title: Use of the Monocyte-to-Lymphocyte Ratio to Predict Diabetic Retinopathy.
abstract: BACKGROUND
  Diabetic retinopathy (DR) is a common complication of type 2 diabetes mellitus (T2DM) and the leading cause of blindness in adults. DR pathogenesis has not been fully elucidated, but inflammation is widely accepted to play an important role. Emerging evidence suggests that the platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) are novel potential markers of inflammatory responses. The present study aimed to evaluate the associations between DR and the PLR, MLR, and NLR.
  
  
  METHODS
  We performed a case-control study involving 247 patients with T2DM. The patients were divided into three groups: 125 control subjects with T2DM, 63 diabetic subjects with non-proliferative diabetic retinopathy (NPDR), and 59 patients with proliferative diabetic retinopathy (PDR).
  
  
  RESULTS
  The mean PLR and NLR were significantly higher in patients with DR compared with patients without DR (p < 0.01, p = 0.02, respectively). The mean MLR in the NPDR group was higher than that of patients without DR, but there were no significant differences among the three groups (p = 0.07). Logistic regression showed that the MLR was an independent risk factor for DR (odds ratio [OR]: 54.574, 95% confidence interval [CI]: 2.708-1099.907). Based on the receiver operating characteristic (ROC) curve, use of the MLR as an indicator for DR diagnosis was projected to be 2.25, and yielded a sensitivity and specificity of 47.1% and 69.6%, respectively, with an area under the curve of 0.581 (95% CI: 0.510-0.653).
  
  
  CONCLUSIONS
  The PLR and NLR are significantly increased in the setting of DR. After correcting for possible confounding factors, the MLR was found to be a risk factor for DR. Although the MLR may be pathophysiologically and clinically relevant in DR, its predictive ability was limited.
authors: Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China. yuesong567@163.com.
authors: Song
authors: S
authors: Yue
authors: Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China. jiahuaz1986@163.com.
authors: Jiahua
authors: J
authors: Zhang
authors: Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China. happygirl860824@163.com.
authors: Jingyang
authors: J
authors: Wu
authors: Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, China. twp@vip.163.com.
authors: Weiping
authors: W
authors: Teng
authors: Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China. liuleijiao@163.com.
authors: Lei
authors: L
authors: Liu
authors: Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China. leichen0501@163.com.
authors: Lei
authors: L
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000378:metabolism*; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000276:immunology* / Q000378:metabolism; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism*; D009504:Neutrophils / Q000378:metabolism*; D010976:Platelet Count; D055815:Young Adult
keywords: diabetic retinopathy; monocyte-to-lymphocyte ratio; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio