Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic cardiovascular diseases in patients with type 2 diabetes mellitus

Tsai, Jack C.-R.; Sheu, Sheng‐Hsiung; Chiu, Herng‐Chia; Chung, Fu‐Mei; Chang, De-Kuan; Chen, Miao-Pei; Shin, Shyi–Jang; Lee, Yau-Jiunn

doi:10.1002/dmrr.647

Cited by 92 publications

(65 citation statements)

References 54 publications

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“…The authors subsequently found that total WBC count was an independent predictor of death/ MI in the patients with or at high risk for CAD, although the most effective risk prediction was observed for the NLR, with the hazard ratio increasing by 2.2-fold for quartile (Q) 4 versus Q1. Thereafter, Tsai J.C. and colleagues studied more than 800 high-risk Korean adult patients (with diabetes mellitus and metabolic syndrome) and determined that NLR was associated with both metabolic syndrome and the risk of ischemic cardiovascular disease 33) . Another prospective study analyzed the predictive ability for cardiac events of the differential WBC count versus was useful, inexpensive and widely available markers of inflammation for predicting the risk and severity of CAD, consistent with the results of our previous study of diabetic patients with stable CAD 17) .…”

Section: Discussionmentioning

confidence: 99%

“…It has also been reported that an increased NLR ratio is associated with the incidence of ventricular arrhythmia during PCI 30,31) and a worse outcome after CABG 11) . Moreover, an elevated NLR, both independently and in combination with other disease markers and risk factors, is a significant predictor of the development, progression and mortality of stable CAD 4, 11,23,32,33) . Horne et al MI in patients with stable CAD during a three-year follow-up period.…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Coronary Artery Disease: A Gensini Score Assessment

Chen

et al. 2014

JAT

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Aim:The usefulness of the white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR) in predicting the severity of stable coronary artery disease (CAD) has not been sufficiently evaluated, particularly based on strict coronary assessments. The aim of the present study was to investigate the WBC count and NLR in predicting the severity of angiographically proven CAD. Methods: A total of 2,976 CAD patients and 571 non-CAD patients were consecutively enrolled, and the CAD patients were classified into the three groups according to the tertile of the Gensini score (GS, low GS＜18, n = 989; intermediate GS 18-41, n = 995 and high GS＞41, n = 992). The efficacy of the WBC count and NLR in predicting the risk and severity of CAD as well as the correlations between these markers and the GS were analyzed. A receiver operating characteristic (ROC) curve analysis was also performed. Results: The NLR was found to be an independent predictor of both the presence of CAD (OR = 1.18, 95%CI: 1.09-1.27, p = 0.009) and a high GS (OR=1.10, 95%CI: 1.01-1.16, p = 0.032). In addition, there were mild positive correlations between the GS and the NLR, WBC and proportions of neutrophils and monocytes. In the ROC curves analysis, the NLR was found to have the largest area under the curve (AUC = 0.63, 95%CI: 0.59-0.67, p=0.000), with an optimal cut-off value of 2.04 (sensitivity: 62.1%, specificity: 54.8%) for predicting a high GS. Conclusions: The NLR is a valuable independent predictor of the severity of CAD assessed according to the GS. In particular, an NLR of ＞2.04 indicates a higher risk of CAD and greater severity of CAD lesions. Hypertension was diagnosed based on repeated blood pressure measurements of ≥ 140/90 mmHg (at least two times in different environments) or the use of antihypertensive drugs. DM was diagnosed based on a fasting serum glucose level of ≥ 6.99 mmol/L on multiple occasions and/or the use of insulin or oral hypoglycemic agents. Dyslipidemia was diagnosed according to a fasting total cholesterol level of (TC) ≥ 200 mg/dL or triglyceride (TG) level of ≥150 mg/dL. J Atheroscler Laboratory TestsAll baseline laboratory data were acquired from venous blood samples obtained after a 12-hour overnight fast prior to coronary angiography. The levels of WBC, neutrophils, lymphocytes and monocytes were determined using an automated blood cell counter, the Coulter LH780 Hematology Analyzer (Beckman Coulter Ireland Inc. Mervue, Galway, Ireland), and the levels of high-sensitivity C-reactive protein (hs-CRP) were assessed using immunoturbidimetry (Beckmann Assay 360, Bera, California, USA), as previously reported 16,17) . The NLR was calculated as the ratio of neutrophils to lymphocytes, the levels of which were obtained from the same blood samples. The normal range of hs-CRP in our hospital laboratory is 0-3 mg/L. Angiographic ExaminationsSelective coronary angiography was performed in all enrolled subjects using the standard Judkin's technique, and the results were analyzed by at least two interventional physicians w...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Coronary Artery Disease: A Gensini Score Assessment

