Study of neutrophil-lymphocyte ratio as novel marker for diabetic nephropathy in type 2 diabetes

Khandare, Sagar; Chittawar, Sachin; Nahar, Nitin; Dubey, T. N.; Qureshi, Zahraan

doi:10.4103/ijem.ijem_476_16

Cited by 52 publications

(33 citation statements)

References 44 publications

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“…NLR is a novel inflammatory marker known to be increased in patients with type 2 diabetes when compared with the healthy controls. NLR was also higher in patients with microalbuminuria group when compared with the normoalbuminuria group (Huang et al, 2015; Khandare et al, 2017). Our study found elevated levels of TNF-α, NLR, and IL-18 in patients with microalbuminuria and macroalbuminuria that were significantly higher than those detected in the healthy controls and type 2 diabetic patients with normoalbuminuria.…”

Section: Discussionmentioning

confidence: 85%

The role of serum and urinary biomarkers in the diagnosis of early diabetic nephropathy in patients with type 2 diabetes

Zhang

Pan

2019

PeerJ

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Background Previous studies have shown that a variety of biomarkers are closely related to the occurrence and development of early-stage diabetic nephropathy (DN) in patients. The aim of this study was to evaluate the role of multiple sera and urinary biomarkers in the diagnosis of early-stage DN in patients with type 2 diabetes. Methods We enrolled 287 patients with type 2 diabetes, who were classified into normoalbuminuria (n = 144), microalbuminuria (n = 94), or macroalbuminuria (n = 49) groups based on their urine albumin to creatinine ratios (UACR), along with 42 healthy controls. We assessed 13 biomarkers, including transferrin (Tf), immunoglobulin G (IgG), podocalyxin, neutrophil gelatinase-associated lipocalin (NGAL), N-acetyl-beta-glucosaminidase, α-1-microglobulin, 8-hydroxy-deoxyguanosine, tumor necrosis factor-alpha (TNF-α), and interleukin-18 in urine samples, along with cystatin C, total bilirubin, and uric acid in sera samples, to evaluate their diagnostic roles. From the measurements, the blood neutrophil to lymphocyte ratio was also calculated. Results Urinary Tf, IgG, NGAL, and TNF-α were significantly related to the UACR. We calculated the area under the receiver operating characteristic curves (area under the curve) and found that urinary IgG (0.894), NGAL (0.875), Tf (0.861), TNF-α (0.763), and the combination of urinary Tf + IgG + TNF-α + NGAL (0.922) showed good diagnostic value for early-stage DN. Conclusions Urinary Tf, IgG, NGAL, TNF-α, and the combination of all four biomarkers demonstrated excellent diagnostic value for early-stage DN in patients with type 2 diabetes.

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Section: Discussionmentioning

confidence: 85%

The role of serum and urinary biomarkers in the diagnosis of early diabetic nephropathy in patients with type 2 diabetes

Zhang

Pan

2019

PeerJ

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“…The number of the included subjects in the case group and the control group ranged from 20 to 328 and 20 to 192, respectively. Of these 48 articles, 27 came from China [ 22 , 30 , 34 , 36 , 37 , 41 , 43–46 , 48 , 49 , 55–60 , 64 , 65 , 67 , 68 , 70–73 ], 16 from Turkey [ 21 , 23 , 29 , 31 , 35 , 38 , 40 , 42 , 47 , 50–54 , 61 , 69 ], 3 from India [ 32 , 63 , 39 ], 1 from Greece [ 62 ] and 1 from Kazakhstan [ 33 ]. Amongst these studies, 21 reported NLR (9 enrolled patients with DR, 12 enrolled patients with DN) [ 21 , 23 , 31 , 32 , 34 , 35 , 38 , 41–43 , 45 , 47 , 50–54 , 56–60 , 62 , 63 , 65 , 67–69 , 71–73 ], 33 reported the data of MPV (23 enrolled patients with DR, 10 enrolled patients with DN) [ 22 , 29 , 30 , 33 , 36–40 , 44 , 46 , 48–50 , 55 , 61 , 64 , 66 , 70 , 73 ], and 12 reported PDW (12 enrolled patients with DR, 3 enrolled patients with DN) […”

Section: Resultsmentioning

confidence: 99%

The association of neutrophil to lymphocyte ratio, mean platelet volume, and platelet distribution width with diabetic retinopathy and nephropathy: a meta-analysis

