Association of Neutrophil-to-Lymphocyte Ratio With All-Cause Mortality in the Elderly Population in China: A Retrospective Cohort Study.

Neutrophil-to-lymphocyte ratio (NLR) is an emerging systemic inflammation marker associated with disease progression and mortality in patients. However, there is limited research on the predictive value of NLR in the general population. This study aimed to investigate the relationship between NLR and all-cause mortality in an elderly Chinese population. A retrospective cohort study was conducted based on health examination in a community in Shanghai, China, between 2015 and 2020. Among 6364 participants (aged ≥ 55 years), a total of 169 (2.66%) participants died during a median follow-up period of 5.37 years. The median NLR was 1.63. Multivariate analysis revealed that the upper 2 quartiles of NLR were positively associated with all-cause mortality (Q3 vs Q1: hazard ratio [HR] = 1.82; Q4 vs Q1: HR = 2.22). The stratified and interaction analyses showed that age, sex, body mass index (BMI), history of diabetes, or history of hypertension did not significantly modify the association between NLR and all-cause mortality. Elevated NLR was independently associated with an increased risk of all-cause mortality in the elderly Chinese population.

Increased neutrophil count Is associated with the development of chronic kidney disease in patients with diabetes.

BACKGROUND: This study aims to investigate the potential association of peripheral inflammatory blood cell parameters with the incidence and progression of chronic kidney disease (CKD) in patients with diabetes. METHODS: The cross-sectional study included 1192 subjects with diabetes derived from one center. The cohort study included 2060 subjects with diabetes derived from another two centers followed up for 4 years. Logistic regression and Cox proportional hazards models were used to evaluate the association of peripheral inflammatory blood cell with CKD. RESULTS: In the cross-sectional study, neutrophil count performed best as an independent risk factor for CKD (odds ratio 2.556 [95% confidence interval 1.111, 5.879]) even after 1:1 case-control matching for age, gender, history of high blood pressure and duration of diabetes. Spline regression revealed a significant linear association of CKD incidence with continuous neutrophil count in excess of 3.6 × 109 /L. In the cohort study, subjects were grouped based on tertile of neutrophil count and neutrophil-to-lymphocyte ratio. Cox regression analysis results showed that only neutrophil count was independently associated with CKD progression (the highest group vs. the lowest group, hazard ratio 2.293 [95% confidence interval 1.260, 4.171]) after fully adjusting for potential confounders. The cumulative incidence of CKD progression in patients with diabetes gradually increased with increasing neutrophil count (53 (7.7%) subjects in the lowest group vs. 60 (8.2%) in the middle group vs. 78 (12.2%) in the highest group). CONCLUSIONS: This study suggested that neutrophil count is an independent risk factor for progression of CKD in patients with diabetes.

Fibrosis Risk in Nonalcoholic Fatty Liver Disease Is Related to Chronic Kidney Disease in Older Type 2 Diabetes Patients.

CONTEXT: Nonalcoholic fatty liver disease (NAFLD) is a multisystem disease, associated with fibrosis and an increased risk of type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). OBJECTIVE: This work aimed to investigate the association of NAFLD fibrosis with the development of CKD in aged patients with T2DM. METHODS: This cross-sectional study enrolled 13 915 participants. A further 1734 individuals who had been followed annually for 5 years comprised the retrospective cohort study. Noninvasive markers, NAFLD fibrosis score (NFS), and fibrosis index based on 4 factors (FIB-4) were applied to determine NAFLD fibrosis risk. RESULTS: In the cross-sectional study, there was an additive interaction for NAFLD with increased risk of fibrosis and T2DM on CKD incidence. Logistic regression demonstrated that as NAFLD fibrosis risk progressed from low to intermediate and high, there was a stepwise increase in CKD in patients with NAFLD, T2DM, and those with coexistent NAFLD and T2DM when stratified by diabetes and fibrosis stage. FIB-4 had a much higher odds ratio (OR) value than NFS for prediction of CKD incidence. In the cohort study, individuals were grouped according to FIB-4 and NFS. Cox regression analysis showed that FIB-4 intermediate risk (hazard ratio [HR] 1.268; 95% CI, 1.056-1.521) and high risk (HR 2.516; 95% CI, 1.970-3.214) were significant predictors of CKD progression. When NFS was applied, only high risk was a significant predictor. CONCLUSION: NAFLD with an increased risk of fibrosis and presence of T2DM had an additive interaction on CKD incidence. Increased risk of NAFLD fibrosis was closely associated with CKD incidence and progression in aged T2DM patients. FIB-4 outperformed NFS as a noninvasive means to predict CKD development.

Association of TLR4 gene polymorphisms with susceptibility to type 2 diabetes mellitus in the Chinese Han population.

Toll-like receptor 4 (TLR4) gene plays important roles in the susceptibility to type 2 diabetes mellitus (T2DM). This study aims to detect the potential association of TLR4 gene polymorphisms with the susceptibility to T2DM in the Chinese Han population. 685 T2DM patients and 690 healthy controls were enrolled in this case-control study. The genotypes of TLR4 gene polymorphisms were analyzed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and DNA sequencing methods. We detected the g.13726T>C and g.15090G>A genetic polymorphisms. Our data supported that the g.13726T>C and g.15090G>A genetic polymorphisms were significantly associated with the increased susceptibility to T2DM in the homozygote comparison, recessive model, and allele contrast (all P-values<0.01). The allele-C and genotype-CC of g.13726T>C and allele-A and genotype-AA of g.15090G>A genetic polymorphisms might be the risk factors for increasing the susceptibility to T2DM. These preliminary findings indicate that the g.13726T>C and g.15090G>A genetic polymorphisms of TLR4 gene are potentially related to the susceptibility to T2DM in the studied population, and might be used as molecular markers for evaluating the risk of T2DM.

Association between the g.14461A>G genetic polymorphism of the TLR4 gene and type 2 diabetes mellitus risk in a Chinese population.

OBJECTIVE: Toll-like receptor 4 (TLR4) is an important candidate gene for mediating the susceptibility to type 2 diabetes mellitus (T2DM). The purpose of this study was to investigate the association between the TLR4 gene polymorphisms and T2DM susceptibility. METHODS: A total of 671 T2DM patients and 677 healthy controls were recruited in this study. The created restriction site-polymerase chain reaction and DNA sequencing methods have been used to analyze the TLR4 gene polymorphisms. RESULTS: One novel genetic polymorphism (g.14461A>G) was found. Our data indicated that the g.14461A>G genetic polymorphism was significantly associated with the increased susceptibility to T2DM in a homozygote comparison (GG vs. AA: odds ratio [OR]=2.09, 95% confidence interval [CI] 1.44-3.04, p<0.001), dominant model (GG/AG vs. AA: OR=1.27, 95% CI 1.03-1.57, p=0.028), recessive model (GG vs. AG/AA: OR=1.98, 95% CI 1.39-2.83, p<0.001), and allele contrast (G vs. A: OR=1.33, 95% CI 1.13-1.57, p=0.001). The allele-G might be the risk allele for enhancing the susceptibility to T2DM. CONCLUSION: These preliminary findings suggest that the g.14461A>G genetic polymorphism of the TLR4 gene is potentially related to the susceptibility to T2DM in the studied population.