Diagnostic Accuracy of Neutrophil-to-Lymphocyte Ratio and Platelet-to- Lymphocyte Ratio for Detection of Microalbuminuria in Patients with Diabetes Mellitus: A Hospital-Based Cross-Sectional Observational Study
Keywords:
Diabetes mellitus; Microalbuminuria; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio; Diabetic nephropathy; Diagnostic accuracy.Abstract
Background: Diabetes mellitus (DM) is one of the leading causes of chronic kidney disease worldwide. Diabetic nephropathy develops
gradually, with microalbuminuria representing the earliest clinically detectable manifestation of renal involvement. Early identification
of patients at increased risk is essential because timely intervention can delay or prevent progression to overt nephropathy and endstage
renal disease. Although urinary albumin estimation remains the gold standard for detecting microalbuminuria, it may not always
be readily available in resource-limited settings. Chronic low-grade inflammation plays a pivotal role in the development of diabetic
vascular complications. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), derived from routine complete
blood counts, have emerged as inexpensive inflammatory biomarkers reflecting systemic inflammation. Their potential diagnostic
value in identifying microalbuminuria among patients with diabetes has generated increasing research interest.
Methodology: A hospital-based cross-sectional observational study was conducted in the Department of Medicine, Pt. Jawaharlal
Nehru Memorial Medical College and Dr. B.R.A.M. Hospital, Raipur, Chhattisgarh, over one year. One hundred twenty adult patients
with diabetes mellitus fulfilling the eligibility criteria were enrolled consecutively. Clinical characteristics, duration of diabetes,
anthropometric measurements, laboratory investigations, complete blood count parameters, NLR, PLR, HbA1c, and urinary albumin
excretion were recorded. Diagnostic performance of NLR and PLR for detecting microalbuminuria was evaluated using receiver
operating characteristic (ROC) curve analysis. Statistical analysis was performed using IBM SPSS Statistics version 26.0.
Results: Among 120 patients, 48 (40.0%) had microalbuminuria. Patients with microalbuminuria demonstrated significantly higher
mean NLR (3.91 ± 1.24 vs. 2.18 ± 0.76; p<0.001) and PLR (164.7 ± 39.8 vs. 118.5 ± 28.9; p<0.001) compared with normoalbuminuric
patients. ROC analysis showed that NLR had an area under the curve (AUC) of 0.86 (95% CI: 0.79–0.92), whereas PLR demonstrated
an AUC of 0.81 (95% CI: 0.73–0.89). At an optimal cut-off value of 2.95, NLR showed 83.3% sensitivity and 80.6% specificity for
detecting microalbuminuria.
Conclusion: Both NLR and PLR were significantly associated with microalbuminuria among patients with diabetes mellitus. NLR
demonstrated superior diagnostic accuracy compared with PLR and may serve as a practical, inexpensive, and readily available
screening biomarker for early diabetic nephropathy.
References
International Diabetes Federation. IDF Diabetes Atlas. 10th
ed. Brussels: International Diabetes Federation; 2021.
American Diabetes Association Professional Practice
Committee. Classification and diagnosis of diabetes:
Standards of Care in Diabetes—2025. Diabetes Care.
;48(Suppl 1):S20-S38.
American Diabetes Association Professional Practice
Committee. Chronic kidney disease and risk management:
Standards of Care in Diabetes—2025. Diabetes Care.
;48(Suppl 1):S219-S238.
Kidney Disease: Improving Global Outcomes (KDIGO)
Diabetes Work Group. KDIGO 2022 Clinical Practice
Guideline for Diabetes Management in Chronic Kidney
Disease. Kidney Int. 2022;102(5 Suppl):S1-S127.
Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease:
Challenges, progress, and possibilities. Clin J Am Soc
Nephrol. 2017;12(12):2032-2045.
Thomas MC, Brownlee M, Susztak K, Sharma K, Jandeleit-
Dahm K, Zoungas S, et al. Diabetic kidney disease. Nat Rev
Dis Primers. 2015;1:15018.
Mogensen CE. Microalbuminuria predicts clinical proteinuria
and early mortality in maturity-onset diabetes. N Engl J Med.
;310(6):356-360.
