Predictive value of neutrophil-to-lymphocyte ratio for atrial fibrillation and stroke in type 2 diabetes mellitus: The Hong Kong Diabetes Study

Introduction: Neutrophil-to-lymphocyte ratio (NLR) is a routinely available biomarker that reflects systemic inflammation. The study evaluated the predictive value of NLR for ischemic stroke and atrial fibrillation (AF) in patients with type 2 diabetes mellitus. Methods: This was a population-based cohort study of patients with type 2 diabetes mellitus and complete blood count tests at baseline between 1 January 1st, 2009, and 31 December, 2009, at government-funded hospitals/clinics in Hong Kong. Follow-up was until 31 December, 2019, or death. Results: A total of 85,351 patients (age = 67.6 ± 13.2 years old, male = 48.8%, follow-up = 3101 ± 1441 days) were included. Univariable Cox regression found that increased NLR at quartiles 2, 3 and 4 was significantly associated with higher risks of new-onset ischemic stroke (hazard ratio [HR]: 1.28 [1.20–1.37], p <.001, HR: 1.41 [1.32–1.51], p <.001 and HR: 1.38 [1.29–1.47], p <.001) and AF (HR: 1.09 [1.02–1.17], p <.015; HR: 1.28 [1.20–1.37], p <.001; HR: 1.39 [1.31–1.49], p <.001) compared to quartile 1. On multivariable analysis, NLR remained a significant predictor of ischemic stroke risk for quartiles 2 and 3 (quartile 2: HR: 1.14 [1.05, 1.22], p =.001; quartile 3: HR: 1.14 [1.06, 1.23], p <.001) but not quartile 4 (HR: 1.08 [0.994, 1.17], p =.070). NLR was not predictive of AF after adjusting for confounders (quartile 2: HR: 0.966 [0.874, 1.07], p =.499; quartile 3: HR: 0.978 [0.884, 1.08], p =.661; quartile 4: HR: 1.05 [0.935, 1.16], p =.462). Conclusion: NLR is a significant predictor of new-onset ischaemic stroke after adjusting for significant confounders in Chinese type 2 diabetes patients.