The Predictive Value Of Neutrophil-to-Lymphocyte Ratio And Platelet-to-Lymphocyte Ratio Levels Of Diabetic Peripheral Neuropathy

Objective:This study was designed to evaluate the relationship between neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)levels and diabetic peripheral neuropathy(DPN)in different types of diabetes to determine their prognostic value in predicting the disease of diabetic peripheral neuropathy.Method:We recruited 225 diabetes cases from the department of endocrinology of Anhui provincial hospital from August 2018 to October 2019,including 70 cases of type 1 diabetes mellitus(T1DM)and 155 cases of type 2 diabetes mellitus(T2DM).A total of103 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 theDM with DPN group.The included subjects were divided into four different groups,including T1DM with DPN group(T1DPN group),T1DM without DPN group(T1 without DPN group),T2DM with DPN group(T2DPN group),T2DM without DPN group(T2 without 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:For type 1 diabetes,patients with DPN shared distinct characteristics.For example,the patients were older,and had higher levels of inflammatory indicators(i.e.,levels of PLR and NLR),higher total cholesterol(TC)lever and platelet counts,and lower level of indirect bilirubin(I-BIL),compared with patients without DPN.For type 2 diabetes,the patients with DPN were older,with longer disease course,had higher levels of NLR,and lower level of I-BIL and triglyceride(TG),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(AUC;0.878),and was able to distinguish between patients with and without DPN.The cut-off level for PLR to predict DPN was97.880,with a sensitivity of 70.80%,a specificity of 77.30%,and an AUC of 0.753.For type 2 diabetes,NLR showed the highest AUC of 0.602,with the cut-off level of 2.485,a sensitivity of 38.00% and a specificity of 79.00%.For the follow-up results,The type of diabetes mellitus was a significant factor for the new onset of DPN.And the levels of neutrophils(NC),the percentage of neutrophils(NEUT),PLR and NLR were all statistically higher in the group with newly diagnosed DPN.However,the levels of BWI,lymphocytes(LC),the percentage of lymphocytes(LYMPH),TC(mmol/L),TG(mmol/L)and LDL-C(mmol/L)were significantly lower in the group with newly diagnosed DPN(P<0.05).Multivariate binary logistic regression analysis showed that the adjusted ORs of diabetes type and NLR with newly diagnosed DPN were 0.091(95%CI,0.010-0.799)and 0.060(95%CI,0.014-0.258;p ≤ 0.001)respectively.Conclusion:The T1DM patients who has a higher level of PLR is more likely to develop into DPN,while T2DM patients who has a higher level of NLR is more likely to develop into DPN.NLR and PLR could be used as predictors to help clinicians screening for DPN in different types of diabetes.In this study,we also found that type 1 diabetes is more likely to develop DPN in the future.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.