The Optimal Cutoff Value of Neutrophil/Lymphocyte Ratio in Severe Grades of Diabetic Retinopathy Short Title: NLR in Diabetic Retinopathy

Abstract

OBJECTIVES The aim of this study was to define the optimal cutoff value of the neutrophil/lymphocyte ratio (NLR) to predict severe grades of diabetic retinopathy (DR). METHODS A total of 40 patients with proliferative DR (PDR) and 40 patients with severe non-proliferative DR (NPDR) were included this prospective, case control study, and 35 age- and sex-matched healthy subjects were recruited as a control group. White blood cell (WBC) count mean values and ratios were compared between the groups. RESULTS The groups were statistically similar in terms of age and sex. The neutrophil, lymphocyte, monocyte, platelet counts, and main platelet volume (MPV) values were similar in all 3 groups (all p values >0.05). The mean NLR was 2.67±1.02 in the PDR cases, 2.16±0.58 in severe NPDR, and 1.85±0.49 in the control group, which represented a statistically significant difference between the 3 groups (p=0.003). In post-hoc analysis, the NLR of the PDR and severe NPDR groups was statistically significantly greater than that of the control group (p=0.002 and p=0.048, respectively), but there was no statistically significant difference between the PDR and severe NPDR groups (p=0.083). The monocyte/lymphocyte, platelet/lymphocyte, and MPV/lymphocyte ratios were also similar in all 3 groups (all p values >0.05). CONCLUSION An NLR value of 2.11 or more predicted DR (PDR or severe NPDR) with a sensitivity of 76% and a specificity of 80%.