Association of platelet-to-lymphocyte ratio with kidney clinicopathologic features and renal outcomes in patients with diabetic kidney disease

Association of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-to-high-density lipoprotein ratio with diabetic nephropathy

INTRODUCTION

The aim of this study was to determine the relationship between albuminuria and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and monocyte-to-high density lipoprotein-cholesterol ratio (MHR).

METHODS

Patients with type 2 diabetes mellitus diagnosis, aged over 18, had estimated glomerular filtration rate (eGFR) ≥60 mL/dk/1.73 m2 included. Patients were divided into groups according to ACR values: <30 mg/g (group 1), 30-300 mg/g (group 2) and >300 mg/g (group 3). We examined whether there was a significant difference in NLR, PLR, and MHR among the three groups.

RESULTS

A total of 360 patients were included in the study. NLR was significantly higher in group 3 than in group 1 (p = 0.016). There was no significant difference in PLR or MHR among the three groups (p = 0.312 and p = 0.687, respectively). A significant difference was detected in NLR in comparison between the groups with and without diabetic nephropathy, but there was no significant difference in PLR or MHR (p = 0.028; p = 0.950 and p = 0.389, respectively). NLR correlated with creatinine and ACR (r: 0.166, p = 0.002; r: 0.144, p = 0.006, respectively). MHR correlated positively with creatinine (r: 0.25.3, p = 0.016, respectively).

CONCLUSION

NLR was significantly higher in the diabetic nephropathy group than in the non-diabetic nephropathy group. This may suggest that NLR can be used as a prognostic marker in diabetic nephropathy. Although there was no significant relationship between MHR and albuminuria, MHR positively correlated with creatinine and negatively correlated with eGFR. Therefore, MHR may be useful in monitoring the development and progression of chronic kidney disease in diabetic patients rather than in the early stages. However, further studies are needed.

Association Between Pentraxins and Obesity in Prediabetes and Newly Diagnosed Type 2 Diabetes Mellitus Patients

Systemic inflammation has an important role in the prognosis and progression of many chronic diseases, including diabetes (T2DM). This retrospective study aimed to evaluate inflammatory status by determining the serum inflammatory biomarkers (PTX3, hs-CRP, TNF-α, and IL-6) and new indices, like the mean corpuscular volume (MCV) to lymphocyte ratio (MCVL) and cumulative inflammatory index (IIC), in a cohort of patients with prediabetes (PreDM) and newly diagnosed T2DM. We also wanted to assess the association with clinical parameters and different obesity-related indices, to identify possible correlations and to evaluate the diagnostic accuracy of the biomarkers using ROC curve analysis. In this study, we included 60 patients diagnosed with T2DM and 30 patients with PreDM. The ELISA method was applied. Elevated PTX3, hs-CRP, TNF-α, and IL-6 levels were found in T2DM patients compared to preDM patients. An independent relationship was found between PTX3, hs-CRP, and different obesity-related indices in patients with preDM and T2DM. The MCVL index exhibited an inverse trend proportional to the rising levels of HbA1c in the T2DM group. Spearman's analysis revealed in the T2DM group that the PTX3 values correlated much better with IIC (rho = 0.445, p-value = 0.014) and MCVL (rho = 0.338, p-value = 0.048). Hs-CRP values expressed moderate-to-weak correlations with IIC and MCVL in both groups. Additionally, ROC analysis showed that the PTX3 (AUC was 0.720; p = 0.003; cut-off value 1888.00 pg/mL, with 67.60% sensitivity and 73.30% specificity) and MCVL index (AUC was 0.677; p = 0.047; cut-off value 39.60, with 63.30% sensitivity and 66.70% specificity) have a good, accurate diagnosis compared with IL-6 (AUC was 0.866; p < 0.0001; cut-off value 40.30 pg/mL, with 100.00% sensitivity and 60.00% specificity). IIC showed 61.70% sensitivity and 60.00% specificity, with an AUC of 0.572, p = 0.027 and a cut-off value of 2.35. PTX3 and MCVL can serve as independent predictor factors in the inflammatory status in preDM and T2DM patients, supporting their potential as biomarkers for T2DM management and future research.

Prognostic effect of neutrophil percentage-to-albumin ratio (NPAR) on all-cause and cardiovascular mortality in diabetic kidney disease (DKD): NHANES 1999-2018

BACKGROUND

This study aimed to evaluate the associations between neutrophil percentage-to-albumin ratio (NPAR) and both all-cause and cardiovascular mortality in diabetic kidney disease (DKD) patients.

