PDF(Pubmed)
Abstract：
BACKGROUND: The neutrophil-lymphocyte ratio (NLR) is a novel hematological parameter to assess systemic inflammation. Prior investigations have indicated that an increased NLR may serve as a potential marker for pathological states such as cancer and atherosclerosis. However, there exists a dearth of research investigating the correlation between NLR levels and mortality in individuals with diabetes and prediabetes. Consequently, this study aims to examine the connection between NLR and all-cause as well as cardiovascular mortality in the population of the United States (US) with hyperglycemia status.
METHODS: Data were collected from a total of 20,270 eligible individuals enrolled for analysis, spanning ten cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The subjects were categorized into three groups based on tertiles of NLR levels. The association of NLR with both all-cause and cardiovascular mortality was evaluated using Kaplan-Meier curves and Cox proportional hazards regression models. Restricted cubic splines were used to visualize the nonlinear relationship between NLR levels and all-cause and cardiovascular mortality in subjects with diabetes after accounting for all relevant factors.
RESULTS: Over a median follow-up period of 8.6 years, a total of 1909 subjects with diabetes died, with 671 deaths attributed to cardiovascular disease (CVD). And over a period of 8.46 years, 1974 subjects with prediabetes died, with 616 cases due to CVD. The multivariable-adjusted hazard ratios (HRs) comparing high to low tertile of NLR in diabetes subjects were found to be 1.37 (95% CI, 1.19-1.58) for all-cause mortality and 1.63 (95% CI, 1.29-2.05) for CVD mortality. And the correlation between high to low NLR tertile and heightened susceptibility to mortality from any cause (HR, 1.21; 95% CI, 1.03-1.43) and CVD mortality (HR, 1.49; 95% CI, 1.08-2.04) remained statistically significant (both p-values for trend < 0.05) in prediabetes subjects. The 10-year cumulative survival probability was determined to be 70.34%, 84.65% for all-cause events, and 86.21%, 94.54% for cardiovascular events in top NLR tertile of diabetes and prediabetes individuals, respectively. Furthermore, each incremental unit in the absolute value of NLR was associated with a 16%, 12% increase in all-cause mortality and a 25%, 24% increase in cardiovascular mortality among diabetes and prediabetes individuals, respectively.
CONCLUSIONS: The findings of this prospective cohort study conducted in the US indicate a positive association of elevated NLR levels with heightened risks of overall and cardiovascular mortality among adults with diabetes and prediabetes. However, potential confounding factors for NLR and the challenge of monitoring NLR\'s fluctuations over time should be further focused.
METHODS: Data were collected from a total of 20,270 eligible individuals enrolled for analysis, spanning ten cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The subjects were categorized into three groups based on tertiles of NLR levels. The association of NLR with both all-cause and cardiovascular mortality was evaluated using Kaplan-Meier curves and Cox proportional hazards regression models. Restricted cubic splines were used to visualize the nonlinear relationship between NLR levels and all-cause and cardiovascular mortality in subjects with diabetes after accounting for all relevant factors.
RESULTS: Over a median follow-up period of 8.6 years, a total of 1909 subjects with diabetes died, with 671 deaths attributed to cardiovascular disease (CVD). And over a period of 8.46 years, 1974 subjects with prediabetes died, with 616 cases due to CVD. The multivariable-adjusted hazard ratios (HRs) comparing high to low tertile of NLR in diabetes subjects were found to be 1.37 (95% CI, 1.19-1.58) for all-cause mortality and 1.63 (95% CI, 1.29-2.05) for CVD mortality. And the correlation between high to low NLR tertile and heightened susceptibility to mortality from any cause (HR, 1.21; 95% CI, 1.03-1.43) and CVD mortality (HR, 1.49; 95% CI, 1.08-2.04) remained statistically significant (both p-values for trend < 0.05) in prediabetes subjects. The 10-year cumulative survival probability was determined to be 70.34%, 84.65% for all-cause events, and 86.21%, 94.54% for cardiovascular events in top NLR tertile of diabetes and prediabetes individuals, respectively. Furthermore, each incremental unit in the absolute value of NLR was associated with a 16%, 12% increase in all-cause mortality and a 25%, 24% increase in cardiovascular mortality among diabetes and prediabetes individuals, respectively.
