Top

BMC Endocrine Disorders

Published in:

01-12-2020 | Diabetic Cardiomyopathy | Research article

Neutrophil: lymphocyte ratio is positively associated with subclinical diabetic cardiomyopathy

Authors: Xiaoli Huang, Zihan Qin, Min Xu, Feifei Zhang, Xiaohong Jiang, Fei Hua, Lichan Tao

Published in: BMC Endocrine Disorders | Issue 1/2020

Abstract

Background

Subclinical diabetic cardiomyopathy (DCM) occurs frequently in asymptomatic subjects with Type 2 diabetes mellitus (T2DM). The direct association between the immune system and DCM with effective biomarkers has been demonstrated in previous studies.

Methods

Five hundred seven subjects with T2DM were recruited from April 2018 to October 2019 and divided into T2DM with cardiac dysfunction (DCM) group and T2DM without cardiac dysfunction (non-DCM) group. The relationship between the quartiles of Neutrophil: lymphocyte ratio (NLR) and subclinical DCM was evaluated by using adjusted logistic regression models.(covariates: age, sex, BMI, duration of diabetes, and hyperlipidemia).

Results

Blood NLR was significantly upregulated in DCM group compared to non-DCM group (P = 0.05). Then the adjusted odds ratio (95% CI) of the highest NLR quartile was 14.32 (2.92–70.31) compared with the lowest quartile of NLR after multiple adjusted (P < 0.001). However, there was no significant relation between neutrophil and lymphocyte counts and the occurrence of DCM in T2DM patients.

Conclusions

This study demonstrated that NLR was associated with the occurrence of subclinical DCM, suggesting that NLR may be a biomarker for predicting DCM with effectiveness and accuracy.

Trial registration

Chinese Clinical Trial Registry (ChiCTR1900027080). Registered 30 October 2019. Retrospectively registered: www.medresman.org

Available only for authorised users

Paolillo S, Marsico F, Prastaro M, Renga F, Esposito L, De Martino F, et al. Diabetic cardiomyopathy: definition, diagnosis, and therapeutic implications. Heart Fail Clin. 2019;15(3):341–7.PubMedCrossRef

Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;130(25):2354–94.PubMedCrossRef

Fang ZY, Schull-Meade R, Downey M, Prins J, Marwick TH. Determinants of subclinical diabetic heart disease. Diabetologia. 2005;48(2):394–402.PubMedCrossRef

Jellis CL, Jenkins C, Leano R, Martin JH, Marwick TH. Reduced end-systolic pressure-volume ratio response to exercise: a marker of subclinical myocardial disease in type 2 diabetes. Circ Cardiovasc Imaging. 2010;3(4):443–9.PubMedCrossRef

Giorda CB, Cioffi G, de Simone G, Di Lenarda A, Faggiano P, Latini R, et al. Predictors of early-stage left ventricular dysfunction in type 2 diabetes: results of DYDA study. Eur J Cardiovasc Prev Rehabil. 2011;18(3):415–23.PubMedCrossRef

Faden G, Faganello G, De Feo S, Berlinghieri N, Tarantini L, Di Lenarda A, et al. The increasing detection of asymptomatic left ventricular dysfunction in patients with type 2 diabetes mellitus without overt cardiac disease: data from the SHORTWAVE study. Diabetes Res Clin Pract. 2013;101(3):309–16.PubMedCrossRef

Cioffi G, Giorda CB, Chinali M, Di Lenarda A, Faggiano P, Lucci D, et al. Analysis of midwall shortening reveals high prevalence of left ventricular myocardial dysfunction in patients with diabetes mellitus: the DYDA study. Eur J Prev Cardiol. 2012;19(5):935–43.PubMedCrossRef

Low A, Mak E, Rowe JB, Markus HS, O'Brien JT. Inflammation and cerebral small vessel disease: a systematic review. Ageing Res Rev. 2019;53:100916.PubMedCrossRef

Zhang W, Xu W, Feng Y, Zhou X. Non-coding RNA involvement in the pathogenesis of diabetic cardiomyopathy. J Cell Mol Med. 2019;23(9):5859–67.PubMedPubMedCentralCrossRef

10.