METHODS

The data for this study were sourced from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Weighted logistic regression, Cox proportional hazards model, and Fine-Gray competing risk model were used to assess the association between NPAR and both all-cause and cardiovascular mortality in DKD patients.

RESULTS

A total of 2,699 participants were enrolled in this study. Cox regression analysis revealed that elevated NPAR levels were associated with a higher risk of all-cause mortality in all participants (HR: 2.17, 95%CI: 1.83-2.58). Meanwhile, a significant difference in cardiovascular mortality was observed in males (HR: 1.83, 95%CI: 1.42-2.38) but not in females. Finally, the adjusted Fine-Gray model identified NPAR as an independent predictor of cardiovascular mortality in males (SHR: 1.86 95%CI: 1.28-2.72) but not in females.

CONCLUSIONS

In a nationally representative sample of DKD participants in the US, a significant association was detected between elevated NPAR and increased all-cause and cardiovascular mortality. In addition, gender differences in the relationship between NPAR and both all-cause and cardiovascular mortality were also observed.

Associations of Systemic Immune-Inflammation Index With Mortality Risk Among Adults in Diabetic Kidney Disease, NHANES 1999 to 2018

OBJECTIVES

Immune-inflammation plays a crucial role in the pathogenesis of diabetic kidney disease (DKD), but an exact assessment of indicators remains undefined. In this study we address the link between systemic immune-inflammation index (SII) and mortality risk in DKD, and we explore the effect of sex disparities.

METHODS

Data from patients with DKD from the National Health and Nutritional Examination Surveys (NHANES, 1999 to 2018) were studied and their causes of death were identified from NHANES-related files. A weighted Cox model was used to evaluate hazard ratios for all-cause, cardiovascular, and cardiocerebrovascular mortality, and these associations were visualized by smoothing curves.

RESULTS

The average SII was 634.20 (103/μL). There were 1,283 deaths recorded during 273,422 person months (396 were cardiovascular related and 461 were cardiocerebrovascular related). Higher SIIs in the fifth quintile were significantly associated with increased mortality (p<0.01). SII trends showed an increased risk of all-cause mortality of >697.0 (103/μL), cardiovascular risk of >717.8 (103/μL), and cardiocerebrovascular risk of >650.0 (103/μL). In men, mortality increased when SII reached 500 to 660 (103/μL) and 700 to 760 (103/μL) for women.

CONCLUSIONS

There was a significant association between higher SII and increased risk of all-cause, cardiovascular, and cardiocerebrovascular mortality in DKD patients. In addition, although men had lower SII, their mortality was higher than that of women.

Development of Predictive Models for Progression from Diabetic Kidney Disease to End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Aim

The aim of this study was to develop a predictive model for the progression of diabetic kidney disease (DKD) to end-stage renal disease (ESRD) and to evaluate the effectiveness of renal pathology and the kidney failure risk equation (KFRE) in this context.

Methods

The study comprised two parts. The first part involved 555 patients with clinically diagnosed DKD, while the second part focused on 85 patients with biopsy-proven DKD. Cox regression analysis and competing risk regression were employed to identify independent predictors. Time-dependent receiver operating characteristic (ROC) was used to evaluate prediction performance, and the area under the curve (AUC) was calculated to assess the model's accuracy.

Results

The Cox regression model developed for the 555 patients clinically diagnosed with DKD identified 5 predictors (body mass index (BMI), estimated glomerular filtration rate (eGFR), 24-hour urinary total protein (UTP), systemic immune-inflammatory index (SII), and controlling nutritional status (CONUT), whereas the Competing risks model included 4 predictors (BMI, eGFR, UTP, CONUT). Among 85 patients with biopsy-proven diabetic DKD, the combined prognostic model integrating KFRE, interstitial fibrosis and tubular atrophy (IFTA), SII and BMI demonstrated enhanced predictive ability at 5 years. The developed models offer improved accuracy over existing methods by incorporating renal pathology and novel inflammatory indices, making them more applicable in clinical settings.

Conclusion

The predictive model proved to be effective in assessing the progression of DKD to ESRD. Additionally, the combined model of KFRE, IFTA, SII, and BMI demonstrates high predictive performance. Future studies should validate these models in larger cohorts and explore their integration into routine clinical practice to enhance personalized risk assessment and management.

Prediction Model and Decision Analysis for Early Recognition of SDNS/FRNS in Children

Purpose

This study identified factors that identification of progression-predicting utility from steroid-sensitive nephrotic syndrome(SSNS) to steroid-dependent or frequently relapsing nephrotic syndrome (SDNS/FRNS) in patients and developed a corresponding predictive model.

