Neutrophil–Lymphocyte Ratio (NLR) for Predicting Clinical Outcomes in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus: A Propensity Score Matching Analysis

Shang Qiao, Wen Gao, Shujun Guo Department of Cardiology, Bayan Nur Hospital of the Nei Monggol Autonomous Region, Bayan Nur City 015000, People’s Republic of ChinaCorrespondence: Shujun GuoDepartment of Cardiology, Bayan Nur Hospital of the Nei Monggol Autonomous Region, Bayan Nur Hospital, No. 98 Wulanbuhe Road, Linhe District, Bayan Nur City 015000, People’s Republic of ChinaEmail zuiailicip@126.comBackground: Cardiovascular diseases (CVD) combined with Type 2 diabetes mellitus (T2DM) frequently occurred. In this study, we aimed at exploring the prognostic significance of blood neutrophil–lymphocyte ratio (NLR) in these types of patients.Patients and Methods: Between June 30, 2010 and August 30, 2017, 1454 patients with CVD were enrolled in this study. Kaplan and Meier methodology was used for survival analysis. We also used propensity score matching (PSM) to further compare survival in patients with or without T2DM.Results: Among all patients, we applied ROC curve analysis to stratify all patients into two different groups including NLR > 2.5 (n=432) and NLR≤ 2.5 (n=1022) groups. After that, we further performed survival analysis between different groups. We found that patients with NLR ≤ 2.5 had significantly favorable OS compared with the overall survival in patients with NLR > 2.5. We further built the PSM using 242 pairs of patients who have CVD and with or without T2DM. After adjusting for competing risk factors, we performed Cox proportional hazards models to identify the independent prognostic factors in multivariable adjustment. We found that NLR ≤ 2.5 (HR: 2.576, 95% CI: 1.241– 4.583, P =0.001) and extent of coronary artery disease (HR: 2.432, 95% CI: 1.189– 4.392, P =0.005) remained independent predictors of OS.Conclusion: In conclusion, we have established an PSM model and found that a high NLR value was an independent prognostic factor for survival, predicting in patients with both CAD and T2DM. The NLR value would be a valuable biomarker to evaluate the outcomes of patients and give them opportunities for choosing alternative therapies.Keywords: neutrophil–lymphocyte ratio, NLR, cardiovascular diseases, CVD, type 2 diabetes mellitus, T2DM