Immunoglobulin A levels and its correlation with neutrophil-to-lymphocyte ratio as inflammatory biomarkers for dry eye disease in type 2 diabetes: a retrospective study

Abstract

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) and immunoglobulin A (IgA) level are commonly used as biomarkers for inflammation. Patients with type 2 diabetes (T2D) may experience an imbalance of tear film and inflammation, which can result in dry eye disease (DED). This study aimed to assess the levels of IgA and explore its correlation with the NLR as potential inflammatory biomarkers for dry eye disease in patients with T2D.MethodsA retrospective study was conducted at the cornea clinic and diabetes centre of King Abdulaziz Medical City (Jeddah, Saudi Arabia). The study included patients with DED and the number of available T2D-DED patients determined the sample size. Neutrophil, lymphocyte, IgA and CRP (C-reactive protein) laboratory values were obtained from medical records and correlational analyses were performed.ResultsThe study included 85 patients with an average age of 54 ± 14.4 years for the DED group (n=32) and 62 ± 13.9 years for the T2D-DED group (n=53). The age difference between the two groups was statistically significant (p 0.0001). The NLR values of the T2D-DED and DED groups were 3.203 ± 0.66 and 2.406 ± 0.46, respectively, with no significant difference (p<0.285). Similarly, there were no significant differences in neutrophil and lymphocyte values between the two groups. The IgA levels showed no significant variation between T2D-DED and DED groups (p<0.364). Spearman’s correlation analysis in the DED group showed a significant negative correlation between IgA and lymphocyte (p=0.011; r= - 0.471) values and significant positive correlations between IgA and neutrophil (p=0.014; r=0.309) and NLR (p=0.052; r= - 0.283) values. In the T2D-DED group, a significant correlation was found between IgA and CRP values (p=0.032; r=0.33).ConclusionAlthough diabetic patients may exhibit higher levels of NLR and IgA that correlate with disease severity, our study did not find significant differences in NLR and IgA values between the two groups. These findings may guide future research and enhance understanding of the disease’s underlying mechanisms.

Assessment of the systemic immune‐inflammation index in type 2 diabetic patients with and without dry eye disease: A case‐control study

“… 40 , 41 , 42 , 43 Based on that, this study employed PLR, NLR, and SII laboratory findings for patients with DM2‐DED, alongside, although few studies have been carried out to investigate the association of DM2 with DED patients, further investigation is required. 4 , 16 , 31 , 33 , 44 , 45 …”

“…As well as in diabetes, PLR, NLR, and SII levels are considered predictive and prognostic markers for metabolic diseases such as diabetes with complications 40–43 . Based on that, this study employed PLR, NLR, and SII laboratory findings for patients with DM2‐DED, alongside, although few studies have been carried out to investigate the association of DM2 with DED patients, further investigation is required 4,16,31,33,44,45 …”

“…4,16,31,33,44,45 T A B L E 1 Baseline characteristics of the study and control groups by (A) gender and (B) age.…”

Immune-Mediated Ocular Surface Disease in Diabetes Mellitus—Clinical Perspectives and Treatment: A Narrative Review

“…The same patients also showed a strong association between their C-reactive protein and IgA levels. These findings imply that IgA might be a factor in the low-grade chronic systemic inflammation in DM and that it might be employed as a biomarker for inflammation [ 61 ].…”