Predictive value of neutrophil‐to‐lymphocyte ratio for atrial fibrillation and stroke in type 2 diabetes mellitus: The Hong Kong Diabetes Study

Chang, Carlin; Zhou, Jiandong; Chou, Oscar Hou In; Chan, Justin; Leung, Keith Sai Kit; Lee, Teddy Tai Loy; Wong, Wing Tak; Wai, Abraham Ka Chung; Liu, Tong; Zhang, Qingpeng; Lee, Sharen; Tse, Gary

doi:10.1002/edm2.397

Cited by 10 publications

(3 citation statements)

References 61 publications

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“…The utility of traditional biomarkers like estimation of blood glucose and HbA1c to manage T2DM appears to be limited. This is evident from the reports that suggest the potential application of NLR to manage T2DM and predict long-term complications like stroke and kidney and cardiovascular diseases, among others [20,21].…”

Section: Discussionmentioning

confidence: 94%

Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker to Managing Type 2 Diabetes Mellitus and Predicting Disease Progression

Mohammed,

Khaleel,

R. M.

et al. 2024

Cureus

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IntroductionDiabetes is a chronic disease that causes dysregulation of blood glucose. Type 2 diabetes mellitus (T2DM) could result in long-term inflammatory conditions that affect different organs of the body. Despite the availability of diagnostic markers like glycated hemoglobin (HbA1c) for T2DM, it is essential to find an appropriate marker that could predict long-term complications. This study evaluates the potential role of neutrophil-to-lymphocyte ratio (NLR) in predicting disease progression and treatment responses. MethodsThis case-control study was carried out among 160 T2DM patients and 132 non-diabetic persons. Blood samples were collected from each participant and were processed for hemoglobin, HbA1c, iron, ferritin, and complete blood picture (NLR). ResultsThe study showed that there was a significant variation in the serum levels of ferritin (264.8±611.6 ng/ml versus 168.3±364.7 ng/ml, p=0.392), iron (4.095±8.851 mcg/dl versus 55.20±37.62 mcg/dl, p=0.0111), and HbA1c (8.169±1.635% versus 5.668±0.5260% p<0.0001) among T2DM patients compared to non-diabetic persons. The NLR values (4.189±4.154 versus 4.095±8.851, p=0.009) among patients with T2DM significantly varied with that of non-diabetic persons. A significant negative correlation was noticed between the serum levels of iron and NLR (r=-0.17, p=0.014) and a positive correlation was noticed between HbA1c and NLR (r=0.19, p=0.014). The serum levels of iron revealed a significant positive correlation with the serum levels of ferritin (r=0.24, p=0.002) and hemoglobin percentage (r=0.41, p=0.008). HbA1c revealed a significant positive correlation with NLR (r=0.19, p=0.014). Additionally, a significant negative correlation was observed between iron with NLR (r=-0.17, p=0.029) and hemoglobin percentage with NLR (r=-0.30, p=0.005). However, no such correlation was demonstrated among non-diabetic persons. With an accuracy of 89.85% and high sensitivity and specificity, NLR showed diagnostic accuracy like HbA1c. ConclusionsNLR demonstrated equivalent efficacy to HbA1c in predicting glycemic control. Since diabetes affects different organs of the body, evaluating NLR probably predicts inflammation. Therefore, NLR could be useful in the management of T2DM and in predicting long-term complications.

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Section: Discussionmentioning

confidence: 94%

Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker to Managing Type 2 Diabetes Mellitus and Predicting Disease Progression

Mohammed,

Khaleel,

R. M.

et al. 2024

Cureus

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“…Our AI-enhanced diabetes model complement previously published, Chinese-specific diabetes CVD risk models by other groups 45,46 . Our future model will also capture fluctuations in inflammation using biomarkers 47 . Finally, we are developing cancer-specific CVD risk models based on our recent publications 48 , most notably our series on prostate cancer 49-53 .…”

Section: Discussionmentioning

confidence: 99%

ChineseCVD: first-in-world, web-based, Chinese-specific Cardiovascular Risk Calculator incorporating long COVID, COVID-19 vaccination, SGLT2i and PCSK9i treatment effects

