China: Type 2 diabetes presence with elevated neutrophil to lymphocyte ratio (NLR) may worsen clinical outcomes in coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI), researchers state in a recent study.
The findings, published in Cardiovascular Diabetology, imply that categorizing patients with increased NLR and T2DM could provide important information for the risk stratification of CAD patients.

Inflammation is crucial for the pathogenesis and progression of CAD. NLR is a novel inflammatory biomarker and its association with different glycemic metabolism following PCI remains undetermined. Therefore, Kefei Dou, State Key Laboratory of Cardiovascular Disease, Beijing, China, and colleagues aimed to examine the effect of NLR on the prognosis of patients undergoing PCI with or without type 2 diabetes.
For this purpose, the researchers consecutively enrolled 8,835 patients with CAD hospitalized for PCI at Fuwai hospital. Neutrophil (*109/L)/lymphocyte (*109/L) was used to calculate NLR. Study patients were categorized as having a higher level of NLR (NLR-H) and lower levels of NLR (NLR-L) according to optimal cut-off, and were further stratified as NLR-H with T2DM and non-T2DM, and NLR-L with T2DM and non-T2DM.
Major adverse cardiovascular and cerebrovascular events (MACCEs), defined as myocardial infarction (MI), stroke, all-cause mortality, and target vessel revascularization the primary endpoint. During a median follow-up of 2.4 years, a total of 674 (7.6%) MACCEs were recorded.
The key findings of the study are as follows:
The optimal cut-off value of NLR was 2.85 determined by the surv_cutpoint function.
Compared to those in the NLR-H/T2DM groups, patients in the NLR-L/non-T2DM, NLR-H/non-T2DM, and NLR-L/T2DM groups were at significantly lower risk of 2-year MACCEs [adjusted hazard ratio (HR): 0.67; adjusted HR: 0.62; adjusted HR: 0.77 respectively].
Patients in the NLR-L/non-T2DM group also had a significantly lower risk of a composite of all-cause mortality and MI than those in the NLR-H/T2DM group (adjusted HR: 0.57).
The Multivariable Cox proportional hazards model also indicated the highest risk of MACCEs in diabetic patients with higher levels of NLR than others.
Subgroup analysis indicated a consistent impact of NLR on MACCEs across different subgroups.
"T2DM presence with increased NLR is associated with worse clinical outcomes in CAD patients undergoing PCI," the researchers wrote in their study. "Categorization of patients with elevated NLR and T2DM could provide valuable information for risk stratification of CAD patients."
Reference:
He, J., Bian, X., Song, C. et al. High neutrophil to lymphocyte ratio with type 2 diabetes mellitus predicts poor prognosis in patients undergoing percutaneous coronary intervention: a large-scale cohort study. Cardiovasc Diabetol 21, 156 (2022). https://doi.org/10.1186/s12933-022-01583-9