Patients and Methods

This retrospective study analyzed clinical data from 756 patients aged 1 to 18 years, diagnosed with SSNS, who received treatment at the Department of Nephrology, Children's Hospital of Chongqing Medical University, between November 2007 and May 2023. We developed a shrinkage and selection operator (LASSO) - logistic regression model, which was visualized using a nomogram. The model's performance, validity, and clinical utility were evaluated through receiver operating characteristic curve analysis, confusion matrix, calibration plot, and decision curve analysis.

Results

The platelet-to-lymphocyte ratio (PLR) was identified as an independent risk factor for progression, with an odds ratio (OR) of 1.01 (95% confidence interval (CI) = 1.01-1.01, p = 0.009). Additionally, other significant factors included the time for urinary protein turned negative (OR = 1.17, 95% CI = 1.12-1.23, p < 0.001), estimated glomerular filtration rate(eGFR) (OR = 0.99, 95% CI = 0.98-0.99, p < 0.001), low-density lipoprotein (OR = 0.90, 95% CI = 0.83-0.97, p = 0.006), thrombin time (OR = 1.22, 95% CI = 1.07-1.39, p = 0.003), and neutrophil absolute counts (OR = 1.10, 95% CI = 1.02-1.18, p = 0.009). The model's performance was assessed through internal validation, yielding an area under the curve of 0.78 (0.73-0.82) for the training set and 0.81 (0.75-0.87) for the validation set.

Conclusion

PLR, eGFR, the time for urinary protein turned negative, low-density lipoprotein, thrombin time, and neutrophil absolute counts may be effective predictors for identifying SSNS patients at risk of progressing to SDNS/FRNS. These findings offer valuable insights for early detection and support the use of precision medicine strategies in managing SDNS/FRNS.

Inflammation-related markers and prognosis of alpha-fetoprotein producing gastric cancer

BACKGROUND

Inflammation-related markers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and prognostic nutritional index (PNI) could reflect tumor immune microenvironment and predict prognosis of cancers. However, it had not been explored in alpha-fetoprotein (AFP) producing gastric cancer (GC).

AIM

To determine the predictive value of inflammation-related peripheral blood markers including as NLR, PLR, MLR, SII, SIRI and PNI in the prognosis of AFP- producing GC (AFPGC). Besides, this study would also compare the differences in tumor immune microenvironment, clinical characteristics and prognosis between AFPGC and AFP- GC patients to improve the understanding of this disease.

METHODS

573 patients enrolled were retrospectively studied. They were divided into AFP+ group (AFP ≥ 20 ng/mL) and AFP- group (AFP < 20 ng/mL), comparing the levels of NLR/PLR/MLR/SII/SIRI/PNI and prognosis. In AFP+ group, the impact of NLR/PLR/MLR/SII/SIRI/PNI and their dynamic changes on prognosis were further explored.

RESULTS

Compared with AFP- patients, AFP+ patients had higher NLR/PLR/MLR/SII/SIRI and lower PNI levels and poorer overall survival (OS). In the AFP+ group, mortality was significantly lower in the lower NLR/PLR/MLR/SII/SIRI group and higher PNI group. Moreover, the dynamic increase (NLR/PLR/MLR/SII/SIRI) or decrease (PNI) was associated with the rise of mortality within 1 year of follow-up.

CONCLUSION

Compared with AFP- patients, the level of inflammation-related peripheral blood markers significantly increased in AFP+ patients, which was correlated with OS of AFP+ patients. Also, the gradual increase of SII and SIRI was associated with the risk of death within one year in AFP+ patients. AFPGC should be considered as a separate type and distinguished from AFP- GC because of the difference in tumor immune microenvironment. It requires basic experiments and large clinical samples in the future.

Association Between Systemic Immune Inflammation Index and Diabetes Mellitus in the NHANES 2003-2018 Population

Objects

This study aimed to explore the association between the Systemic Immune-Inflammation Index (SII) and diabetes mellitus (DM) and to assess its influence on the prognosis of the DM and no-DM groups.

Methods

The study used data from the National Health and Nutrition Examination Survey; 9643 participants were included. Logistic regression analysis was employed to evaluate connections between SII and DM. We used the Cox proportional hazards model, restricted cubic spline, and Kaplan-Meier curve to analyze the relationship between SII and mortality.

