Assessment of the Neutrophil-To-Lymphocyte Ratio And Platelet-To-Lymphocyte Ratios as Predictor Of Inflammation Markers in Type Two Diabetic Individuals at Ambo University Referral Hospital, Ethiopia

Abstract

Background: Diabetic mellitus is a metabolic disorder characterized by chronic inflammation. Inflammation is a predictor of type 2 diabetes complication that it shows the elevated many inflammation markers. The interest in this study of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) has grown recently because they are predictive of the complication of diseases with diverse inflammatory and these ratios are easily calculated from hematology analyzer printout. However, in Ethiopia we have not seen published study is available in this regard. Objective: This study aimed to assess neutrophil to lymphocyte ratio and platelet -lymphocyte ratio as Marker of inflammation in type two Diabetic mellitus at Ambo university referral hospital, Ambo, Ethiopia from September 1 –November 30, 2021. Method: Enrolling 134 participants conducted comparative cross-sectional study; 67 type 2 diabetic mellitus patients and 67sex and age matched healthy controls. A 4ml blood sample was collected from all study participants. Systematic random sampling was used for selecting type 2 diabetics. Fasting blood sugar was measured by glucometer for screening apparently healthy control, Cell Blood count was measured using Sysmex XN 550 hematology analyzer and C - reactive protein was done based on semi-quantitative method. Data analysis was entered by Epidata 4.6 version, and exported to SPSS version 20. Simple descriptive statistics such as; mean, standard deviation and percentages was used to present socio-demographic characteristics, clinical parameters, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio, and other laboratory tests, and the value was compared between Diabetics and healthy Controls. Student t-test, Receiver operating characteristic performance and Pearson correlation was applied to analyze the statically significance of dependent variable. Result-The mean NLR and PLR were significantly increased in type two diabetic patients compared with healthy controls (2.20±0.82 vs 1.43 ± 0.49, p<0.001) and (120.52±37.6 vs 100.47±32.98, p<0.001) respectively. Both NLR and PLR in type two Diabetic patients were positively correlated with ESR and C-RP. Receiver operating curve analysis showed good predictive of NLR and PLR in type two diabetic patients those have at least one complication with optimum cut-off point of 1.89 (AUC = 0.882, 95% CI 0.810-0.963, Se =87.2 %, and Sp = 78.6%) and 111.38.8 (AUC = 0.706, 95% CI 0.523-0.831, Se = 61.5%, and sp =60.7%), respectively. Conclusion: There was a statistically significant increment in the level of Neutrophil to lymphocyte ratio and Platelet to lymphocyte ratio between type two diabetic patients compared with healthy controls. Both NLR and PLR in type two Diabetic patients were positively correlated with ESR and C-RP. Therefore, NLR and PLR could predict inflammation in type two diabetics. Recommendations: physicians can be used as alternative inflammatory markers during type two diabetics follow-up condition.