Journal Menu
Submit Manuscript via ScholarOne

Annals of Medicine and Medical Education
Volume 1, Issue 1 (March 2014), pp. 8-13

DOI: 10.12973/ejms.2014.102p

Downloaded 730 times.

Research Article

Published online on Apr 02, 2014

How to reference this article?

 

Neutrophil-to-lymphocyte ratio in diabetes mellitus patients with and without diabetic foot ulcer

Cüneyt Kahraman, Gündüz Yümün, Nilüfer Kuzeyli Kahraman, Nazli Dizen Namdar, Süleyman Cosgun

Abstract

Background: Diabetes mellitus (DM), with the cost of treatment and complications causes the increasing economic burden. Inflammation in the pathogenesis of type 2 DM and developing complications are considered to have a role. Macrovascular complications of diabetes, diabetic foot ulcers and amputations consequently reduce quality of life is seriously. Atherosclerosis and related complications is considered as an inflammatory process. To show the severity and course of this inflammatory process, the studies including many markers are available. Recently, it is reported as a cheap and accessible marker, neutrophil/lymphocyte ratio (NLR) is a good indicator of the inflammatory condition. The aim of this study to investigate the relationship between the presence of the diabetic foot and neutrophil / lymphocyte ratio. Methods: It has been noted retrospectively the charts of the data of internal medicine clinic patients with diabetes. Patients' age, sex, duration of diabetes, blood count and biochemical parameters were recorded. The data of patients with and without diabetic foot ulcers were assessed using SPSS 19.0. Results: Statistically significant differences were also observed according to HbA1c (P = 0.006), serum urea (P = 0.042), CRP (P < 0.001), neutrophil percent (P < 0.001), lymphocyte percent (P < 0.001), NLR (P = 0.001), among the 2 groups. A correlation was determined between NLR and age, serum urea, creatinine, white blood cell (WBC), neutrophil percent, lymphocyte percent, total cholesterol, HDL-cholesterol. Conclusion: The presence of diabetic foot ulcers alone may also represent a systemic inflammatory response. NLR can be a cheap and accessible marker for presence of this inflammatory process via using the response rates and follow-up of patients.

Key Words: Diabetic foot ulcermacrovascular complications, neutrophil/lymphocyte ratio.


References
  1. Wild, S., Roglic, G., Green, A., Sicree, R., and King, H. (2004). Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27,1047–1053.
  2. Levin ME. Foot lesions in patients with diabetes mellitus. End Met Clin North Amer 1996; 25: 447-462.
  3. Mark P, Sloven Ki. Foot problems in diabetes. Med Clin North Am. 1998; 82 (4):949-71.
  4. Laing P. The development and conıplications of diabetic foot ulcers. Am J Surg. 1998 Aug 176 (Suppl 2A): 11-19
  5. Levin ME. Foot lesions in patients with diabetes mellitus. End Metab Clin North Am.1996; 5 (2): 448-54.
  6. Pitsavos C, Tampourlou M, Panagiotakos DB, Skoumas Y, Chrysohoou C, Nomikos T, et al: Association Between Low-Grade Systemic Inflammation and Type 2 Diabetes
  7. Mellitus Among Men and Women from the ATTICA Study. Rev Diabet Stud 2007, 4:98-104.
  8. Nakanishi N, Sato M, Shirai K, Suzuki K, Tatara K: White blood cell count as a risk factor for hypertension; a study of Japanese male office workers. J Hypertens 2002, 20:851-857.
  9. Bell DS, O’Keefe JH: White cell count, mortality, and metabolic syndrome in the Baltimore longitudinal study of aging. J Am Coll Cardiol 2007, 50:1810-1811.
  10. Marsland AL, McCaffery JM, Muldoon MF, Manuck SB: Systemic inflammation and the metabolic syndrome among middle-aged community volunteers. Metabolism 2010, 59:1801-1808.
  11. Brooks GC, Blaha MJ, Blumenthal RS: Relation of C-reactive protein to abdominal adiposity. Am J Cardiol 2010, 106:56-61.
  12. Yasue H, Hirai N, Mizuno Y, Harada E, Itoh T, Yoshimura M, et al: Low-grade inflammation, thrombogenicity, and atherogenic lipid profile in cigarette smokers. Circ J 2006, 70:8-13.
  13. Pirkola J, Vaarasmaki M, Ala-Korpela M, Bloigu A, Canoy D, Hartikainen AL, et al: Low-grade, systemic inflammation in adolescents: association with early-life
  14. factors, gender, and lifestyle. Am J Epidemiol 2010, 171:72-82.
  15. Lee S, Choe JW, Kim HK, Sung J: High-Sensitivity C-Reactive Protein and Cancer. J Epidemiol 2011.
  16. Saito K, Kihara K: Role of C-reactive protein as a biomarker for renal cell carcinoma. Expert Rev Anticancer Ther 2010, 10:1979-1989.
  17. Bovill EG, Bild DE, Heiss G, Kuller LH, Lee MH, Rock R, et al: White blood cell counts in persons aged 65 years or more from the Cardiovascular Health Study. Correlations with baseline clinical and demographic characteristics. Am J Epidemiol 1996, 143:1107-1115.
  18. Freedman DS, Joesoef MR, Barboriak JJ, Stallone DD, Byers T: Correlates of leukocyte counts in men. Ann Epidemiol 1996, 6:74-82.
  19. Facchini F, Hollenbeck CB, Chen YN, Chen YD, Reaven GM: Demonstration of a relationship between white blood cell count, insulin resistance, and several risk factors for coronary heart disease in wome. J Intern Med 1992, 232:267-272.
  20. Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS: Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 2008, 102(6):653–7.
  21. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ: Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005, 91(3):181–4.
  22. Imtiaz, Fauzia, et al. "Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population." Int Arch Med 5.1 (2012): 2.
  23. Aydanur K. Endokrin sistem.In: Temel Patoloji. Edited by Çevikbaş U. İstanbul, Nobel, 2000, pp: 637-666.
  24. Masoudkabir F, Karbalai S, Vasheqhani-Farahani A et al. The association of liver transaminase activity with presence and severity of premature coronary artery disease. Angiology 2011;62(8):614-9.
  25. Uthamalingam S, Patvardhan EA., Subramanian S et al. Utility of the Neutrophil to Lymphocyte Ratio in Predicting Long-Term Outcomes in Acute Decompensated Heart Failure. Am J Cardiol 2011;107(3):433-8.
  26. Afsar B. The Relationship Between Neutrophil Lymphocyte Ratio With Urinary Protein and Albumin Excretion in Newly Diagnosed Patients With Type 2 Diabetes. Am J Med Sci. 2013 Feb 25.
  27. Pickup, J.and Crook, M. (1998)Is type II diabetes mellitus a disease of the innate immune system. Diabetologia41, 1241–1248.
  28. Navarro, J.F. and Mora, C.(2005) Role of inflammation on diabetic complications. Nephrol. Dial. Transplant.20, 2601–2604.
  29. JC Pickup, MB Mattock, GD Chusney, D Burt, NIDDM as a disease of the İnnate immune system: Association of acute-phase reactants and IL-6 with metabolic syndrome X, Diabetologia 1997; 40:1286-1292
  30. Çürüksulu, Hayrettin, et al. "Diyabetik ayak komplikasyonu bulunan ve bulunmayan DM’li hastalarda serum interlökin-6 ve HS-CRP düzeyleri." Haseki Tıp Bülteni 43 (2005): 121-125.