Chen

et al. 2014

JAT

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“…[27][28][29][30] This finding was found not only in acute conditions but also in stable and preoperative medical conditions. [31][32][33] In a cross-sectional study, Chung et al 34 found a higher neutrophil and lower lymphocyte count in patients with microalbuminuria and overt nephropathy compared with diabetics without albuminuria. Nevertheless, the usefulness of NLR as a predictor of worsening of renal functions among diabetic patients has not been elucidated.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil-to-Lymphocyte Ratio as a Predictor of Worsening Renal Function in Diabetic Patients (3-Year Follow-Up Study)

et al. 2012

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Background: Previous studies have demonstrated the role of inflammation in diabetic nephropathy (DN). Neutrophil to lymphocyte ratio (NLR) rather than other white cell parameters was found to be a useful inflammatory marker to predict adverse outcomes in medical and surgical conditions. Nevertheless, the value of NLR in predicting DN has not been elucidated. Method: An observational study included 338 diabetic patients, who were followed at our clinic between 2007 and 2009. We arranged our patients into tertiles according to their 2007 NLR. The primary outcome was continuous decrease of GFR >12 mL/min between 2007 and 2009 with the last GFR <60 mL/min. Result: The lowest NLR tertile had fewer patients (2.7%) with primary outcome (i.e., worsening renal function) compared with middle and highest NLR tertiles, which had more patients with primary outcomes (8.7% and 11.5%, respectively) with a significant p-value 0.0164. When other potential confounders were individually analyzed with NLR tertile, the NLR tertiles remained a significant predictor of poor GFR outcome in the presence of other variables (hemoglobin A1C, systolic blood pressure, diastolic blood pressure, age, and congestive heart failure with p-values 0.018, 0.019, 0.017, 0.033, and 0.022, respectively). Conclusion: NLR predicted the worsening of the renal function in diabetic patients. Further studies are needed to confirm this result.

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“…Each subtype involved in the inflammatory process in a different way. A number of observational studies have shown a positive correlation between the counts of certain types of leukocytes and the metabolic syndrome or cardiovascular disease (Tsai et al 2007;Kim et al 2008). However, the relationship between specific subtypes of leukocyte and NAFLD has not been studied.…”

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confidence: 99%

Elevated Peripheral Blood Monocyte Fraction in Nonalcoholic Fatty Liver Disease

Kim

Chung

Park

et al. 2011

Tohoku J. Exp. Med.

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An elevated white blood cell (WBC) count is associated with nonalcoholic fatty liver disease (NAFLD); however, a leukocyte subtype that is involved in the pathogenesis of NAFLD is not known. This study was conducted to investigate the association between NAFLD and WBC subtype fractions (%) among healthy elderly Koreans. A total of 794 subjects who underwent a health check-up were investigated. After excluding excessive alcohol intake and other liver diseases, NAFLD was diagnosed based on sonographic findings: hyperechogenecity of liver tissue, difference of echogenicity between liver and kidney, and visibility of vascular structures. The prevalence of NAFLD among entire cohort was 39.0% (310/794). The presence of NAFLD was significantly associated with higher blood WBC counts (5,485 ± 1073 vs. 5,230 ± 995 per mm 3 , p = 0.001) and monocyte fraction (6.08 ± 2.40% vs. 5.12 ± 1.31%, p < 0.001). The multiple logistic regression analysis, after controlling confounders, including age, gender, body mass index, systolic and diastolic blood pressure, fasting blood glucose, alanine aminotransferase, triglyceride, and high-density lipoprotein cholesterol, showed that the prevalence risk of NAFLD was increased significantly according to the monocyte fraction quartiles: odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD were 1.00, 2.75 (1.63-4.62), 2.84 (1.67-4.84) and 5.17 (3.03-8.83), respectively. There were no significant associations between NAFLD and the total WBC count quartiles in this model. These results indicate that the elevated peripheral blood monocyte fraction is associated with NAFLD. The monocyte fraction might be a useful marker for NAFLD.

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Association of peripheral total and differential leukocyte counts with metabolic syndrome and risk of ischemic cardiovascular diseases in patients with type 2 diabetes mellitus

Abstract: Our results indicate that differential leukocyte counts are associated with MetS and that peripheral leukocytes may play a role in the pathogenesis of macrovascular complications in patients with T2DM.

Cited by 92 publications

References 54 publications

Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Coronary Artery Disease: A Gensini Score Assessment

Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Coronary Artery Disease: A Gensini Score Assessment

Neutrophil-to-Lymphocyte Ratio as a Predictor of Worsening Renal Function in Diabetic Patients (3-Year Follow-Up Study)

Elevated Peripheral Blood Monocyte Fraction in Nonalcoholic Fatty Liver Disease

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