Results

The logistic regression analysis indicated that a significant increase in the likelihood of developing DM with higher SII levels (odds ratio, 1.31; 95% CI, 1.09-1.57, P = .003). The Cox model showed that there is a positive association between increased SII and higher all-cause mortality. The hazard ratios for SII were 1.53 (1.31, 1.78), 1.61 (1.31, 1.98), and 1.41 (1.12, 1.78) in the total, DM and non-DM groups, respectively. We observed a linear correlation between SII and all-cause mortality in DM participants, whereas non-DM participants and the total population showed a nonlinear correlation.

Conclusion

Elevated SII levels are linked to an augmented risk of DM. Those with DM and higher SII levels demonstrated an elevated risk of mortality.

Hemogram-Derived Inflammatory Markers in Cats with Chronic Kidney Disease

Chronic kidney disease (CKD) is characterized by chronic inflammation, which mediates the progressive replacement of functional nephrons by fibrotic tissue. Hemogram-derived inflammatory markers are known to serve as markers of pathological conditions; however, their diagnostic value in feline CKD is still unknown. The aim of this retrospective study was to investigate selected hemogram-derived inflammatory markers (neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and the systemic immune-inflammatory index (SII)) in cats at different clinical stages of CKD. Eighty-eight client-owned cats with CKD and thirty-two healthy control cats were included. Cats with CKD were divided into two groups: early CKD (IRIS stage 1 and 2; 62 cats) and progressed CKD (IRIS stage 3 and 4; 26 cats). The values of inflammatory markers were compared between the two CKD groups and the control group. All investigated hemogram-derived inflammatory markers were significantly (p < 0.05) greater in cats with advanced CKD than in those in the other two groups. Additionally, we demonstrated a statistically significant weak to moderate correlation between serum urea, creatinine, selected hematologic and urinary parameters, and the investigated inflammatory markers in cats with CKD. Chronic inflammation can be easily and inexpensively assessed with hemogram-derived markers.

Research progress on Alpinia oxyphylla in the treatment of diabetic nephropathy

Diabetic nephropathy (DN) constitutes a major microvascular complication of diabetes and is a primary cause of mortality in diabetic individuals. With the global rise in diabetes, DN has become an urgent health issue. Currently, there is no definitive cure for DN. Alpinia oxyphylla, a Chinese herbal medicine traditionally used, exhibits a wide range of pharmacological effects and is frequently used in the prevention and management of DN. This paper offers an extensive review of the biological mechanisms by which A. oxyphylla delivers therapeutic advantages in DN management. These mechanisms include activating podocyte autophagy, regulating non-coding RNA, modulating gut microbiota, alleviating lipotoxicity, counteracting oxidative stress, and diminishing inflammatory responses, underscoring the therapeutic potential of A. oxyphylla in DN treatment.

Significance of Neutrophil to Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) in Diabetic Foot Ulcer and Potential New Therapeutic Targets

Diabetic foot ulcer (DFU) is a well-known complication of diabetes and a significant burden on the national health systems. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio are inexpensive and easily accessible biomarkers that have proved to be useful in several inflammatory, infectious and cardiovascular diseases. We carried out a comprehensive review examining the association of NLR and PLR with the onset and progression of DFU. PLR and NLR were significantly increased in patients with DFU, compared with a control group of T2DM patients without DFU, and correlate well with DFU severity, evaluated by Wagner and IWGDF grading scales. In patients with diabetic foot infections (DFI), elevated NLR and PLR were correlated with osteomyelitis, increased risk of amputation, and septic complications. The significance of the elevated value of these biomarkers in DFU is related to chronic hyperglycemia and low-grade systemic inflammation, atherosclerotic and vascular complications, and also the associated septic factor. Serial, dynamic follow-up can provide useful information in planning and monitoring DFU treatment, as well as in risk stratification of these vulnerable patients. Further randomized studies are needed to set the cut-off values with clinical significance.

Association of the systemic immuno-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio with diabetic microvascular complications

Background

The systemic immuno-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) are widely used and have been shown to be predictive indicators of various diseases. Diabetic nephropathy (DN), retinopathy (DR), and peripheral neuropathy (DPN) are the most prominent and common microvascular complications, which have seriously negative impacts on patients, families, and society. Exploring the associations with these three indicators and diabetic microvascular complications are the main purpose.

Methods

There were 1058 individuals with type 2 diabetes mellitus (T2DM) in this retrospective cross-sectional study. SII, NLR, and PLR were calculated. The diseases were diagnosed by endocrinologists. Logistic regression and subgroup analysis were applied to evaluate the association between SII, NLP, and PLR and diabetic microvascular complications.

