Diagnostic value of neutrophil gelatinase-associated lipocalin and neutrophil-to-lymphocyte ratio in type 2 diabetes mellitus individuals with reduced estimated glomerular filtration rate(eGFR): A case-control study in a municipal hospital in Ghana

Introduction Serum neutrophil gelatinase-associated lipocalin (sNGAL), a renal tubular marker, and Neutrophil-to-Lymphocyte Ratio (NLR), a haematological inflammatory marker are two biomarkers that have recently received attention, because of their association with kidney disease. This study examined the diagnostic value sNGAL and NLR in type 2 diabetes mellitus (T2DM) patients with reduced eGFR. Materials and methods In this hospital-based case-control research, 97 T2DM participants and 70 healthy subjects were included. Participants’ information was documented using a structured questionnaire and patient case records. Venous blood was drawn from each participant to evaluate absolute neutrophil and lymphocyte count ratio, glycosylated haemoglobin (HBA1c), creatinine, sNGAL, and fasting blood glucose. Results sNGAL and NLR were higher in diabetes patients with reduced eGFR than those with normal eGFR and control (p < 0.05). sNGAL level was negative correlated with eGFR among both good (r= -0.317, p = 0.036) and poor (r= -0.544, p < 0.001) glycaemic-controlled T2DM subjects with reduced eGFR. A negative correlation was observed between NLR and eGFR among poor glycaemic-controlled T2DM subjects with reduced eGFR (r= -0.329, p = 0.016). At a cut off of 8.87 µg/L and 2.34 respectively, sNGAL and NLR were found to be good predictors of nephropathy among T2DM patients (AUC=100.0, p< 0.0001 and AUC=76.0, p< 0.0001 respectively) with sNGAL being the superior marker. Conclusions sNGAL and NLR have important diagnostic value for diabetic with reduced eGFR. Whiles sNGAL showed superiority and is recommended, NLR can serve as a less expensive and readily measurable alternative biomarker for diabetic patients with reduced eGFR, particularly in poorly controlled diabetes. These two markers can be added to the available array of tests used to indicate nephropathy in type 2 diabetics to help clinicians in better management of the disease.