Nikolajevic Starcevic J, Janic M, Sabovic M. Molecular Mechanisms Responsible for Diastolic Dysfunction in Diabetes Mellitus Patients. Int J Mol Sci. 2019;20(5):1197.

11.

Humeres C, Frangogiannis NG. Fibroblasts in the infarcted, remodeling, and failing heart. JACC Basic Transl Sci. 2019;4(3):449–67.PubMedPubMedCentralCrossRef

12.

Davidovich P, Kearney CJ, Martin SJ. Inflammatory outcomes of apoptosis, necrosis and necroptosis. Biol Chem. 2014;395(10):1163–71.PubMedCrossRef

13.

Hussain T, Tan B, Yin Y, Blachier F, Tossou MC, Rahu N. Oxidative stress and inflammation: what polyphenols can do for us? Oxidative Med Cell Longev. 2016;2016:7432797.CrossRef

14.

de Rooij SR, Nijpels G, Nilsson PM, Nolan JJ, Gabriel R, Bobbioni-Harsch E, et al. Low-grade chronic inflammation in the relationship between insulin sensitivity and cardiovascular disease (RISC) population: associations with insulin resistance and cardiometabolic risk profile. Diabetes Care. 2009;32(7):1295–301.PubMedPubMedCentralCrossRef

15.

Garcia C, Feve B, Ferre P, Halimi S, Baizri H, Bordier L, et al. Diabetes and inflammation: fundamental aspects and clinical implications. Diabetes Metab. 2010;36(5):327–38.PubMedCrossRef

16.

Jia G, Whaley-Connell A, Sowers JR. Diabetic cardiomyopathy: a hyperglycaemia- and insulin-resistance-induced heart disease. Diabetologia. 2018;61(1):21–8.PubMedCrossRef

17.

Jia G, DeMarco VG, Sowers JR. Insulin resistance and hyperinsulinaemia in diabetic cardiomyopathy. Nat Rev Endocrinol. 2016;12(3):144–53.PubMedCrossRef

18.

Pickup JC, Mattock MB, Chusney GD, Burt D. NIDDM as a disease of the innate immune system: association of acute-phase reactants and interleukin-6 with metabolic syndrome X. Diabetologia. 1997;40(11):1286–92.PubMedCrossRef

19.

Suhett LG, Hermsdorff HHM, Rocha NP, Silva MA, Filgueiras MS, Milagres LC, et al. Increased C-reactive protein in Brazilian children: association with Cardiometabolic risk and metabolic syndrome components (PASE study). Cardiol Res Pract. 2019;2019:3904568.PubMedPubMedCentralCrossRef

20.

Park MH, Park SI, Kim JH, Yu J, Lee EH, Seo SR, et al. The acute effects of hydrocortisone on cardiac electrocardiography, action potentials, intracellular calcium, and contraction: the role of protein kinase C. Mol Cell Endocrinol. 2019;494:110488.PubMedCrossRef

21.

Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, et al. Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives. Eur Respir Rev. 2018;27(147):170113.

22.

He ZQ, Duan H, Lin FH, Zhang J, Chen YS, Zhang GH, et al. Pretreatment neutrophil-to-lymphocyte ratio plus albumin-to-gamma-glutamyl transferase ratio predict the diagnosis of grade III glioma. Ann Transl Med. 2019;7(22):623.PubMedPubMedCentralCrossRef

23.

Kang JW, Kim MG, Kim SS, Im HI, Dong SH, Kim SH, et al. Neutrophil-lymphocyte ratio as a valuable prognostic marker in idiopathic sudden sensorineural hearing loss. Acta Otolaryngol. 2019:1–7. https://doi.org/10.1080/00016489.2019.1705998.

24.

Guo X, Zhang S, Zhang Q, Liu L, Wu H, Du H, et al. Neutrophil:lymphocyte ratio is positively related to type 2 diabetes in a large-scale adult population: a Tianjin chronic Low-grade systemic inflammation and health cohort study. Eur J Endocrinol. 2015;173(2):217–25.PubMedCrossRef

25.

Mertoglu C, Gunay M. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diab Metab Syndr. 2017;11(Suppl 1):S127–s31.CrossRef

26.

Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277–314.CrossRef

27.

Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: stress, protocols, and tracers. J Nuci Cardiol. 2016;23(3):606–39.CrossRef

28.

