Two user-friendly models and a simple cutoff value of neutrophil to lymphocyte ratio (NLR) for early diagnosis of diabetic nephropathy in middle-elderly aged patients with type 2 diabetes: A cross-sectional study

Abstract Background: Neutrophil to lymphocyte ratio (NLR) has been shown to predict worse outcomes of diabetic nephropathy (DN). This cross-sectional study aimed to investigate the association of NLR and DN in middle-elderly aged patients with type 2 diabetes, and attempted to confirm an optimized cutoff value of NLR for DN prediction.Methods: A total of 146 patients with type 2 diabetes were retrospectively included in this study. DN was defined as urine albumin to creatinine ratio (UACR) ≥30mg/g, or effective glomerular filtration rate (eGFR) ≤ 60ml/min·1.73m2. To evaluate the predictive role of NLR, logistic regression analysis and receiver operating characteristics (ROC) curve analysis were applied. Canonical discriminant functions were used to construct the discriminant equations.Results: NLR, diabetes duration, systolic blood pressure (SBP) and lipo-protein a [Lp(a)] independently predicted DN diagnosis after adjusted by multi-variables. NLR value of 2.04 had a sensitivity of 48.9% and a specificity of 80.8% in predicting DN, with area under the curve (AUC) of 0.666. When the threshold of NLR was elevated to 2.50, the specificity and sensitivity were 90.9% and 29.8%, respectively. User-friendly model 1 and model 2 were constructed using the independent risk factors mentioned above, with the AUC of 0.819 and 0.817, respectively.Conclusions: Two models of user-friendly equations were constructed for early prediction of DN, which could be easily calculated and stored in office computer. NLR threshold of 2.50 is recommended in clinical use to identify the patients at high risk of DN, for its high specificity and remarkable convenience.