Relationship Between Neutrophil-Lymphocyte Ratio and Microvascular Complications in Egyptian Patients with Type 2 Diabetes
American Journal of Internal Medicine
Volume 3, Issue 6, November 2015, Pages: 250-255
Received: Oct. 29, 2015;
Accepted: Nov. 18, 2015;
Published: Dec. 22, 2015
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Eman Youssef Moursy, Unit of Diabetes & Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Magdy Helmy Megallaa, Unit of Diabetes & Metabolism, Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Reham Fadl Mouftah, Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Soha Magdy Ahmed, Alexandria Students Hospital, Ministry of Health, Alexandria, Egypt
Several epidemiological studies have shown that chronic inflammation plays a central role in the pathogenesis of diabetes and its various complications. Neutrophil-lymphocyte ratio (NLR) is a novel potential marker in determining inflammation. The aim of this study was to evaluate the relationship between diabetic microvascular complications, namely diabetic retinopathy, nephropathy, neuropathy, and neutrophil-lymphocyte ratio in type 2 diabetic patients. The study took place in the Unit of Diabetes & Metabolism at the Faculty of Medicine, Alexandria University, Alexandria, Egypt, and included a total of 280 subjects, 200 male patients with type 2 diabetes, 108 of them having one or more microvascular complication, and a control group including 80 healthy age and sex-matched subjects. Results of our study showed that neutrophil-lymphocyte ratio (NLR) values were significantly higher in diabetic patients with retinopathy (p<0.001), neuropathy (p=0.025) and nephropathy (p<0.001) than those of diabetic patients without any microvascular complications and healthy control subjects. NLR levels correlated positively with body mass index (BMI) (r=0.436, p<0.001), glycosylated hemoglobin (HbA1c) (r=0.526, p=0.001) and erythrocyte sedimentation rate (ESR) (r=0.396, p=0.017). Based on the results of this study, we can conclude that neutrophil-lymphocyte ratio (NLR), which is an efficient, simple and stable marker of inflammation, can serve as an important predictor for the presence of microvascular complications in Egyptian patients with type 2 diabetes.
Eman Youssef Moursy,
Magdy Helmy Megallaa,
Reham Fadl Mouftah,
Soha Magdy Ahmed,
Relationship Between Neutrophil-Lymphocyte Ratio and Microvascular Complications in Egyptian Patients with Type 2 Diabetes, American Journal of Internal Medicine.
Vol. 3, No. 6,
2015, pp. 250-255.
Reyden L, Standhl E, Bartnik M, BergheGVd, Betteridge J. Guidelines on diabetes, pre-diabetes, and cardiovascular disease. Eur Heart J. 2007: 1-72.
Pisarczyk-Wiza D, Zozulinska-Ziolkiewicz D, Wysocki H, Wierusz-Wysocka B. Increase in glycemia stimulates reactive oxygen species (ROS) production by polymorphonuclear neutrophils in type 2 diabetic patients. J Pre-clin Clin Res 2011; 5: 22-7.
Tian JY, Yang Y, Cheng Q, Huang HE, Li R, Jiang GX, et al. Association of WBC count and glucose metabolism among Chinese population aged 40 years and over. Diabetes Res Clin Pract 2008; 82: 132-8.
Narayan KM, Gregg EW, Fagot-Campagna A, Engelau MM, Vinicor F. Diabetes: a common, growing, serious, costly and potentially preventable public health problem. Diabetes Res Clin Pract 2000; 50: S77-84.
Fujita T, Hemmi S, Kajiwara M, Yabuki M, Fuke Y, Satomura A, et al. Complement-mediated chronic inflammation is associated with diabetic microvasvular complication. Diabetes Metab Res Rev 2013; 29: 220-6.
Nguyen D, Shaw L, Grant M. Inflammation in the pathogenesis of microvascular complications in diabetes. Front Endocrinol 2012; 3: 170.
Rajala MW, Scherer PE. Mini review: the adipocyte–at the crossroads of energy homeostasis, inflammation, and atherosclerosis. Endocrinology 2003, 144(9): 3765-73.
Pitsavos C, Tampourlou M, Panagiotakos DB, Skoumas Y, Chrysohoou C, Nomikos T, et al. Association Between Low-Grade Systemic Inflammation and Type 2 Diabetes Mellitus Among Men and Women from the ATTICA Study. Rev Diabet Stud 2007; 4(2): 98-104.
Bhutta H, Agha R, Wong J, Tang TY, Wilson YG, Walsh SR. Neutrophil lymphocyte ratio predicts medium-term survival following elective major vascular surgery: a cross sectional study. Vasc Endovascular Surg 2011; 45: 227–31.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-19.
Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007; 154: 995-1002.
Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008; 102: 653-7.
Núñez J, Núñez E, Bodí V, Sanchis J, Miñana G, Mainar L, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 2008; 101: 747-52.
Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Renal Failure 2012; 34: 155-9.
Ulu S, Bucak A, Ulu MS, Ahsen A, Duran A, Yucedag F, et al. Neutrophil-lymphocyte ratio as a new predictive and prognostic factor at the hearing loss of diabetic patients. Eur Arch Otorhinolaryngol 2013; 13: 2734-43.
Ross R. Atherosclerosis an inflammatory disease. N Engl J Med 1999; 340: 115-26.
Lim LS, Tai ES, Mitchell P, Wang JJ, Tay WT, Lamoureux E, et al. C-reactive protein, body mass index, and diabetic retinopathy. Invest Ophthalmol Vis Sci 2010; 51: 4458-63.
Joussen AM, Poulaki V, Le ML, Koizumi K, Esser C, Janicki H, et al. A central role for inflammation in the pathogenesis of diabetic retinopathy. Faseb J 2004; 18(12): 1450-2.
Yue S, Zhang J, Wu J, Teng W, Liu L, Chen L. Use of the monocyte-to-lymphocyte ratio to predict diabetic retinopathy. Int J Environ Res Public Health 2015; 12: 10009-19.
Ciray H, Aksoy A H, Ulu N, Cizmecioglu, Gaibov A, Solak Y. Nephropathy, but not angiographically proven retinopathy is associated with neutrophil to lymphocyte ratio in patients with type 2 diabetes. Exp Clin Endocrinol Diabetes 2015; 123(5): 267-71.
Satoh J, Yagihashi S, Toyota T. The possible role of tumor necrosis factor-alpha in diabetic polyneuropathy. Exp Diabesity Res 2003; 4: 65–71.
Herder C, Lankisch M, Ziegler D, Rathmann W, Koenig W, Illig T, et al. Subclinical Inflammation and Diabetic Polyneuropathy. Diabetes Care 2009; 32: 680–2.
Tong PC, Lee KF, So WY, Ng MH, Chan WB, Lo MK, et al. White blood cell count is associated with macro- and microvascular complications in Chinese patients with type 2 diabetes. Diabetes Care 2004; 27: 216-22.
Cavalot F, Massucco P, Perna P, Traversa M, Anfossi G, Trovati M. White blood cell count is positively correlated with albumin excretion rate in subjects with type 2 diabetes. Diabetes Care 2002; 25: 2354-5.
Asfar B. The relationship between neutrophil lymphocyte ratio with urinary protein and albumin excretion in newly diagnosed patients with Type 2 Diabetes. Am J Med Sci 2013; 347(3): 217-20.
Huang W, Huang J, Liu Q, Lin F, He Z, Zeng Z, et al. Neutrophil-lymphocyte ratio is a reliable predictive marker for early-stage diabetic nephropathy. Clin Endocrinol 2015; 82: 229-33.