiaotong University, Xian, 710061 Shaanxi People’s Republic of China
| | - XiQiang Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xian Jiaotong University, Xian, 710061 Shaanxi People’s Republic of China
| | - XiaoNa Ning
- Department of Ophthalmology, Tangdu Hospital, the Fourth Military Medical University, Xian, 710038 Shaanxi People’s Republic of China
| | - BaBo Zhang
- Department of Ophthalmology, Tangdu Hospital, the Fourth Military Medical University, Xian, 710038 Shaanxi People’s Republic of China
| | - Heng Shi
- Department of Ophthalmology, Tangdu Hospital, the Fourth Military Medical University, Xian, 710038 Shaanxi People’s Republic of China
| | - Hong Yan
- Department of Ophthalmology, Tangdu Hospital, the Fourth Military Medical University, Xian, 710038 Shaanxi People’s Republic of China
- Department of Ophthalmology, Xi’an No. 4 Hospital, Shaanxi Eye Hospital, Affiliated Guangren Hospital School of Medicine, Xi’an Jiaotong University, Xian, 710004 Shaanxi China
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Luo WJ, Zhang WF. The relationship of blood cell-associated inflammatory indices and diabetic retinopathy: a Meta-analysis and systematic review. Int J Ophthalmol 2019; 12:312-323. [PMID: 30809490 DOI: 10.18240/ijo.2019.02.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022] Open
Abstract
AIM To explore the correlation between several blood cell-associated inflammatory indices including mean platelet volume (MPV), platelet distribution width (PDW), neutrophil to lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), and the presence and severity of diabetic retinopathy (DR). METHODS We searched for eligible studies from PubMed, EMBASE, Web of Science and CNKI up to December 13, 2017. Standardized mean difference (SMD) calculated with confidence interval (CI) of 95% was used to estimate the values of those indices. RESULTS A total of 31 studies were included in the present Meta-analysis. As compared with type 2 diabetes mellitus (T2DM) patients without DR, the values of MPV, PDW, NLR, and PLR were higher in patients with DR (SMD=0.67; 95%CI: 0.36 to 0.98; SMD=0.51; 95%CI: 0.27 to 0.75; SMD=0.77; 95%CI: 0.49 to 1.05 and SMD=1.18; 95%CI: 0.07 to 2.28). Additionally, it was also observed that MPV was closely correlated with the severity of DR. CONCLUSION MPV, PDW, NLR, and PLR could be recommended as diagnostic biomarkers for DR, and MPV could be applied to assess the severity of DR.
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Affiliation(s)
- Wen-Juan Luo
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou 730000, Gansu Province, China
| | - Wen-Fang Zhang
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou 730000, Gansu Province, China
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Mendes BB, Oliveira ACR, Alcântara KCD. Comparison of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in normoglycemic and hyperglycemic subjects. EINSTEIN-SAO PAULO 2019; 17:eAO4403. [PMID: 30652737 PMCID: PMC6333213 DOI: 10.31744/einstein_journal/2019ao4403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/24/2018] [Indexed: 01/22/2023] Open
Abstract
Objective: To compare the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as possible parameters of systemic inflammation in hyperglycemic and normoglycemic subjects. Methods: A retrospective, cross-sectional study of data collected from patients tested for fasting blood glucose, glycated hemoglobin (HbA1c) and blood count on the same day, between July and December 2016. Patients were divided into hyperglycemic and normoglycemic, and matched by age and sex. The data were analyzed using Epi Info™, version 7.2.1.0, for the Windows® platform. Results: We enrolled 278 subjects, 139 hyperglycemic and 139 normoglycemic. The absolute number of leukocytes and neutrophils was higher in the Hyperglycemic Group (p=0.006 and p=0.004, respectively). There was no difference in the neutrophil-to-lymphocyte ratio between the Hyperglycemic Group and the Normoglycemic Group (2.1 versus 2.0; p=0.264), and both neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios showed no differences between those with HbA1c ≥7% (n=127, p=0.778) and those with HbA1c <7% (n=12, p=0.490). In contrast, the platelet-to-lymphocyte ratio was lower in the Hyperglycemic Group (117.8 versus 129.6; p=0.007). Conclusion: Hyperglycemic subjects had a neutrophil-to-lymphocyte ratio similar to that of normoglycemic subjects, but had a lower platelet-to-lymphocyte ratio. Future prospective studies will be useful to determine the importance and prognostic value of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in the hyperglycemic state.
