Work

Competing Risks Analysis for Neutrophil to Lymphocyte Ratio as a Predictor of Diabetic Nephropathy Incidence

Year: 2026

Type: article

Abstract: Purpose: Diabetic nephropathy (DN) is a serious complication of diabetes mellitus. A high level of neutrophil-lymphocyte ratio (NLR) is an indicator of abnormal immune system activity which may serve as an effective potential inflammatory marker for identifying the risk of DN. This study aimed to investigate the relationship between neutrophil-lymphocyte ratio (NLR) and the incidence of DN in type 2 diabetes mellitus (T2DM) patients. Patients and Methods: DN incidence was defined as the time from baseline diabetes diagnosis to first DN occurrence (KDIGO CKD criteria). NLR's effect and interactions were evaluated using covariate-adjusted competing risks regression (death as competing event). The optimal NLR cut-point for DN prediction was determined by ROC analysis. The Fine and Gray subdistribution hazard model assessed NLR's effect on DN incidence, with subdistribution hazard ratios (sHR) validated via bootstrap sampling. The final sample consisted of the records of 220 individuals (median age 64 years (IQR: 55-72)) with T2DM with complete covariates information which were available for incidence analysis with NLR. Results: <0.01), with optimal cut-off at 3.02. NLR showed associations with DN in cause-specific (CSH=1.66; 95% CI: 1.13, 2.52) and FGR models (sHR=2.26; 95% CI: 1.72, 2.92). Bootstrap validation yielded consistent results (sHR= 2.36; 95% CI: 1.76, 3.02). Notably, NLR better predicts DN risk in older adults (>65 years) and those with well-controlled HbA1c (≤7.5%). Conclusion: NLR shows promise for predicting DN incidence in Chinese patients, especially those >65 years or with good glycemic control.

Source: Diabetes Metabolic Syndrome and Obesity

DOI: 10.2147/dmso.s570594

Authors: Xiaoyi Song, Wenrui Dong, Yuhao Fu, Jiaqiang Wang, Jiajia Wang

Institutions: University of Electronic Science and Technology of China, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu University of Traditional Chinese Medicine

Language: English

Topic: Chronic Kidney Disease and Diabetes

Subfield: Nephrology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,836