Chang,

Tse,

Lee

et al. 2023

Preprint

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BackgroundWeb-based risk prediction tools for cardiovascular diseases are crucial for providing rapid risk estimates for busy clinicians, but there is none available specifically for Chinese subjects. This study developed ChineseCVD, first-in-world web-based Chinese-specific Cardiovascular Risk Calculator incorporating long COVID, COVID-19 vaccination, SGLT2i and PCSK9i treatment effects.MethodsAdult patients attending government-funded family medicine clinics in Hong Kong between 1stJanuary 2000 and 31stDecember 2003 were included. The primary outcome was major adverse cardiovascular events (MACE) defined as a composite of myocardial infarction, heart failure, transient ischaemic attacks/ischaemic strokes, and cardiovascular mortality.ResultsA total of 155,066 patients were used as the derivation cohort. Over a median follow-up of 16.1 (11.6-17.8) years, 31,061 (20.44%) had MACE. Cox regression identified male gender, age, comorbidities, cardiovascular medications, systolic and diastolic blood pressure, and laboratory test results (neutrophil-lymphocyte ratio, creatinine, ALP, AST, ALT, HbA1c, fasting glucose, triglyceride, LDL and HDL) as significant predictors of the above outcomes. ChineseCVD further incorporates the impact of smoking status, COVID-19 infection, number of COVID-19 vaccination doses, and modifier effects of newest medication classes of PCSK9i and SGLT2i. The calculator enables clinicians to demonstrate to patients how risks vary with different medications.ConclusionsThe ChineseCVD risk calculator enables rapid web-based risk assessment for adverse cardiovascular outcomes, thereby facilitating clinical decision-making at the bedside or in the clinic.

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“…Patients of this study have been identified from the Clinical Data Analysis and Reporting System (CDARS), which centralizes information on patients from individual local hospitals to establish comprehensive medical data throughout the Hong Kong. The system has been previously utilized by multiple teams to conduct population-based cohort studies [21][22][23][24], including those focused on diabetes [25]. All pertinent data including clinical characteristics, disease diagnoses, laboratory results and drug treatment details based on the population in Hong Kong can be extracted from this system.…”

Section: Methods Study Design and Populationmentioning

confidence: 99%

New-onset syncope in diabetic patients treated with sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors: a Chinese population-based cohort study

Gao,

Zhang,

et al. 2023

European Heart Journal - Cardiovascular Pharmacotherapy

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Background and Aims Syncope is a symptom posing an important diagnostic and therapeutic challenge, and generate significant cost for the healthcare system. Sodium-glucose cotransporter-2 inhibitor (SGLT2i) have demonstrated beneficial cardiovascular effects, but their possible effects on incident syncope have not been fully investigated. This study compared the effects between SGLT2i and dipeptidyl peptidase-4 inhibitor (DPP4i) on new-onset syncope. Methods This was a retrospective, territory-wide cohort study enrolling type 2 diabetes mellitus (T2DM) patients treated with SGLT2i or DPP4i between January 1st, 2015, and December 31st, 2020, in Hong Kong, China. The outcomes were hospitalization of new-onset syncope, cardiovascular mortality, and all-cause mortality. Multivariable Cox regression and different approaches using the propensity score were applied to evaluate the association between SGLT2i and DPP4i with incident syncope and mortality. Results After matching, a total of 37 502 patients with T2DM were included (18 751 SGLT2i users versus 18 751 DPP4i users). During a median follow-up of 5.56 years, 907 patients were hospitalized for new-onset syncope (2.41%), and 2346 patients died from any cause (6.26%), among which 471 deaths (1.26%) were associated with cardiovascular causes. Compared to DPP4i users, SGLT2i therapy was associated with a 51% lower risk of new-onset syncope (HR, 0.49; 95%CI [0.41–0.57], P < 0.001), 65% lower risk of cardiovascular mortality (HR, 0.35; 95%CI [0.26–0.46], P < 0.001), and a 70% lower risk of all-cause mortality (HR, 0.30; 95%CI [0.26–0.34], P < 0.001) in the fully adjusted model. Similar associations with syncope were observed for dapagliflozin (HR, 0.70; 95%CI [0.58–0.85], P < 0.001), canagliflozin (HR, 0.48; 95%CI [0.36–0.63], P < 0.001) and ertugliflozin (HR, 0.45; 95%CI [0.30–0.68], P < 0.001), but was attenuated for empagliflozin (HR, 0.79; 95%CI [0.59–1.05], P = 0.100) after adjusting for potential confounders. The subgroup analyses suggested that, compared to DPP4i, SGLT2i was associated with a significantly decreased risk of incident syncope among T2DM patients, regardless of gender, age, glucose control status, Charlson comorbidity index, and the association remained constant amongst those with common cardiovascular drugs and most antidiabetic drugs at baseline. Conclusions Compared to DPP4i, SGLT2i was associated with a significantly lower risk of new-onset syncope in patients with T2DM, regardless of gender, age, degree of glycaemic control, and comorbidity burden.

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Predictive value of neutrophil‐to‐lymphocyte ratio for atrial fibrillation and stroke in type 2 diabetes mellitus: The Hong Kong Diabetes Study

Cited by 10 publications

References 61 publications

Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker to Managing Type 2 Diabetes Mellitus and Predicting Disease Progression

Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker to Managing Type 2 Diabetes Mellitus and Predicting Disease Progression

ChineseCVD: first-in-world, web-based, Chinese-specific Cardiovascular Risk Calculator incorporating long COVID, COVID-19 vaccination, SGLT2i and PCSK9i treatment effects

New-onset syncope in diabetic patients treated with sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors: a Chinese population-based cohort study

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