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Lim HH, Jeong IH, An GD, Woo KS, Kim KH, Kim JM, Cha JK, Han JY. Early prediction of severity in acute ischemic stroke and transient ischemic attack using platelet parameters and neutrophil-to-lymphocyte ratio. J Clin Lab Anal 2018; 33:e22714. [PMID: 30411816 DOI: 10.1002/jcla.22714] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND It is still not easy to predict severity promptly in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA). We investigated that platelet parameters or combinations of them could be a useful tool for early prediction of severity of AIS and TIA at admission and after 3 months. METHODS We prospectively recruited 104 patients newly diagnosed with AIS and TIA. We investigated their neutrophil-to-lymphocyte ratio (NLR) and platelet parameters. According to the Modified Rankin Scale scores, the patients were divided into two groups. RESULTS In receiver operating characteristic (ROC) curve analyses, mean platelet volume (MPV), NLR/platelet count (PLT), MPV/PLT, MPV*NLR, and MPV*NLR/PLT showed statistically significant results in both at admission and after 3 months. Values of area under ROC curves for those tests at admission were 0.646, 0.697, 0.664, 0.708, and 0.722, respectively. Also, values after 3 months were 0.591, 0.661, 0.638, 0.662, and 0.689, respectively. CONCLUSION MPV*NLR/PLT could be used as a relatively good tool for predicting severity at the time of admission and after 3 months than other parameters or combinations of them. Further studies have to be carried out to investigate the best parameter for predicting the severity of AIS and TIA.
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Affiliation(s)
- Hyeon-Ho Lim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - In-Hwa Jeong
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Gyu-Dae An
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Kwang-Sook Woo
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong-Hee Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jeong-Man Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
| | - Jin-Yeong Han
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
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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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Khalighi K, Cheng G, Mirabbasi S, Khalighi B, Wu Y, Fan W. Opposite impact of Methylene tetrahydrofolate reductase C677T and Methylene tetrahydrofolate reductase A1298C gene polymorphisms on systemic inflammation. J Clin Lab Anal 2018; 32:e22401. [PMID: 29396861 DOI: 10.1002/jcla.22401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/13/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms have been found to be related with many diseases. Systemic inflammation is now considered as a major predisposition factor for diseases including diabetes mellitus (DM), coronary arterial disease (CAD), stroke, and cancer. This study aimed to investigate whether systemic inflammation is a possible underlying pathogenesis for MTHFR gene polymorphism-related disease. METHODS A total of 292 patients were enrolled, and single nucleotide polymorphisms for MTHFR C667T and A1298C were genotyped. Systemic inflammation markers, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were collected. RESULTS In our study population, MTHFR 677 variants had significant higher NLR level than MTHFR 677 wild type (3.77 ± 0.26 vs 3.06 ± 0.18, P = .028). Logistic regression analysis showed that MTHFR 677 variants were significantly associated with increased NLR level. MTHFR 1298 variants showed the opposite effects which tended to have lower level of NLR (3.21 ± 0.16 vs 3.79 ± 0.34, P = .087) and PLR (137.0 ± 4.8 vs 157.7 ± 9.4, P = .052) than MTHFR 1298 wild type. General linear model showed that there was no statistically significant interaction between MTHFR C667T and A1298C gene polymorphism on NLR or PLR. CONCLUSIONS This study indicates that MTHFR C677T and MTHFR A1298C gene polymorphisms have opposite effect on systemic inflammation, and systemic inflammation may contribute to the pathogenesis for diseases associated with MTHFR C667T gene polymorphism.
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Affiliation(s)
- Koroush Khalighi
- Easton Hospital, Easton, PA, USA.,Easton Cardiovascular Associates, Easton, PA, USA.,School of Medicine, Drexel University, Philadelphia, PA, USA
| | | | | | - Bahar Khalighi
- School of Pharmacy, Temple University, Philadelphia, PA, USA
| | - Yin Wu
- Easton Hospital, Easton, PA, USA
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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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The Relationship Between Serum Pentraxine 3 Levels and Hematological Markers in Patients With Rheumatoid Arthritis. Arch Rheumatol 2017; 33:39-44. [PMID: 29900992 DOI: 10.5606/archrheumatol.2018.6394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/12/2017] [Indexed: 12/29/2022] Open
Abstract
Objectives This study aims to investigate the association of pentraxin 3 (PTX3) with neutrophil/lymphocyte ratio (NLR) rather than the disease activity score 28 using C-reactive protein in rheumatoid arthritis (RA). Patients and methods The study included 59 RA patients (11 males, 48 females; mean age 53.79±13.55 years; range 40 to 66 years) and 20 healthy controls (5 males, 15 females; mean age 50.41±6.11 years; range 43 to 56 years). Complete blood count tests were recorded and NLR and platelet/ lymphocyte ratio were calculated. PTX3 and interleukin-6 levels were examined in serum samples. Disease activity of RA patients was assessed by disease activity score 28. Results Demographic characteristics were similar between the two groups, with no statistically significant difference in terms of sex, age, and body mass index (p>0.05). NLR, PTX3 and interleukin-6 levels were higher in patients with RA than the control group (p<0.05). While erythrocyte sedimentation rate had a positive correlation with mean platelet volume, we found no correlation between NLR and other parameters of disease activity, PTX3, and interleukin-6. Conclusion We found no correlation between PTX3 and disease activity score 28 or NLR, although PTX3 levels were higher in RA patients than the controls. As a result, we were unable to establish a relationship between PTX3 and disease activity, directly or indirectly. To our knowledge, our study was the first to investigate the relationship between PTX3 and NLR.