Liu

Li³

et al. 2018

Bioscience Reports

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The aim of the present study was to investigate the correlation of neutrophil to lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet distribution width (PDW) with diabetic nephropathy (DN) and diabetic retinopathy (DR). We searched for eligible studies from PubMed, Embase, Web of Science, and CNKI up to 1 December 2017. Standardized mean difference (SMD) was calculated with a confidence interval (CI) of 95%. A total of 48 studies were included in our meta-analysis. Compared with patients with type Ⅱ diabetes mellitus (T2DM) and without DR, NLR, MPV, and PDW were higher in patients with DR (SMD = 0.77; 95% CI: 0.49–1.05; P<0.001; SMD = 0.68; 95% CI: 0.36–0.99; P<0.001; SMD = 0.52; 95% CI: 0.28–0.76; P<0.01). Compared with patients with T2DM and without DN, NLR, MPV, and PDW were higher in patients with DN (SMD = 0.63; 95% CI: 0.43–0.83; P<0.001; SMD = 0.81; 95% CI: 0.36–1.25; P<0.001; SMD = 0.70; 95% CI: 0.50–0.90; P<0.001). We also found that MPV was strongly associated with the severity of DR, and NLR was closely related to the degree of DN. Our findings indicated that NLR, MPV, and PDW could be recommended as inexpensive diagnostic biomarkers for DN and DR. However, considering several limitations in the present study, further high-quality clinical studies should be performed to investigate the relationship of NLR, MPV, and PDW to DN and DR.

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“…In T2DM, the increase in blood NLR and urinary IL-8 is of concern as high IL-8 can increase the progression of renal disease. 23,24 Renal damage and scarring are reported to be due to cytotoxic products of neutrophils. 25 A positive correlation between NLR and diabetic peripheral neuropathy has been recently suggested.…”

Section: Discussionmentioning

confidence: 99%

<p>Blood Neutrophil-to-Lymphocyte Ratio and Urine IL-8 Levels Predict the Type of Bacterial Urinary Tract Infection in Type 2 Diabetes Mellitus Patients</p>

Sharif-Askari¹,

Sharif-Askari²,

Guella³

et al. 2020

IDR

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Background: Extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the most common uropathogens causing UTI (urinary tract infection) in type 2 diabetes mellitus (T2DM). Circulatory inflammatory markers such as C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are usually dysregulated during UTI. However, the differential regulation of these inflammatory signatures during E. coli and K. pneumoniae UTI in T2DM has not been determined. Methods: A case-control study on 466 patients was performed to investigate the inflammatory signatures indicative of ESBL-E. coli and K. pneumoniae UTIs in T2DM. Serum CRP levels and blood NLR for these patients were determined and associated with E. coli and K. pneumoniae ESBL uropathogen using multivariate logistic regression analysis. Urinary interleukin 8 (IL-8) levels were also assessed and associated with these two UTI uropathogens in T2DM. The association of the two ESBL-uropathogens with the survival outcomes of T2DM patients was also analyzed using Cox-proportional hazard model. Results: T2DM patients with ESBL-E. coli UTI had lower serum CRP levels (median, CRP mg/dL 33.7 vs 39.8, respectively; P=0.023) and higher blood NLR (median, NLR 3.2 vs 2.6, respectively; P=0.010) compared to those with K. pneumoniae UTIs (P<0.001). Moreover, in T2DM, the urinary IL-8 levels was higher in ESBL-E. coli compared to those with K. pneumoniae UTIs (P<0.0001). After adjusting for confounders, including age, gender, serum albumin, hemoglobulin, leukocytes, and platelet counts, T2DM patients with blood NLR ≥ 3.5 were at higher risk for ESBL-E. coli UTIs than ESBL-K. pneumoniae UTIs (odds ratio [OR], 3.61, 95% confidence interval, Cl, 1.49-8.73; P=0.004). Moreover, T2DM patients with ESBL-E. coli UTIs had higher all-cause mortality (hazard ratio [HR], 4.09; 95%, 1.14-14.59) than those with K. pneumoniae UTIs. Conclusion: Serum CRP levels, blood NLR, and IL-8 urinary levels differentiate ESBL-E. coli from K. pneumoniae UTIs in T2DM.

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Study of neutrophil-lymphocyte ratio as novel marker for diabetic nephropathy in type 2 diabetes

Cited by 52 publications

References 44 publications

The role of serum and urinary biomarkers in the diagnosis of early diabetic nephropathy in patients with type 2 diabetes

The role of serum and urinary biomarkers in the diagnosis of early diabetic nephropathy in patients with type 2 diabetes

The association of neutrophil to lymphocyte ratio, mean platelet volume, and platelet distribution width with diabetic retinopathy and nephropathy: a meta-analysis

<p>Blood Neutrophil-to-Lymphocyte Ratio and Urine IL-8 Levels Predict the Type of Bacterial Urinary Tract Infection in Type 2 Diabetes Mellitus Patients</p>

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