Results

SII, NLR, and PLR were significantly associated with the risk of DN [odds ratios (ORs): 1.52, 1.71, and 1.60, respectively] and DR [ORs: 1.57, 1.79, and 1.55, respectively] by multivariate logistic regression. When NLR ≥2.66, the OR was significantly higher for the risk of DPN (OR: 1.985, 95% confidence interval: 1.29-3.05). Subgroup analysis showed no significant positive associations across different demographics and comorbidities, including sex, age, hypertension, HbA1c (glycated hemoglobin), and dyslipidemia.

Conclusion

This study found a positive relationship between NLR and DN, DR, and DPN. In contrast, SII and PLR were found to be only associated with DN and DR. Therefore, for the diagnosis of diabetic microvascular complications, SII, NLR and PLR are highly valuable.

Association between Relative Thrombocytosis and Microalbuminuria in Adults with Mild Fasting Hyperglycemia

An elevated platelet count may contribute to significant thrombotic events and pose a risk for diabetic microvascular complications. Albuminuria, one of the hallmarks of diabetes, is thought to be a risk factor for endothelial dysfunction. In this study, we investigated the association between relative thrombocytosis and an increased urine albumin-to-creatinine ratio in healthy adult participants. Using multivariate analyses on data from the Korea National Health and Nutrition Examination Survey V-VI, 12,525 eligible native Koreans aged ≥ 20 were categorized into platelet count quintiles by sex. The highest platelet count quintile included younger, more obese participants with elevated white blood cell counts, poor lipid profiles, and a better estimated glomerular filtration rate. Restricted cubic spline regression analysis revealed significant associations between platelet count and fasting blood glucose, glycated hemoglobin, and urine albumin-to-creatinine ratio. Adjusted logistic regression models indicated that heightened fasting blood glucose and platelet count were linked to risk of microalbuminuria (fasting blood glucose, odds ratio = 1.026, 95%CI = 1.011-1.042; platelet count, odds ratio = 1.004, 95%CI = 1.002-1.006). Particularly, an increased platelet count was notably associated with microalbuminuria progression in subjects with impaired fasting glucose. These findings suggest that an elevated platelet count, even below diagnostic thrombocytosis levels, independently correlates with an increased risk of vascular endothelial dysfunction in patients with impaired fasting glucose.

Association between the Prognostic Nutritional Index and Chronic Microvascular Complications in Patients with Type 2 Diabetes Mellitus

The prognostic nutritional index (PNI) is associated with inflammatory conditions. Since type 2 diabetes mellitus (T2DM) and its microvascular complications produce a significant inflammatory burden, we aimed to compare the PNI levels of the subjects with T2DM to those of healthy individuals. Furthermore, we aimed to compare the PNI levels of the diabetic subjects, with and without microvascular complications. The study cohort consisted of T2DM patients and healthy volunteers. The general characteristics, laboratory data, and PNI of the T2DM and control groups were compared. We further compared the PNI levels of the diabetic patients, with and without diabetic microvascular complications. The PNI levels of the T2DM patients and the control group were 51.6 (30.1-73.8)% and 64.8 (49.4-76)%, respectively (p < 0.001). Subgroup analyses revealed that the PNI was lower in the diabetic subjects with diabetic microvascular complications than in the diabetic patients without microvascular complications (p < 0.001), in patients with diabetic nephropathy compared to those without nephropathy (p < 0.001), in patients with diabetic retinopathy compared to those without retinopathy (p < 0.001), and in patients with diabetic neuropathy compared to those without neuropathy (p < 0.001). In conclusion, we assert that assessing the PNI may yield additional diagnostic value in regards to the timely determination of diabetic microvascular complications.

Controlling nutritional status score is associated with renal progression, cardiovascular events, and all-cause mortality in biopsy-proved diabetic kidney disease