Stevens PE, Levin A; Kidney Disease: Improving Global
Outcomes Chronic Kidney Disease Guideline Development
Work Group Members. Evaluation and management of
chronic kidney disease: Synopsis of the KDIGO 2012 Clinical
Practice Guideline. Ann Intern Med. 2013;158(11):825-830.
Pearson TA, Mensah GA, Alexander RW, Anderson JL,
Cannon RO III, Criqui M, et al. Markers of inflammation
and cardiovascular disease: Application to clinical and public
health practice. Circulation. 2003;107(3):499-511.
Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC,
De Kock M. What is the normal value of the neutrophil-tolymphocyte
ratio? BMC Res Notes. 2017;10:12.
Balta S, Ozturk C. The platelet-to-lymphocyte ratio: A simple,
inexpensive and rapid prognostic marker for cardiovascular
events. Platelets. 2015;26(7):680-681.
Akbas EM, Demirtas L, Ozcicek A, Timuroglu A, Bakirci
EM, Hamur H, et al. Association of epicardial adipose tissue,
neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte
ratio with diabetic nephropathy. Int J Clin Exp Med.
;7(7):1794-1801.
Sagoo MK, Gnudi L. Diabetic nephropathy: An overview.
In: Methods in Molecular Biology. Vol. 2067. Humana Press;
:3-7.
Huang W, Huang J, Liu Q, Lin F, He Z, Zeng Z, et al.
Neutrophil-lymphocyte ratio is a reliable predictive marker
for early-stage diabetic nephropathy: A meta-analysis. Int
Immunopharmacol. 2015;26(1):229-233.
Ciray H, Aksoy AH, Ulu N, Kaya M, Cinar V. Neutrophil-tolymphocyte
ratio and platelet-to-lymphocyte ratio in patients
with diabetic nephropathy. Ren Fail. 2015;37(7):1125-1129.
Lou M, Luo P, Tang R, Peng Y, Yu S, Huang W, et al.
Relationship between neutrophil-to-lymphocyte ratio and
diabetic nephropathy: A systematic review and meta-analysis.
Diabetes Res Clin Pract. 2021;172:108630.
Akbas EM, Hamur H, Demirtas L, Bakirci EM, Ozcicek
A, Ozcicek F, et al. Predictive value of neutrophil-tolymphocyte
ratio in diabetic nephropathy. Clin Exp Nephrol.
;18(4):610-615.
Azab B, Daoud J, Naeem FB, Nasr R, Ross J, Ghimire P, et
al. Neutrophil-to-lymphocyte ratio as a predictor of adverse
outcomes in patients with chronic kidney disease. Ann Med
Surg (Lond). 2016;6:90-96.
Afkarian M, Sachs MC, Kestenbaum B, Hirsch IB, Tuttle KR,
Himmelfarb J, et al. Kidney disease and increased mortality
risk in Type 2 diabetes. J Am Soc Nephrol. 2013;24(2):302-
Alicic RZ, Cox EJ, Tuttle KR. Inflammatory mechanisms as
new biomarkers and therapeutic targets for diabetic kidney
disease. Kidney Int Suppl (2011). 2020;10(1):54-61.
Navarro-González JF, Mora-Fernández C. The role of
inflammatory cytokines in diabetic nephropathy. J Am Soc
Nephrol. 2008;19(3):433-442.
Pichler R, Afkarian M, Dieter BP, Tuttle KR. Immunity and
inflammation in diabetic kidney disease. Nat Rev Nephrol.
;13(1):17-32.
Donate-Correa J, Luis-Rodríguez D, Martín-Núñez E, Tagua
VG, Hernández-Carballo C, Ferri C, et al. Inflammatory
targets in diabetic nephropathy. J Clin Med. 2020;9(2):458.
Chen Y, Lee K, Ni Z, He JC. Diabetic kidney disease:
Challenges, advances, and opportunities. Kidney Dis (Basel).
;6(4):215-225.
de Boer IH, Caramori ML, Chan JCN, Heerspink HJL, Hurst
C, Khunti K, et al. KDIGO 2022 Clinical Practice Guideline
for Diabetes Management in Chronic Kidney Disease:
Synopsis. Ann Intern Med. 2023;176(3):381-391.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
