Study of absolute neutrophil count and neutrophil-lymphocyte ratio in patients with type 2 diabetes mellitus and its correlation with diabetic nephropathy

Abstract

Background and Objectives: Diagnostic markers to detect diabetic nephropathy at the early stage are important as early intervention can slow the loss of kidney function. Currently, there are very few diagnostic markers available. Micro-albuminuria is an accepted sign of early renal injury. Measurement of other markers such as neutrophil gelatinase-associated lipocalin and cystatin C, etc., is costly, and their utility is still under the research. Diabetic nephropathy in type 2 diabetes mellitus is thought to have elevated cytokines. However, their measurement is not easy. Absolute neutrophil count (ANC) and neutrophil-lymphocyte ratio (NLR) can act as a surrogate marker for the same. There is limited research concerning the correlation between ANC, NLR, and diabetic nephropathy. ANC is a very simple and inexpensive laboratory parameter. There are only a few studies done previously studying the association between ANC and albuminuria in the Indian population with type 2 diabetes mellitus. Subjects and Methods: This cross-sectional study was conducted in the hospitals attached to Bangalore Medical College and Research Institute. One hundred and forty-five Type II diabetes patients who gave consent for the study and satisfy the inclusion criteria were included in the study. Data were collected using semi-structured questionnaire, clinical examination, and relevant investigations. Statistical analysis was performed using the SPSS software. P < 0.05 was considered statistically significant. Results: Among the 145 individuals in the study, the mean age of the study population was 53.33 years (standard deviation: 11.90). The female-to-male ratio is 1.01: 1. The mean duration of disease was 5.88 years. The average ANC and NLR was higher in patients with proteinuria as compared to those without proteinuria. P value was statistically significant. It was noted that the NLR progressively increased from KDIGO stage G2 to G4, and the P value was statistically significant at 0.001. Interpretation and Conclusion: The NLR and ANC were significantly higher in patients with micro-albuminuria and macro-albuminuria compared to patients without proteinuria. They are simple, cost-effective parameters and can be considered as a surrogate marker for the detection and prognostic purposes of diabetic nephropathy. We hope this study adds to the existing data on NLR and ANC which are less studied parameters and paves way to future, well-matched, prospective studies which may define more in detail about the temporal correlation between ANC, NLR, and diabetic nephropathy.