Assessment of Systemic Immune-Inflammatory (SII) Index, Systemic Inflammatory Response (SIR) Index, Neutrophil to HDL-C ratio (NHR), Monocyte to HDL-C ratio (MHR) and Lymphocyte to HDL-C ratio (LHR) as markers of Inflammation in Type 2 Diabetes Mellitus
Keywords:
Inflammation, Lymphocyte to HDL-C ratio (LHR), Monocyte to HDL-C ratio (MHR), Neutrophil to HDL-C ratio (NHR), Systemic Immune-Inflammatory (SII) Index, Systemic Inflammatory Response (SIR) IndexAbstract
Background: Diabetes mellitus (DM), a chronic metabolic disease with increasing prevalence in India. Type 2 diabetes mellitus (T2DM) and its associated vascular complications are major contributors to mortality and morbidity worldwide. Inflammation and immune response play a significant role in the pathogenic mechanism and progression of DM. Chronic low-grade inflammation contributes to organ dysfunction and tissue damage, promoting insulin resistance (IR) by inhibiting β-cell function, impairing insulin secretion, and accelerating apoptosis.
Aim: The present study aimed to assess the systemic immune inflammation (SII) index and systemic inflammation response (SIR) Index in patients with T2DM.
Materials and Methods: This retrospective study was conducted in the Department of Biochemistry in association with the Department of Pathology, Gayatri Vidhya Parishad Institute of Health Care & Medical Technology (GVPIHC&MT), Visakhapatnam, Andhra Pradesh, India. After obtaining the Institutional Ethics Committee, a total 280 subject’s data was collected. Among them, 140 were type 2 diabetes mellitus patients and 140 were non-diabetic subjects. Necessary details were collected from medical records including demographic details like age, sex, BMI and blood pressure. Details of biochemical parameters such as fasting and post-prandial glucose, urea, creatinine, total cholesterol, Triglycerides, and high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C) and HbA1c. Hematological parameters like complete blood count (CBC) values were collected. The SII index, SIR index, NHR, MHR and LHR were calculated by using the formulas.
Results: In the present study, significant increase in blood pressure [(systolic 120.2±6.2 mmHg), (diastolic 80.2±2.2 mmHg)], fasting blood sugar (FBS) (155.2±50.1 mg/dl), post-prandial blood sugar (PPBS) (211.5±58.4 mg/dl), HbA1c (8.1±2.5 %), urea (30.4±7.1 mg/dl), creatinine (1.2±0.2 mg/dl), total cholesterol (196.7±56.7 mg/dl), triglycerides (178.5±68.5 mg/dl), LDL-C (130.6±31.5 mg/dl), VLDL-C (35.6±13.7 mg/dl) and neutrophil count (64.6±11.4 %) was
observed in T2DM cases than non-diabetic subjects. Significant decrease in HDL-C (30.5±11.5 mg/dl), and lymphocytes (26.5±10.9%) observed in T2DM subjects. Concerned with inflammatory markers such as SII index (12.6±3.6), SIR index (25.7±5.2), NHR (1.9±0.72), MHR (0.15±0.08), PHR (0.07±0.02), NLR (4.2±1.1) and PLR (0.17±0.01) were significantly increased in T2DM cases than non-diabetic subjects. In this study, FBS significantly correlated (positive) with SII index (r=0.367), SIR index (r=0.199), NHR (r=0.524), MHR (r=0.368), PHR (r=0.225), and NLR (r=0.289). HbA1c also showed a positive correlation with SII index (r=0.253), SIR index (r=0.199), NHR (r=0.462), and PHR (r=0.198).
Conclusion: The present study results may conclude significant elevation of inflammatory markers such as SII index, SIR index, NHR, MHR, PHR, NLR, and PLR and a significant positive correlation with blood sugar and HbA1c.
Downloads
Metrics
References
Nanditha A, Susairaj P, Satheesh K, Raghavan A, Snehalatha C, Ramachandran A. The rising prevalence of type 2 diabetes among the youth in southern India - An ancillary analysis of the Secular TRends in DiabEtes in India (STRiDE-I) study. Journal of Diabetes. 2024;16(7):e13576. doi:10.1111/1753-0407.13576
Ratnesh Sinha, Angelin Priya, Anuvi Sinha and Mohammad Hifz Ur Rahman. Prevalence of diabetes distress among type 2 diabetes mellitus patients in India: a systematic review and meta-analysis. Health Psychology and Behavioral Medicine. 2024; 12(1):2324091. https://doi.org/10.1080/21642850.2024.2324091
Olefsky JM, Glass CK. Macrophages, inflammation, and insulin resistance. Annu Rev Physiol. 2010;72(1):219–246. PMID: 20148674. doi:10.1146/ annurev-physiol-021909-135846
Chen M, Zhu Y, Wang J, Wang G and Wu Y. The predictive value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio levels of diabetic peripheral neuropathy. J Pain Res. 2021:14:2049-2058.
Marwa Jaaban, Almoutassem Billah Zetoune, Sondos Hesenow, Razan Hessenow. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as novel risk markers for diabetic nephropathy in patients with type 2 diabetes. Heliyon. 2021; 7:e07564
Guo W, Song Y, Sun Y, et al. Systemic immune-inflammation index is associated with diabetic kidney disease in type 2 diabetes mellitus patients: evidence from NHANES 2011–2018. Front Endocrinol (Lausanne). 2022;13:1071465. PMID: 36561561; PMCID: PMC9763451. doi:10.3389/ fendo.2022.1071465
Xie R, Xiao M, Li L, et al. Association between SII and hepatic steatosis and liver fibrosis: a population-based study. Front Immunol. 2022;13:925690. PMID: 36189280; PMCID: PMC9520084. doi:10.3389/fimmu.2022.9256908.
