Increased neutrophil-to-lymphocyte ratio (quartile 3 vs 1) was significantly associated with a higher risk of new-onset ischemic stroke (HR 1.14; 95% CI 1.06-1.23; p<0.001) in type 2 diabetes.
Cohort (n=85,351)
Yes
Does increased neutrophil-to-lymphocyte ratio predict new-onset ischemic stroke and atrial fibrillation in patients with type 2 diabetes mellitus?
Neutrophil-to-lymphocyte ratio is an independent predictor of new-onset ischemic stroke, but not atrial fibrillation, in Chinese patients with type 2 diabetes.
Effect estimate: HR 1.14 (95% CI 1.06-1.23)
p-value: p=<.001
INTRODUCTION: Neutrophil-to-lymphocyte ratio (NLR) is a routinely available biomarker that reflects systemic inflammation. The study evaluated the predictive value of NLR for ischemic stroke and atrial fibrillation (AF) in patients with type 2 diabetes mellitus. METHODS: This was a population-based cohort study of patients with type 2 diabetes mellitus and complete blood count tests at baseline between 1 January 1st, 2009, and 31 December, 2009, at government-funded hospitals/clinics in Hong Kong. Follow-up was until 31 December, 2019, or death. RESULTS: A total of 85,351 patients (age = 67.6 ± 13.2 years old, male = 48.8%, follow-up = 3101 ± 1441 days) were included. Univariable Cox regression found that increased NLR at quartiles 2, 3 and 4 was significantly associated with higher risks of new-onset ischemic stroke (hazard ratio HR: 1.28 1.20-1.37, p < .001, HR: 1.41 1.32-1.51, p < .001 and HR: 1.38 1.29-1.47, p < .001) and AF (HR: 1.09 1.02-1.17, p < .015; HR: 1.28 1.20-1.37, p < .001; HR: 1.39 1.31-1.49, p < .001) compared to quartile 1. On multivariable analysis, NLR remained a significant predictor of ischemic stroke risk for quartiles 2 and 3 (quartile 2: HR: 1.14 1.05, 1.22, p = .001; quartile 3: HR: 1.14 1.06, 1.23, p < .001) but not quartile 4 (HR: 1.08 0.994, 1.17, p = .070). NLR was not predictive of AF after adjusting for confounders (quartile 2: HR: 0.966 0.874, 1.07, p = .499; quartile 3: HR: 0.978 0.884, 1.08, p = .661; quartile 4: HR: 1.05 0.935, 1.16, p = .462). CONCLUSION: NLR is a significant predictor of new-onset ischaemic stroke after adjusting for significant confounders in Chinese type 2 diabetes patients.
Chang et al. (Sun,) conducted a cohort in Type 2 diabetes mellitus (n=85,351). Neutrophil-to-lymphocyte ratio (NLR) vs. Lowest quartile of NLR was evaluated on New-onset ischemic stroke (HR 1.14, 95% CI 1.06-1.23, p=<.001). Increased neutrophil-to-lymphocyte ratio (quartile 3 vs 1) was significantly associated with a higher risk of new-onset ischemic stroke (HR 1.14; 95% CI 1.06-1.23; p<0.001) in type 2 diabetes.