Original Research

Study of Platelet to Lymphocyte Ratio as a Predictor Inflammatory Marker for Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus

Heba Tul Noor
King Edward Medical University/Mayo Hospital Lahore
Nasir Farooq Butt
King Edward Medical University/Mayo Hospital Lahore
Hina Latif
King Edward Medical University/Mayo Hospital Lahore
Rabia Rathore
King Edward Medical University/Mayo Hospital Lahore
Anam Fatima Bangash
King Edward Medical University/Mayo Hospital Lahore
Adil Iqbal
King Edward Medical University/Mayo Hospital Lahore

✉ Correspondence: Heba Tul Noor Email: hebatulnoor@gmail.com

DOI https://doi.org/10.70302/jpsim.v6i1.2504
Volume: 6, Issue 1 Pages: 16–21 Published: 10 Mar 2025
Received: 17 Sep 2024 Revised: 23 Jan 2025 Accepted: 24 Feb 2025 Published Online: 10 Mar 2025

Abstract

Objective

To compare ratio of platelet to lymphocyte (PLR) in diabetic patients with nephropathy to those diabetics without nephropathy.

Methods

It was an observational study carried out in the medical department from June 2022 to May 2023. A total of 246 patients of type 2 diabetes mellitus hospitalized in all medical wards were included. Based on urinary albumin excretion, two groups of patients were formed: diabetics without nephropathy (Group A) and diabetics with nephropathy (Group B). Ratio of Platelet to lymphocyte was calculated by dividing platelet count with lymphocyte count and ratio of neutrophil to lymphocyte (NLR) was calculated by dividing neutrophil to lymphocyte count. PLR and NLR were compared amongst both groups.

Results

There were 246 subjects (111 females, 134 males). 131 subjects did not have nephropathy, 115 patients had nephropathy. Comparison of hematological parameters showed that NLR of patients with type 2 DM with nephropathy was 2.59 ± 0.51 and without nephropathy group was 1.70 ± 0.44. The PLR of diabetic nephropathy group was 251 ± 62.4 and that without nephropathy was 213 ± 59.6. Statistical significance (p < 0.05) was seen in the NLR and PLR values of the two groups when compared using the student t-test.

Conclusion

Increased ratio of platelet-to-lymphocyte significantly correlates with diabetic nephropathy, and may serve as a predictor inflammatory marker for diabetic nephropathy.

Keywords
Diabetic Nephropathy platelet-to-lymphocyte ratio type 2 Diabetes mellitus

How to Cite This Article

Noor HT, Butt NF, Latif H, Rathore R, Bangash AF, Iqbal A. Study of Platelet to Lymphocyte Ratio as a Predictor Inflammatory Marker for Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus. J Pak Soc Intern Med. 2025;6(1):16–21. doi:10.70302/jpsim.v6i1.2504

