Cosma-Lăzuran Raluca, Leucuta Daniel-Corneliu, Popoviciu Mihaela-Simona
Faculty of Medicine and Pharmacy, University of Oradea, Piața 1 Decembrie Street nr 10, 410073 Oradea, Romania.
Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania.
Medicina (Kaunas). 2025 Aug 9;61(8):1433. doi: 10.3390/medicina61081433.
Chronic low-grade inflammation plays a key role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its vascular complications. Hematological indices derived from routine blood counts, such as neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), have been proposed as surrogate markers for systemic inflammation and predictors of cardiovascular risk. This study aimed to evaluate the predictive value of these inflammatory indices concerning the presence of micro- and macrovascular complications and cardiovascular mortality in patients with type 2 diabetes mellitus. We conducted a retrospective cohort study including 237 patients with T2DM. We assessed the association between hematological indices and cardiovascular mortality, followed by a ROC curve analysis to evaluate their predictive performance, and a multiple logistic regression. Thirty patients (12.66%) died during the study period. ROC analysis showed that SIRI (AUC = 0.680 [95% CI 0.576-0.779]), LMR (AUC = 0.667 [95% CI 0.564-0.763]), AISI (AUC = 0.662 [95% CI 0.553-0.768]), and NLR (AUC = 0.657 [95% CI 0.545-0.764]) had the best discriminative capacity, all with specificity >70%. The relation remained significant even after adjustments for confounding variables in multiple logistic regression. For microvascular complications, Monocyte count (AUC = 0.611 [95% CI 0.532-0.69]) and LMR (AUC = 0.608 [95% CI 0.521-0.695]) showed minimal but notable predictive value. SIRI, LMR, AISI, and NLR were significantly associated with mortality and demonstrated modest discriminative ability. These markers, accessible and cost-effective, may be useful tools for risk stratification in T2DM patients. Further validation in prospective cohorts is warranted.
慢性低度炎症在2型糖尿病（T2DM）及其血管并发症的发病机制中起关键作用。源自常规血常规的血液学指标，如中性粒细胞与淋巴细胞比值（NLR）、衍生中性粒细胞与淋巴细胞比值（dNLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）、全身免疫炎症指数（SII）、全身炎症反应指数（SIRI）和全身炎症聚集指数（AISI），已被提议作为全身炎症的替代标志物和心血管风险的预测指标。本研究旨在评估这些炎症指标对2型糖尿病患者微血管和大血管并发症的存在以及心血管死亡率的预测价值。我们进行了一项回顾性队列研究，纳入了237例T2DM患者。我们评估了血液学指标与心血管死亡率之间的关联，随后进行ROC曲线分析以评估其预测性能，并进行多因素逻辑回归分析。在研究期间，30例患者（12.66%）死亡。ROC分析显示，SIRI（AUC = 0.680 [95% CI 0.576 - 0.779]）、LMR（AUC = 0.667 [95% CI 0.564 - 0.763]）、AISI（AUC = 0.662 [95% CI 0.553 - 0.768]）和NLR（AUC = 0.657 [95% CI 0.545 - 0.764]）具有最佳的判别能力，特异性均>70%。在多因素逻辑回归中对混杂变量进行调整后，这种关系仍然显著。对于微血管并发症，单核细胞计数（AUC = 0.611 [95% CI 0.532 - 0.69]）和LMR（AUC = 0.608 [95% CI 0.521 - 0.695]）显示出最小但显著的预测价值。SIRI、LMR、AISI和NLR与死亡率显著相关，并表现出适度的判别能力。这些易于获取且具有成本效益的标志物可能是T2DM患者风险分层的有用工具。有必要在前瞻性队列中进行进一步验证。