CONCLUSIONS: The findings of this prospective cohort study conducted in the US indicate a positive association of elevated NLR levels with heightened risks of overall and cardiovascular mortality among adults with diabetes and prediabetes. However, potential confounding factors for NLR and the challenge of monitoring NLR\'s fluctuations over time should be further focused.
摘要：
背景：中性粒细胞-淋巴细胞比率（NLR）是评估全身性炎症的新血液学参数。先前的研究表明，NLR的增加可能是癌症和动脉粥样硬化等病理状态的潜在标志物。然而,对于糖尿病患者和糖尿病前期患者的NLR水平与死亡率之间的相关性缺乏研究.因此,本研究旨在研究美国(US)高血糖状态人群中NLR与全因死亡率和心血管死亡率之间的关系.
方法：从总共20,270名符合条件的个体中收集数据进行分析，从1999年到2018年，国家健康和营养检查调查（NHANES）的十个周期。根据NLR水平的三元组将受试者分为三组。使用Kaplan-Meier曲线和Cox比例风险回归模型评估NLR与全因死亡率和心血管死亡率的相关性。在考虑了所有相关因素后，使用限制性三次样条来可视化糖尿病患者NLR水平与全因死亡率和心血管死亡率之间的非线性关系。
结果：在平均8.6年的随访期内，共有1909名糖尿病患者死亡，671例死亡归因于心血管疾病（CVD）。在8.46年的时间里，1974年糖尿病前期患者死亡,有616例心血管疾病。糖尿病患者NLR高三位数与低三位数的多变量校正风险比(HRs)为1.37(95%CI,1.19-1.58)，CVD死亡率为1.63(95%CI,1.29-2.05)。高、低NLR三元组与任何原因引起的死亡率增加之间的相关性(HR，1.21；95%CI，1.03-1.43）和CVD死亡率（HR，1.49;95％CI，1.08-2.04）在糖尿病前期受试者中仍然具有统计学意义（趋势的两个p值<0.05）。10年累积生存概率确定为70.34%，全因事件占84.65%，和86.21%，94.54%的心血管事件在NLR最高的糖尿病和糖尿病前期个体中，分别。此外，NLR绝对值中的每个增量单位与16%相关，全因死亡率增加12%，增加25%，糖尿病和糖尿病前期患者心血管死亡率增加24%，分别。
结论：这项在美国进行的前瞻性队列研究的结果表明，在患有糖尿病和糖尿病前期的成年人中，NLR水平升高与总体和心血管死亡风险升高呈正相关。然而,应进一步关注NLR的潜在混杂因素和监测NLR随时间波动的挑战。
方法：从总共20,270名符合条件的个体中收集数据进行分析，从1999年到2018年，国家健康和营养检查调查（NHANES）的十个周期。根据NLR水平的三元组将受试者分为三组。使用Kaplan-Meier曲线和Cox比例风险回归模型评估NLR与全因死亡率和心血管死亡率的相关性。在考虑了所有相关因素后，使用限制性三次样条来可视化糖尿病患者NLR水平与全因死亡率和心血管死亡率之间的非线性关系。
结果：在平均8.6年的随访期内，共有1909名糖尿病患者死亡，671例死亡归因于心血管疾病（CVD）。在8.46年的时间里，1974年糖尿病前期患者死亡,有616例心血管疾病。糖尿病患者NLR高三位数与低三位数的多变量校正风险比(HRs)为1.37(95%CI,1.19-1.58)，CVD死亡率为1.63(95%CI,1.29-2.05)。高、低NLR三元组与任何原因引起的死亡率增加之间的相关性(HR，1.21；95%CI，1.03-1.43）和CVD死亡率（HR，1.49;95％CI，1.08-2.04）在糖尿病前期受试者中仍然具有统计学意义（趋势的两个p值<0.05）。10年累积生存概率确定为70.34%，全因事件占84.65%，和86.21%，94.54%的心血管事件在NLR最高的糖尿病和糖尿病前期个体中，分别。此外，NLR绝对值中的每个增量单位与16%相关，全因死亡率增加12%，增加25%，糖尿病和糖尿病前期患者心血管死亡率增加24%，分别。
结论：这项在美国进行的前瞻性队列研究的结果表明，在患有糖尿病和糖尿病前期的成年人中，NLR水平升高与总体和心血管死亡风险升高呈正相关。然而,应进一步关注NLR的潜在混杂因素和监测NLR随时间波动的挑战。