⭳ Download PDF

Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

  1. Williams R. IDF Diabetes Atlas Ninth Edition 2019 IDF Diabetes Atlas, 9th, International Diabetes Federation. 2019.
  2. Punthakee Z, Goldenberg R, Katz P. Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes. 2018;42(S):S10-15.
  3. American Diabetes Association. 10. Microvascular complications and foot care: standards of medical care in diabetes 2018. Diabetes Care. 2018;41(Supp 1):S105-18.
  4. Warren AM, Knudsen ST, Cooper ME. Diabetic nephropathy: an insight into molecular mechanisms and emerging therapies. Expert Opin Ther Targets England. 2019;23(4):579–91.
  5. Ninomiya T, Perkovic V, de Galan BE. Albuminuria and kidney function independently predict cardiovascular and renal outcomes in diabetes. JASN. 2009;doi:10.1681/ASN.2008121270 doi:10.1681/ASN.2008121270
  6. Winter L, Wong LA, Jerums G, Seah JM, Clarke M, Tan SM, et al. Use of readily accessible inflammatory markers to predict diabetic kidney disease. Front Endocrinol. 2018;9(2):225.
  7. Fiseha T. Urinary biomarkers for early diabetic nephropathy in type 2 diabetic patients. Biomarker research. 2015;3(4):1-7.
  8. Liu J, Liu X, Li Y, Quan J, Wei S, An S, et al. The association of neutrophil to lymphocyte ratio, mean platelet volume, and platelet distribution width with diabetic retinopathy and nephropathy: a meta-analysis. Biosci Rep. 2018;38(3):BSR20180172.
  9. Rudiger A, Burckhardt OA, Harpes P, Müller SA, Follath F. The relative lymphocyte count on hospital admission is a risk factor for long term mortality in patients with acute heart failure. Am J Emerg Med. 2006;24(4):451-4.
  10. Winter L, Wong LA, Jerums G, Seah JM, Clarke M, Tan SM, et al. Use of readily accessible inflammatory markers to predict diabetic kidney disease. Front Endocrinol. 2018;9(3):225.
  11. Uwaezuoke SN. The role of novel biomarkers in predicting diabetic nephropathy: a review. Int J Nephrol Renovasc Dis. 2017: https://doi.org/10.2147/IJNRD.S143186. doi:10.2147/IJNRD.S143186
  12. Balta S, Demırkol S, Kucuk U. The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice. Hemodial Int.2013;4(17): 668-9
  13. Liu J, Liu X, Li Y, Quan J, Wei S, An S, et al. The association of neutrophil to lymphocyte ratio, mean platelet volume, and platelet distribution width with diabetic retinopathy and nephropathy: a meta-analysis. Biosc. Rep. 2018;38(3):BSR20180172.
  14. Jeong Y, Jeon SR, Kim HG, et al. The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis. Intest Res. 2021;19(1):62–70. doi:10.5217/ir.2019.09156 doi:10.5217/ir.2019.09156
  15. Lin J, Cheng A, Cheng K, Deng Q, Zhang S, Lan Z, et al. New Insights into the Mechanisms of Proptosis and Implications for Diabetic Kidney Disease. Int J Mol Sci. 2020; 21(19):doi: 10.3390/ijms21197057 doi:10.3390/ijms21197057
  16. Fujita T, Hemmi S, Kajiwara M, Yabuki M, Fuke Y, Satomura A, et al. Complement-mediated chronic inflammation is associated with diabetic microvascular complication. Diabetes Metab Res Rev. 2013;29(2):220–6.
  17. Moursy EY, Megallaa MH, Mouftah RF. Relationship between neutrophil lymphocyte ratio and microvascular complications in Egyptian patients with type 2 diabetes. Am J Intern Med. 2015;3(2):250-5.
  18. Huang W, Huang J, Liu Q, Lin F, He Z, Zeng Z, et al. Neutrophil-lymphocyte ratio is a reliable predictive marker for early-stage diabetic nephropathy. Clin Endocrinol (Oxf). 2015;82(2):229-33.
  19. Li L, Shen Q, Rao S. Association of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Diabetic Kidney Disease in Chinese Patients with Type 2 Diabetes: A Cross-Sectional Study. Therapeut Clin Risk Manage. 2022:8(12):1157-66.
  20. Onalan E, Gozel N, Donder E. Can hematological parameters in type 2 diabetes predict microvascular complication development? Pak J Med Sci. 2019;35(6):1511-5.
  21. Khandare SA, Chittawar S, Nahar N, Dubey TN, Qureshi Z. Study of Neutrophil-lymphocyte Ratio as Novel Marker for Diabetic Nephropathy in Type 2 Diabetes. Indian J Endocrinol Metabol. 2017 May 1;21(3):387-92.
  22. Turkmen K, Erdur FM, Ozcicek F, Ozcicek A, Akbas EM, Ozbicer A, et al. Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17(3):391-6
  23. Wan H, Wang Y, Fang S, Chen Y, Zhang W, Xia F, et al. Associations between the neutrophil-to-lymphocyte ratio and diabetic complications in adults with diabetes: a cross-sectional study. J Diabet Res. 2020; https://doi.org/10.1155/2020/6219545. doi:10.1155/2020/6219545
  24. Duan S, Sun L, Zhang C, Wu L, Nie G, Huang Z, et al. Association of platelet-to-lymphocyte ratio with kidney clinicopathologic features and renal outcomes in patients with diabetic kidney disease. Int Immunopharmacol. 2021; doi:10.1016/j.intimp.2021.107413. doi:10.1016/j.intimp.2021.107413
  25. Temiz A, Gazi E, Güngör Ö, Barutçu A, Altun B, Bekler A, et al. Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction. Med Sci Monit. 2014;22(20):660–5.

Reference list indexed for Google Scholar and ResearchGate. DOI links resolve via doi.org.

CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2025 Journal of Pakistan Society of Internal Medicine.
📃 In This Issue View All
Review Article Thyroid Disorders in Pregnancy: Clinical Implications and Management Strategies Baig BI, Usman A Original Article Prevalence of Hypertension Among Urban Adults in Pakistan: A Cross-Sectional Study Khan TM, Ahmed S, Malik RA Original Article Impact of Diabetes Mellitus on Post-Operative Wound Healing in General Surgery Siddiqui FA, Noor M, Akhtar W Original Article Serum Ferritin as a Prognostic Marker in COVID-19 Severity: A Hospital-Based Study Rehman N, Sheikh I, Javed K Review Article Statin Therapy in Non-Alcoholic Fatty Liver Disease: A Systematic Review Nawaz F, Cheema HA, Mehmood Y
👥 More by These Authors
Review Article Antibiotic Resistance Patterns in Community-Acquired Pneumonia: Emerging Trends Hussain I, Farooq Z Original Article Cervical Cancer Screening Awareness Among Rural Women in Punjab Bibi S, Anjum R, Hassan F Original Article Comparison of Ultrasound-Guided versus Landmark-Based Central Venous Catheter Insertion Zafar S, Gillani SA Original Article Outcomes of Laparoscopic Cholecystectomy in Acute Cholecystitis: A Retrospective Analysis Raza SH, Butt N, Qureshi AM
🔗 Related Articles By Keywords
Original Article Impact of Diabetes Mellitus on Post-Operative Wound Healing in General Surgery Siddiqui FA, Noor M, Akhtar W Original Article Serum Ferritin as a Prognostic Marker in COVID-19 Severity: A Hospital-Based Study Rehman N, Sheikh I, Javed K Review Article Statin Therapy in Non-Alcoholic Fatty Liver Disease: A Systematic Review Nawaz F, Cheema HA, Mehmood Y Original Article Neonatal Sepsis: Bacteriological Profile and Antibiogram in a Tertiary Care Hospital Iqbal M, Rashid T