Choi SJ, Hong YH, Kim SM, Shin JY, Suh YJ, Sung JJ. High neutrophil-to-lymphocyte ratio predicts short survival duration in amyotrophic lateral sclerosis. Sci Rep. 2020;10(1):428.PubMedPubMedCentralCrossRef

29.

Sukhija R, Aronow WS, Sorbera C, Peterson SJ, Frishman WH, Cohen M. Mortality, left ventricular ejection fraction, and prevalence of new left ventricular wall motion abnormality at long-term follow-up in patients with implantable cardioverter defibrillators treated with biventricular pacing versus right ventricular pacing. Am J Ther. 2007;14(4):328–30.PubMedCrossRef

30.

Ulu SM, Dogan M, Ahsen A, Altug A, Demir K, Acarturk G, et al. Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy. Diabetes Technol Ther. 2013;15(11):942–7.PubMedCrossRef

31.

Ozturk ZA, Kuyumcu ME, Yesil Y, Savas E, Yildiz H, Kepekci Y, et al. Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients? J Endocrinol Investig. 2013;36(8):593–9.

32.

Azab B, Daoud J, Naeem FB, Nasr R, Ross J, Ghimire P, et al. Neutrophil-to-lymphocyte ratio as a predictor of worsening renal function in diabetic patients (3-year follow-up study). Renal fail. 2012;34(5):571–6.CrossRef

33.

Kozakova M, Morizzo C, Fraser AG, Palombo C. Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus. Cardiovas Diabetol. 2017;16(1):78.CrossRef

34.

Rawal S, Nagesh PT, Coffey S, Van Hout I, Galvin IF, Bunton RW, et al. Early dysregulation of cardiac-specific microRNA-208a is linked to maladaptive cardiac remodelling in diabetic myocardium. Cardiovasc Diabetol. 2019;18(1):13.PubMedPubMedCentralCrossRef

35.

Al-Rasheed NM, Al-Rasheed NM, Hasan IH, Al-Amin MA, Al-Ajmi HN, Mohamad RA, et al. Simvastatin ameliorates diabetic cardiomyopathy by attenuating oxidative stress and inflammation in rats. Oxidative Med Cell Longev. 2017;2017:1092015.CrossRef

36.

Frati G, Schirone L, Chimenti I, Yee D, Biondi-Zoccai G, Volpe M, et al. An overview of the inflammatory signalling mechanisms in the myocardium underlying the development of diabetic cardiomyopathy. Cardiovasc Res. 2017;113(4):378–88.PubMedCrossRef

37.

Dinh W, Futh R, Nickl W, Krahn T, Ellinghaus P, Scheffold T, et al. Elevated plasma levels of TNF-alpha and interleukin-6 in patients with diastolic dysfunction and glucose metabolism disorders. Cardiovasc Diabetol. 2009;8:58.PubMedPubMedCentralCrossRef

Title: Neutrophil: lymphocyte ratio is positively associated with subclinical diabetic cardiomyopathy
Authors: Xiaoli Huang
Zihan Qin
Min Xu
Feifei Zhang
Xiaohong Jiang
Fei Hua
Lichan Tao
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Diabetic Cardiomyopathy
Type 2 Diabetes
Published in: BMC Endocrine Disorders / Issue 1/2020
Electronic ISSN: 1472-6823
DOI: https://doi.org/10.1186/s12902-020-00571-y

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Neutrophil: lymphocyte ratio is positively associated with subclinical diabetic cardiomyopathy

Abstract

Background

Methods

Results

Conclusions

Trial registration

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2020

Chinese siblings with hereditary medullary thyroid carcinoma caused by RET mutation: implications for RET oncogene detection

Malignancy rates for Bethesda III and IV thyroid nodules: a retrospective study of the correlation between fine-needle aspiration cytology and histopathology

Plasma adiponectin, visfatin, leptin, and resistin levels and the onset of colonic polyps in patients with prediabetes

Steroid metabolites for diagnosing and predicting clinicopathological features in cortisol-producing adrenocortical carcinoma

A case report of thyroid-associated Orbitopathy with elevated TPO antibodies

A remarkable case of thyrotoxicosis initially caused by graves’ disease followed by a probable TSHoma – a case report

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page