Competing risks analysis for neutrophil to lymphocyte ratio as a predictor of diabetic retinopathy incidence in the Scottish population

被引：12

作者：

Rajendrakumar, Aravind Lathika ^{[1
,2
]}

Hapca, Simona M. ^{[1
,3
]}

Nair, Anand Thakarakkattil Narayanan ^{[1
]}

Huang, Yu ^{[1
]}

Chourasia, Mehul Kumar ^{[1
,4
]}

Kwan, Ryan Shun-Yuen ^{[1
,5
]}

Nangia, Charvi ^{[1
]}

Siddiqui, Moneeza K. ^{[1
,6
]}

Vijayaraghavan, Prathiba ^{[7
]}

Matthew, Shona Z. ^{[8
]}

Leese, Graham P. ^{[9
]}

Mohan, Viswanathan ^{[7
]}

Pearson, Ewan R. ^{[1
]}

Doney, Alexander S. F. ^{[1
]}

Palmer, Colin N. A. ^{[1
]}

机构：

[1] Univ Dundee, Ninewells Hosp, Div Populat Hlth & Genom, Dundee, Scotland

[2] Duke Univ, Biodemog Aging Res Unit, Durham, NC 27708 USA

[3] Univ Stirling, Div Comp Sci & Math, Stirling FK9 4LA, Scotland

[4] IQVIA, 3 Forbury Pl,23 Forbury Rd, Reading RG1 3JH, England

[5] Beatson Inst Canc Res, Glasgow, Scotland

[6] Queen Mary Univ London, Wolfson Inst Populat Hlth, London E1 4NS, England

[7] Madras Diabet Res Fdn, Chennai, India

[8] Univ Edinburgh, Edinburgh, Scotland

[9] Univ Dundee, Ninewells Hosp & Med Sch, Dept Med, Dundee, Scotland

来源：

BMC MEDICINE | 2023年 / 21卷 / 01期

关键词：

Diabetic retinopathy; Neutrophil-lymphocyte ratio; Competing risks; Subdistribution hazard ratio; Cause-specific hazard ratio; ASSOCIATION; INFLAMMATION; PROGRESSION; INFECTIONS; INDIANS; COUNT;

D O I：

10.1186/s12916-023-02976-7

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundDiabetic retinopathy (DR) is a major sight-threatening microvascular complication in individuals with diabetes. Systemic inflammation combined with oxidative stress is thought to capture most of the complexities involved in the pathology of diabetic retinopathy. A high level of neutrophil-lymphocyte ratio (NLR) is an indicator of abnormal immune system activity. Current estimates of the association of NLR with diabetes and its complications are almost entirely derived from cross-sectional studies, suggesting that the nature of the reported association may be more diagnostic than prognostic. Therefore, in the present study, we examined the utility of NLR as a biomarker to predict the incidence of DR in the Scottish population.MethodsThe incidence of DR was defined as the time to the first diagnosis of R1 or above grade in the Scottish retinopathy grading scheme from type 2 diabetes diagnosis. The effect of NLR and its interactions were explored using a competing risks survival model adjusting for other risk factors and accounting for deaths. The Fine and Gray subdistribution hazard model (FGR) was used to predict the effect of NLR on the incidence of DR.ResultsWe analysed data from 23,531 individuals with complete covariate information. At 10 years, 8416 (35.8%) had developed DR and 2989 (12.7%) were lost to competing events (death) without developing DR and 12,126 individuals did not have DR. The median (interquartile range) level of NLR was 2.04 (1.5 to 2.7). The optimal NLR cut-off value to predict retinopathy incidence was 3.04. After accounting for competing risks at 10 years, the cumulative incidence of DR and deaths without DR were 50.7% and 21.9%, respectively. NLR was associated with incident DR in both Cause-specific hazard (CSH = 1.63; 95% CI: 1.28-2.07) and FGR models the subdistribution hazard (sHR = 2.24; 95% CI: 1.70-2.94). Both age and HbA(1c) were found to modulate the association between NLR and the risk of DR.ConclusionsThe current study suggests that NLR has a promising potential to predict DR incidence in the Scottish population, especially in individuals less than 65 years and in those with well-controlled glycaemic status.

引用

页数：11

共 55 条

[1] Mediation Effect of Neutrophil Lymphocyte Ratio on Cardiometabolic Risk Factors and Cardiovascular Events [J].