Neutrophil Lymphocytic Ratio and Platelets Lymphocytic Ratio in Type 1 Diabetic Children: Relation to Diabetic Vascular Complications

Abstract

Background: Chronic inflammation plays a pivotal role in the development and progression of type 1diabetes(T1D), as well as diabetic vascular complications. Recently, Neutrophil-to- lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio(PLR) have been identified as novel inflammatory markers in many diseases, however, their role in T1D children remains unraveled. Aim: To compare PLR and NLR in children with T1D to healthy controls and correlate them with diabetic vascular complications. Methodology: Hundred children with T1D were compared to 100 matched controls focusing on diabetes-duration, insulin therapy, hypoglycemic attacks frequency, fundus and the simple rapid neuropathy-disability score. Average self-monitoring of blood glucose(SMBG), fasting lipid-profile, fraction-C of glycosylated-hemoglobin(HbA1C), urinary-albumin excretion and complete-blood count were assessed with calculation of NLR and PLR. Results: Children with T1D had highly significantly higher NLR and significantly lower PLR and platelet counts than controls(P=0.008, P=0.007 and P<0.001,respectively). Moreover, NLR was significantly higher in children with diabetic neuropathy than those without neuropathy(P= 0.033). NLR was positively and PLR was negatively correlated with diabetes-duration, HbA1C, average SMBG, leucocytic-count, fasting cholesterol, triglycerides and LDL. Receiver-operator characteristic(ROC)curve revealed that NLR cut-off of 1.13 and PLR cut-off of 164.44 had sensitivity of 79% and 94% and specificity 48% and 28%,respectively for differentiating children with T1D from healthy controls. Conclusion: Children with T1D had significantly higher NLR and lower PLR than controls. These changes were correlated with diabetes-duration, HbA1C and hyperlipidemia. NLR was higher in T1D children having diabetic neuropathy. Hence, NLR could be a promising biomarker for risk assessment of hyperlipidemia and diabetic neuropathy in children with T1D.