Prognostic value of monocyte-to-lymphocyte ratio for 90-day all-cause mortality in type 2 diabetes mellitus patients with chronic kidney disease

Abstract

The role of inflammation and the correlation between inflammatory markers and type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) have been studied. In clinical work, a large number of T2DM patients complicated with CKD, but the cause of CKD was not clear. Our study aimed to evaluate the relationship between monocyte-to-lymphocyte ratio (MLR) and mortality in T2DM patients with CKD. The data from Medical Information Mart for Intensive Care III was analyzed. The primary outcome was 90-day all-cause mortality; the secondary outcomes were the length of ICU stay, hospital mortality and 30-day all-cause mortality. Cox regression was used to evaluate the association between MLR and 90-day mortality. We performed subgroup analyses to determine the consistency of this association, and used Kaplan–Meier survival curve to analysis the survival of different levels of MLR. A total of 1830 patients were included in study retrospectively. The length of ICU stay, 30-day all-cause mortality, and 90-day all-cause mortality in the MLR > 0.71 group were significantly higher than those in the MLR < 0.28 and 0.28 ≤ MLR ≤ 0.71 group. In Cox regression analysis, high MLR level was significantly associated with increased greater risk of 90-day all-cause mortality. The adjusted HR (95%CIs) for the model 1, model 2, and model 3 were 2.429 (1.905–3.098), 2.070 (1.619–2.647), and 1.898 (1.478–2.437), respectively. Subgroup analyses also showed the consistency of association between MLR and 90-day all-cause mortality. The Kaplan–Meier survival curve analysis revealed that MLR > 0.71 had worst prognosis. In T2DM patients with CKD in the intensive care unit, high MLR was significantly associated with increased risk 90-day all-cause mortality.

Association between monocyte to lymphocyte ratio and diabetic foot ulcer in the population of the US with diabetes based on the 1999-2004 National Health and Nutrition Examination Survey data: a retrospective cross-sectional study

“…In our study, patients with DFU had a significant high MLR and incidence of DFU increases with MLR. This is similar to the research on MLR in other diabetes complications ( 7 , 22 – 24 ). For example, Yue et al.…”

“…The onset of diabetes and its associated problems are mostly influenced by pathophysiological circumstances, including inflammation, endothelial dysfunction, ferroptosis and procoagulant imbalance ( 26 – 28 ). These pathophysiological processes interact with metabolic and inflammatory problems in patients with diabetes, causing tissue damage and ultimately leading to consequences, such as PAD, retinopathy, neuropathy, and nephropathy ( 28 ).According to several studies, changes in inflammatory biomarkers has been confirmed to be closely related to the occurrence and progression of diabetic complications ( 7 , 22 – 24 ). These biomarkers may provide new insights for the early detection and treatment of diabetes and its consequences ( 27 – 30 ).…”

“…Numerous studies have demonstrated that these markers can predict the presence of systemic inflammation and may be helpful in the diagnosis of various disorders ( 8 , 20 , 21 , 31 ). Recently, some studies have shown that the high MLR is associated with the occurrence and progression of diabetes complications, including diabetic nephropathy, DR, and PAD ( 7 , 22 – 24 , 32 ).…”

“…Elevated MLR has been associated with poor prognosis and accelerated disease progression in several disorders, including acute kidney injury and hematoma after cerebral contusion ( 20 , 21 ). Recently, some studies have shown that the MLR is associated with the occurrence and progression of diabetes complications, including diabetic nephropathy, diabetic retinopathy (DR), and PAD ( 7 , 22 – 24 ).It is reasonable to assume that MLR may play a significant role in the onset and progression of DFU, given the mounting body of research emphasizing its importance in diabetes complications ( 7 , 22 – 24 ). However, it is currently unclear whether there is a relationship between MLR and the occurrence and progression of DFU.…”

Association between systemic inflammation response index and chronic kidney disease: a population-based study

“…One biomarker that helps forecast how CKD will progress is the neutrophil-to-lymphocyte ratio (NLR) ( 8 ). Monocyte-to-lymphocyte ratio (MLR) and the risk of 90-day all-cause death in patients with type 2 diabetes (T2DM) and diabetic kidney disease (DKD) were found to be significantly correlated by Qiu’s research ( 9 ). Monocyte/high-density lipoprotein ratio (MHR) may be a biomarker for predicting DKD ( 10 ).…”