Background: The Controlled Nutritional Status (CONUT) score, calculated from albumin, total cholesterol, and lymphocyte count, is a useful indicator for immune-nutritional assessment and is associated with the prognosis of various diseases. However, its relationship with renal outcomes, cardiovascular disease (CVD), and all-cause mortality in patients with diabetic kidney disease is unclear. Methods: This retrospective single-center study enrolled 336 patients with biopsy-confirmed diabetic kidney disease from August 2009 to December 2018. The outcomes were progression to end-stage renal disease (ESRD), CVD events, and death. Univariate and multivariate Cox regression analyses were performed to estimate the association between confounding factors and outcomes. The Kaplan-Meier curve was used to compare the outcomes of the patients according to the median CONUT score. The area under the curve (AUC) evaluated with time-dependent receiver operating characteristics was used to test discriminative power of COUNT score. Results: During a median follow-up period of 5.1 years. The Kaplan-Meier analysis showed that patients in the high CONUT group (CONUT score > 3) had a significantly higher incidence of ESRD, CVD events, and all-cause mortality than those in the low CONUT group (CONUT score ≤ 3). The multivariate COX regression analysis indicated that, The CONUT score was an independent predictor of ESRD (hazards ration [HR] = 1.129, 95% confidence interval [CI] 1.037-1.228, p = 0.005), CVD events (HR = 1.159, 95% CI 1.057-1.271, p = 0.002), and all-cause mortality (HR = 1.299, 95% CI 1.143-1.478, p < 0.001). Conclusion: The CONUT score is an independent risk factor for ESRD, CVD events, and overall death in patients with diabetic kidney disease.

Intimal CD31-Positive Relative Surfaces Are Associated with Systemic Inflammatory Markers and Maturation of Arteriovenous Fistula in Dialysis Patients

BACKGROUND

Arteriovenous fistula dysfunction is a widely disputed subject in the scientific literature on end-stage kidney disease (ESKD). The main cause of mortality and morbidity in these patients is the non-maturation or dysfunction of the arteriovenous fistula. Despite the many complications, the native arteriovenous fistula remains the gold standard in the treatment of these patients requiring renal replacement. This study aims to discuss the predictive role of some systemic inflammatory biomarkers (NLR, PLR, SII, IL-6), intimal hyperplasia, and neoangiogenesis (characterized by intimal-media CD31-positive relative surface) in arteriovenous fistula maturation failure.

METHODS

The present study was designed as an observational, analytical, and prospective study which included patients diagnosed with ESKD with indications of radio-cephalic arteriovenous fistula (RCAVF). Demographic data, comorbidities, preoperative laboratory data and histological/digital morphometry analysis results were processed. The patients included were divided into two groups based on their AVF maturation status at 8 weeks: "Maturation" (Group 1) and "Failed Maturation" (Group 2).

RESULTS

There was no difference in the demographic data. In terms of comorbidities, the second group had a greater incidence of heart failure (p = 0.03), diabetes (p = 0.04), peripheral artery disease (p = 0.002), and obesity (p = 0.01). Additionally, regarding the laboratory findings, these patients had higher levels of serum uric acid (p = 0.0005), phosphates (p < 0.0001), and creatinine (p = 0.02), as well as lower levels of total calcium (p = 0.0002), monocytes (p = 0.008), and lymphocytes (p < 0.0001). Moreover, all inflammatory markers (p = 0.001; p < 0.0001; p = 0.006, and p = 0.03) and Ca-P product (p < 0.0001) had higher baseline values in Group 2. Upon immunohistochemical analysis, regarding the density of neoformed vessels, there was a higher incidence of CD31-positive surfaces (p = 0.006) and CD31-positive relative surfaces (p = 0.001); the NLR (r = 0.323; p = 0.03), PLR (r = 0.381; p = 0.04), SII (r = 0.376; p = 0.03), and IL-6 (r = 0.611; p < 0.001) are all significantly correlated with vascular density, as evidenced by CD31.

CONCLUSIONS

Heart failure, peripheral artery disease, obesity, and diabetes, as well as the systemic inflammatory markers (NLR, PLR, SII, IL-6), intimal hyperplasia, and CD31-positive relative surfaces are predictors of arteriovenous fistula maturation failures.

Association of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Diabetic Kidney Disease in Chinese Patients with Type 2 Diabetes: A Cross-Sectional Study

Purpose

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been extensively studied in a variety of diseases. However, research on their relationship with diabetic kidney disease (DKD) is limited. The aim of our study was to investigate the association between these two indicators and renal function in Chinese patients with type 2 diabetes and assess whether they can serve as predictors of DKD.

Methods

This cross-sectional study enrolled 655 Chinese patients with type 2 diabetes. Subjects were divided into three groups according to the urinary albumin-to-creatinine ratio (UACR). The differences in the NLR and PLR among the groups and their correlation with renal function were analyzed. Logistic regression analysis was used to analyze independent risk factors for DKD, and receiver operating characteristic (ROC) curves were used to assess the predictive values of the NLR and PLR for the disease.

