Pan-immune-inflammation value predicts proliferative diabetic retinopathy in patients with diabetes mellitus and atherosclerotic cardiovascular disease

Abstract

OBJECTIVE: Diabetic retinopathy exhibits a higher risk of atherosclerotic cardiovascular disease-related complications. Proliferative diabetic retinopathy is the most serious complication of diabetic retinopathy and can lead to total visual loss. Given that inflammation plays a key role in diabetic retinopathy, using blood-derived indexes could be a feasible way to predict the proliferative diabetic retinopathy. The aim of this study was to assess the effectiveness of pan-immune-inflammation value in predicting proliferative diabetic retinopathy in type 2 diabetes mellitus patients and atherosclerotic cardiovascular disease. METHODS: This retrospective study included 234 patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease. The study population was classified into three groups according to severity of diabetic retinopathy: no-diabetic retinopathy, non-proliferative diabetic retinopathy, and proliferative diabetic retinopathy groups. Complete blood counts were obtained, and neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and pan-immune-inflammation value ([neutrophils×platelets×monocytes]÷lymphocytes) were calculated. A receiver operating characteristic curve was performed to analyze the ability of inflammatory markers for proliferative diabetic retinopathy. RESULTS: The mean age was 56.6±7.8 years, and there were 109 men and 125 women. The median (interquartile range) pan-immune-inflammation value levels in the no-diabetic retinopathy, non-proliferative diabetic retinopathy, and proliferative diabetic retinopathy groups were 213 (137–325), 240 (157–297), and 375 (318–540), respectively (p<0.001). Multivariate analysis revealed that the pan-immune-inflammation value (OR 1.066; 95%CI 1.051–1.072; p=0.001), total cholesterol (OR 1.055; p=0.018), and hemoglobin (OR 0.145; p=0.036) were independent risk factors of proliferative diabetic retinopathy in patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease. CONCLUSION: Our study revealed a significant association between increased pan-immune-inflammation value levels and high proliferative diabetic retinopathy risk in type 2 diabetes mellitus patients and atherosclerotic cardiovascular disease.