Xie Ruiyan, Bishai David M, Lui David T W, Lee Paul C H, Yap Desmond Y H
Division of Nephrology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR 999077, China.
Division of Health Economics, Policy and Management, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 999077, China.
Biomedicines. 2024 Aug 20;12(8):1907. doi: 10.3390/biomedicines12081907.
Accumulating evidence has suggested the pathogenic roles of chronic inflammation and neutrophils in diabetic kidney disease (DKD). This study investigated the relationship between neutrophils, all-cause, and cardiovascular disease (CVD) mortality in type 2 diabetes mellitus (T2DM) patients with DKD.
We used data from the National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2020 to investigate the relationship between circulating neutrophils counts, kidney function indices, all-cause, and CVD mortality in adult T2DM patients with DKD. Clinical predictive models and risk scores for long-term mortality were constructed.
44,332 patients [8034 with T2DM and 36,323 without T2DM] were included. Two thousand two hundred twenty patients had DKD, and 775 died (31.5% related to CVD) during a follow-up of 6.18 (range: 5.94-6.42) years. Higher neutrophil counts (Quartile 4, Q4) were associated with increased all-cause and CVD mortality [HR 1.73 (95% CI 1.34-2.25) and 1.81 (95% CI 1.14-2.89), respectively, < 0.0001 and 0.01]. Neutrophil counts in Q4 showed a positive correlation with urine albumin-creatinine ratio (UACR) but a negative association with eGFR ( < 0.01 for all). Clinical predictive models incorporating neutrophil counts showed satisfactory performance in forecasting 5-year and 10-year CVD mortality-free survival (ROC AUC 0.824 and 0.842, respectively), and the nomogram-predicted survival demonstrated good concordance with observed survival.
Higher levels of circulating neutrophil counts show a significant correlation with renal abnormalities and higher all-cause and CVD mortality in T2DM patients with DKD. The novel clinical predictive models and risk scores incorporating neutrophil counts may facilitate stratification and, hence, risk factor management in DKD patients.
越来越多的证据表明慢性炎症和中性粒细胞在糖尿病肾病（DKD）中具有致病作用。本研究调查了DKD的2型糖尿病（T2DM）患者中性粒细胞、全因死亡率和心血管疾病（CVD）死亡率之间的关系。
我们使用了2005年至2020年美国国家健康与营养检查调查（NHANES）的数据，以研究成年DKD的T2DM患者循环中性粒细胞计数、肾功能指标、全因死亡率和CVD死亡率之间的关系。构建了长期死亡率的临床预测模型和风险评分。
纳入了44332例患者[8034例患有T2DM，36323例未患有T2DM]。2220例患者患有DKD，在6.18（范围：5.94 - 6.42）年的随访期间，775例死亡（31.5%与CVD相关）。较高的中性粒细胞计数（四分位数4，Q4）与全因死亡率和CVD死亡率增加相关[风险比分别为1.73（95%置信区间1.34 - 2.25）和1.81（95%置信区间1.14 - 2.89），P均<0.0001和0.01]。Q4中的中性粒细胞计数与尿白蛋白 - 肌酐比值（UACR）呈正相关，但与估算肾小球滤过率（eGFR）呈负相关（均P<0.01）。纳入中性粒细胞计数的临床预测模型在预测5年和10年无CVD死亡生存率方面表现出令人满意的性能（受试者工作特征曲线下面积分别为0.824和0.842），列线图预测的生存率与观察到的生存率显示出良好的一致性。
在患有DKD的T2DM患者中，较高水平的循环中性粒细胞计数与肾脏异常以及较高的全因死亡率和CVD死亡率显著相关。纳入中性粒细胞计数的新型临床预测模型和风险评分可能有助于DKD患者的分层，从而有助于危险因素管理。