Results

The NLR and PLR were significantly different among the three groups, and they increased with increasing levels of albuminuria. Pearson's correlation analysis showed that the NLR and PLR were positively correlated with the UACR but negatively correlated with the estimated glomerular filtration rate (eGFR) (p<0.001). Logistic regression analysis showed that these two indicators were independent risk factors for DKD (p<0.001). The results of ROC curve analysis suggested that the NLR (AUC=0.794; 95% CI, 0.760-0.827; p<0.001) and PLR (AUC=0.665; 95% CI, 0.623-0.706, p<0.001) had important diagnostic value for DKD.

Conclusion

The NLR and PLR were closely associated with renal function among Chinese patients with type 2 diabetes, and high NLR and PLR values may serve as predictors of DKD.

The Predictive Value of Systemic Inflammatory Markers, the Prognostic Nutritional Index, and Measured Vessels' Diameters in Arteriovenous Fistula Maturation Failure

Background: An arteriovenous fistula (AVF) is the first-line vascular access pathway for patients diagnosed with end-stage renal disease (ESRD). In planning vascular access, it is necessary to check the diameters of the venous and arterial components for satisfactory long-term results. Furthermore, the mechanism underlying the maturation failure and short-term patency in cases of AVFs is not fully known. This study aims to verify the predictive role of inflammatory biomarkers (the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), and C-reactive protein (CRP)), Ca-P product, the prognostic nutritional index (PNI), and the diameters of the venous and arterial components in the failure of AVF maturation. Methods: The present study was designed as an observational, analytical, and retrospective cohort study with a longitudinal follow-up, and included all patients with a diagnosis of ESRD that were admitted to the Vascular Surgery Clinic of the Targu Mures Emergency County Hospital, Romania, between January 2019 and December 2021. Results: The maturation of AVF at 6 weeks was clearly lower in cases of patients in the high-NLR (31.88% vs. 91.36%; p < 0.0001), high-PLR (46.94% vs. 85.55%; p < 0.0001), high-SII (44.28% vs. 88.89%; p < 0.0001), high-CRP (46.30% vs. 88.73%; p < 0.0001), high-Ca-P product (40.43% vs. 88.46%; p < 0.0001), and low-PNI (34.78% vs. 91.14%; p < 0.0001) groups, as well as in patients with a lower radial artery (RA) diameter (40% vs. 94.87%; p = 0.0009), cephalic vein (CV) diameter (44.82% vs. 97.14%; p = 0.0001) for a radio-cephalic AVF (RC-AVF), and brachial artery (BA) diameter (30.43% vs. 89.47%; p < 0.0001) in addition to CV diameter (40% vs. 94.59%; p < 0.0001) for a brachio-cephalic AVF (BC-AVF), respectively. There was also a significant increase in early thrombosis and short-time mortality in the same patients. A multivariate analysis showed that a baseline value for the NLR, PLR, SII, CRP, Ca-P product, and PNI was an independent predictor of adverse outcomes for all of the recruited patients. Furthermore, for all patients, a high baseline value for vessel diameter was a protective factor against any negative events during the study period, except for RA diameter in mortality (p = 0.16). Conclusion: Our findings concluded that higher NLR, PLR, SII, CRP, Ca-P product, and PNI values determined preoperatively were strongly predictive of AVF maturation failure, early thrombosis, and short-time mortality. Moreover, a lower baseline value for vessel diameter was strongly predictive of AVF maturation failure and early thrombosis.

Association between fibrinogen/albumin ratio and severity of coronary artery calcification in patients with chronic kidney disease: a retrospective study

Aim

Previous studies have shown that the fibrinogen to albumin ratio (FAR) is closely related to the severity and prognosis of coronary atherosclerosis. In this study, we sought to evaluate the association between FAR and the degree of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD).

Methods

In this retrospective study, 218 patients with CKD were stratified into low, medium and high FAR groups according to the tertiles of the FAR values. The CAC scores, clinical information and laboratory test results of the three FAR groups were compared. To explore the relationship between FAR and CAC we conducted binary logistic regression and correlation analyses.

Results

In the low FAR group, the CAC scores were significantly lower than those in the medium and high FAR groups (P  <  0.001). There was a significant correlation between the FAR and CAC scores (r = 0.510, P  <  0.001). The FAR was an independent predictor of CAC (OR = 1.106, 95% CI [1.004-1.218], P = 0.042).

Conclusion

In patients with CKD, the FAR can be considered as an effective predictor of CAC.

