{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:05:42Z","timestamp":1781712342960,"version":"3.54.5"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The neutrophil lymphocyte ratio (NLR) is a readily accessible marker of systemic inflammation. This study evaluated the association between NLR with all-cause mortality, major adverse vascular events and diabetic kidney disease (DKD) progression in a multiethnic cohort of adult type 2 diabetes mellitus (T2DM) individuals in Singapore.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Demographic, anthropometric, biochemistry, mortality and major adverse vascular events (MAVE) were obtained from electronic medical records up to June 30, 2024. Composite renal outcomes were defined as one of the following: decline in eGFR \u2265 40%, decline in eGFR to \u2264 15ml\/min\/1.73m\n                      <jats:sup>2<\/jats:sup>\n                      or initiated maintenance dialysis. Multivariate Cox regression analyses were performed to evaluate associations between NLR, all-cause mortality, MAVE and composite renal outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In this cohort of 959 adult participants with T2DM, there was a significant association between NLR with all-cause mortality, MAVE, baseline albuminuria, renal function and progression of DKD. During the median follow-up of 9.4 years, there were 367 (38.3%) mortalities, 222 (23.1%) cases of MAVE and 285 (30%) participants who developed a renal outcome. The highest NLR was associated with a 1.6-fold increased risk for all-cause mortality (HR 1.63; 95% 1.18 - 2.27, p=0.003), 2.7-fold increased risk of MAVE (HR 2.71; 95% CI 1.75 - 4.20; p&amp;lt;0.001) and 1.55 (HR 1.55, 95% CI 1.09 - 2.19, p=0.014) increased risk of having a renal event compared to the lowest NLR tertile after adjusting for confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated NLR is independently associated with all-cause mortality, MAVE and composite renal outcomes in T2DM. NLR may be considered a potential clinical biomarker of adverse outcomes for use in routine care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1695139","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T05:14:37Z","timestamp":1763961277000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Associations between neutrophil-lymphocyte ratio with all-cause mortality, major adverse vascular events and progression of diabetic kidney disease in type 2 diabetes mellitus"],"prefix":"10.3389","volume":"16","author":[{"given":"Ying Jie","family":"Chee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoe 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