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Khandare SA, Chittawar S, Nahar N, Dubey TN, Qureshi Z. Study of Neutrophil-lymphocyte Ratio as Novel Marker for Diabetic Nephropathy in Type 2 Diabetes. Indian J Endocrinol Metab 2017; 21:387-392. [PMID: 28553592 PMCID: PMC5434720 DOI: 10.4103/ijem.ijem_476_16] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Diabetic nephropathy (DN) is a microvascular complication of diabetes. DN is clinically manifested as an increase in urine albumin excretion. Total white blood cell count is a crude but sensitive indicator of inflammation and studied in many cardiac and noncardiac diseases as an inflammatory marker such as acute myocardial infarction, stroke, and heart failure. In this study, the association of neutrophil-lymphocyte ratio (NLR) with DN is studied. PATIENTS AND METHODS It is an observational cross-sectional study. Totally 115 diagnosed type 2 diabetes mellitus patients were registered in this study. NLR was calculated by analyzing differential leukocyte count in complete blood picture. Albuminuria was tested by MICRAL-II TEST strips by dipstick method. RESULTS Totally 115 diabetic patients were registered. About 56 patients had DN and 59 had normal urine albumin. Mean NLR for a normal group is 1.94 ± 0.65 and in DN group is 2.83 ± 0.85 which was highly significant (P < 0.001). Estimated glomerular filtration rate (P = 0.047) and serum glutamate pyruvate transaminase (P < 0.001) were also significant. CONCLUSION The results of our study show that there was a significant relation between NLR and DN. Therefore, NLR may be considered as a novel surrogate marker of DN in early stages.
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Affiliation(s)
- Sagar Ashokrao Khandare
- Department of Medicine, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - Sachin Chittawar
- Department of Medicine, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - Nitin Nahar
- Department of Medicine, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India
| | - T. N. Dubey
- Department of Medicine, Gandhi Medical College and Hamidia Hospital, Bhopal, Madhya Pradesh, India
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Mercan R, Bitik B, Tufan A, Bozbulut UB, Atas N, Ozturk MA, Haznedaroglu S, Goker B. The Association Between Neutrophil/Lymphocyte Ratio and Disease Activity in Rheumatoid Arthritis and Ankylosing Spondylitis. J Clin Lab Anal 2015; 30:597-601. [PMID: 26666737 DOI: 10.1002/jcla.21908] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/12/2015] [Accepted: 10/13/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Elevated neutrophil count is associated with poor prognosis and increased mortality in many conditions. Neutrophil to lymphocyte ratio (NLR) has emerged as a marker of inflammation in neoplastic and cardiovascular disorders. Herein, we investigated utility of this simple tool in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). METHODS The study consisted of 136 RA and 140 AS patients, along with 117 healthy control subjects. RA and AS activities were determined with Disease Activity Score (DAS) and Bath Ankylosing Spondylitis Disease Activity indices (BASDAI), respectively. The association between NLR and disease activity was analyzed. RESULTS Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and neutrophil counts were significantly higher in RA and AS patients compared to healthy controls. Similarly, NLR was higher compared to control subjects, both in RA (2.53 ± 1.4 vs. 2.16 ± 1.0, P = 0.019) and AS (2.43 ± 1.4 vs. 2.16 ± 1.0, P = 0.077). NLR correlated well with ESR and CRP, both in RA and AS. Moreover, NLR increased across worsening DAS28 activity groups (2.1 ± 1.0 in patients with remission, 2.5 ± 1.0 in low-moderate, 3.8 ± 2.5 in high disease activity). However, no association was found between NLR and BASDAI. CONCLUSION NLR is a cheap and readily available marker for the assessment of disease activity in RA.
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Affiliation(s)
- Ridvan Mercan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey.
| | - Berivan Bitik
- Division of Rheumatology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | | | - Nuh Atas
- Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | - Mehmet Akif Ozturk
- Division of Rheumatology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | - Seminur Haznedaroglu
- Division of Rheumatology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | - Berna Goker
- Division of Rheumatology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
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