The Predictive Value of NLR, MLR, and PLR in the Outcome of End-Stage Kidney Disease Patients

Background: Chronic kidney disease (CKD) is a global public health problem with a high mortality rate and a rapid progression to end-stage kidney disease (ESKD). Recently, the role of inflammation and the correlation between inflammatory markers and CKD progression have been studied. This study aimed to analyze the predictive value of the neutrophil−lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) in assessing the outcome of ESKD patients. Methods: A retrospective study which included all patients admitted in the Department of Nephrology of the County Emergency Clinical Hospital, Târgu-Mureș, Romania, between January 2016 and December 2019, diagnosed with ESKD. Results: Mortality at 30 days was clearly higher in the case of the patients in the high-NLR groups (40.12% vs. 1.97%; p < 0.0001), high-MLR (32.35% vs. 4.81%; p < 0.0001), and respectively high-PLR (25.54% vs. 7.94%; p < 0.0001). There was also a significant increase in the number of hospital days and the average number of dialysis sessions in patients with high-NLR (p < 0.0001), high-MLR (p < 0.0001), and high-PLR (p < 0.0001). The multivariate analysis showed that a high baseline value for NLR (p < 0.0001), MLR (p < 0.0001), and PLR (p < 0.0001) was an independent predictor of 30-day mortality for all recruited patients. Conclusions: Our findings established that NLR, MLR, and PLR determined at hospital admission had a strong predictive capacity of all-cause 30-day mortality in ESKD patients who required RRT for at least 6 months. Elevated values of the ratios were also associated with longer hospital stays and more dialysis sessions per patient.

The association between platelet-to-lymphocyte ratio with mortality among patients suffering from acute decompensated heart failure

Background

Platelet-to-lymphocyte ratio (PLR) is an inflammation index suggested to have the prognostic capability in heart failure (HF). We sought to investigate the association of PLR with cardiovascular disease (CVD) mortality and creatinine (Cr) rise among Iranian individuals suffering from acute decompensated HF (ADHF).

Methods

This retrospective cohort study was in the context of the Persian Registry Of cardioVascular diseasE/Heart Failure (PROVE/HF) study. 405 individuals with ADHF admitted to the emergency department were recruited from April 2019 to March 2020. PLR was calculated by division of platelet to absolute lymphocyte counts and categorized based on quartiles. We utilized the Kaplan–Meier curve to show the difference in mortality based on PLR quartiles. Cr rise was defined as the increment of at least 0.3 mg/dl from baseline. Cox proportional hazard ratio (HR) was used to investigate the association of PLR with CVDs mortality.

Results

Mean age of participants was 65.9 ± 13.49 years (males: 67.7%). The mean follow-up duration was 4.26 ± 2.2 months. CVDs mortality or re-hospitalization was not significantly associated with PLR status. Multivariate analysis of PLR quartiles showed a minimally reduced likelihood of CVDs death in 2nd quartile versus the first one (HR 0.40, 95% confidence interval (CI) 0.16–1.01, P = 0.054). Cr rise had no remarkable relation with PLR status in neither model.

Conclusion

PLR could not be used as an independent prognostic factor among ADHF patients. Several studies are required clarifying the exact utility of this index.

The Predictive Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Levels of Diabetic Peripheral Neuropathy

Objective

This study was designed to assess the levels of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in diabetes patients to determine their prognostic value in predicting the disease of diabetic peripheral neuropathy (DPN).

Methods

We recruited 225 diabetes cases from the department of endocrinology of Anhui Provincial Hospital from August 2018 to October 2019. A total of 103 patients without diabetic peripheral neuropathy (DPN) were followed up for 18 months, and the number of patients of newly diagnosed DPN was counted. According to the results of neuroelectrophysiological examination, these patients were divided into the diabetes mellitus (DM) without DPN group and the DM with DPN group. The general information and results of blood samples were collected. The collected data were compared between groups, and the receiver operating characteristic curve (ROC) was drawn. The follow-up data were compared between groups and Binary Logistic regression analysis was performed.

Results

Patients with DPN shared distinct characteristics. For example, the patients were older, and had higher levels of inflammatory indicators (ie, levels of PLR and NLR), and lower level of indirect bilirubin, compared with patients without DPN. According to the receiver operating characteristic curve analysis, for type 1 diabetes, PLR showed the highest area under the curve (0.753). For type 2 diabetes, NLR showed the highest AUC of 0.602. For the follow-up results, patients with newly diagnosed DPN bad higher NLR level.

Conclusion

If patients of type 1 and type 2 diabetes are combined with elevated level of PLR and NLR, respectively, they are more likely complicated with DPN. NLR and PLR could be used as predictors to help clinicians screening for DPN in different types of diabetes. For type 1 diabetes, if patients who were without DPN had higher NLR level, the risk of developing DPN in the future will be greatly increased.