Li J, He D, Yu J, et al. Dynamic status of sii and siri alters the risk of cardiovascular diseases: evidence from kailuan cohort study. J Inflamm Res. 2022;15:5945–5957. PMID: 36274831; PMCID: PMC9584782. doi:10.2147/JIR.S3783097.
Li J, Cao D, Huang Y, et al. The prognostic and clinicopathological significance of systemic immune-inflammation index in bladder cancer. Front Immunol. 2022;13:865643. PMID: 35572533; PMCID: PMC9097688. doi:10.3389/ fimmu. 2022.8656436
Lin K, Lan Y, Wang A, Yan Y, Ge J. The association between a novel inflammatory biomarker, systemic inflammatory response index and the risk of diabetic cardiovascular complications. Nutr, Metab Cardiovasc Dis. 2023;33(7):1389–1397. PMID: 37156671. doi:10.1016/j. numecd. 2023. 03.013
Liu W, Zheng S, Du X. Association of Systemic Immune-Inflammation Index and Systemic Inflammation Response Index with Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus. Diabetes, Metabolic Syndrome and Obesity. 2024:17 517–531
Wu S, Lin H, Zhang C, Zhang Q, Zhang D, Zhang Y, et al. Association between Erythrocyte Parameters and Metabolic Syndrome in Urban Han Chinese: A Longitudinal Cohort Study. BMC Public Health. 2013,13, 989
Rohatgi, A. High-Density Lipoprotein Function Measurement in Human Studies: Focus on Cholesterol Efflux Capacity. Prog. Cardiovasc. Dis. 2015, 58, 32–40.
Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, et al., HDL Cholesterol, Very Low Levels of LDL Cholesterol, and Cardiovascular Events. N. Engl. J. Med. 2007, 357, 1301–1310.
Xia, Y.; Xia, C.; Wu, L.; Li, Z.; Li, H.; Zhang, J. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. J Clin Med. 2023, 12, 1128
Song Y, Zhao Y, Shu Y, Zhang L, Cheng W, Wang L, Shu M, Xue B, Wang R, Feng Z, Yin Y, Yu F and Jin S (2023) Combination model of neutrophil to high-density lipoprotein ratio and system inflammation response index is more valuable for predicting peripheral arterial disease in type 2 diabetic patients: A cross-sectional study. Front. Endocrinol. 14:1100453. doi: 10.3389/fendo.2023.1100453
Zhang H, Lu J, Gao J, Sha W, Cai X, Rouzi MRYM, Xu Y, Tang W, Lei T. Association of Monocyte-to-HDL Cholesterol Ratio with Endothelial Dysfunction in Patients with Type 2 Diabetes. Journal of Diabetes Research. Volume 2024, Article ID 5287580, 7 pages
Marra A, Bondesan A, Caroli D, Sartorio A. Complete Blood Count (CBC)-Derived Inflammation Indexes Are Useful in Predicting Metabolic Syndrome in Adults with Severe Obesity. J Clin Med. 2024, 13, 1353.
Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al., Harmonizing the Metabolic Syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009, 120,1640–1645.
Feingold, K.R.; Grunfeld, C. The Role of HDL in Innate Immunity. J Lipid Res. 2011, 52, 1–3
Wang S, Pan X, Jia B, Chen S. Exploring the Correlation Between the Systemic Immune Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Type 2 Diabetic Retinopathy. Diabetes, Metabolic Syndrome and Obesity 2023:16 3827–3836
Alhalwani AY, Jambi S, Borai A, Khan MA, Almarzouki H, Elsayid M. Assessment of the systemic immune‐inflammation index in type 2 diabetic patients with and without dry eye disease: A case‐control study. Health Sci Rep. 2024;7:e1954.
Yan P, Yang Y, Zhang X, Zhang Y, Li J, Wu Z, Dan X, Wu X, Chen X, Li S, Xu Y and Wan Q. Association of systemic immune inflammation index with diabetic kidney disease in patients with type 2 diabetes: a cross-sectional study in Chinese population. Front. Endocrinol. 2024; 14:1307692.
Elmeazawy R, Shall SE, AbdElsamea MZ, Helmi Emara MH. Systemic immune inflammatory index and systemic inflammation response index in predicting renal impairment in children with type 1 diabetes mellitus. Egyptian Pediatric Association Gazette. 2024; 72:49
Scutca AC, Juganaru I, Nicoara DM, Brad GF, Bugi MA, Asproniu R, Cristun LI, Marginean O. Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus. J. Clin. Med. 2024, 13, 2582.
Çallı Ü, Açıkalın B, Demir G, Çoban F, Kocapınar Y. Association of Monocyte to High-Density Lipoprotein Cholesterol Ratio with Diabetic Retinopathy in Patients with Type II Diabetes Mellitus. Bosphorus Med J. 2022;9(3):173–177
Tang X, Tan Y, Yang Y, Li M, He X, Lu Y, Shi G, Zhu Y, Nie Y, Li H, Mu P and Chen Y. Association of the Monocyte–to–High-Density Lipoprotein Cholesterol Ratio With Diabetic Retinopathy. Front. Cardiovasc. Med. 2021; 8:707008.
Amouzegar A, Mirzaasgari Z, Mehrabi A, Malek M, Shahmiri FA, Najafi L, Khajavi A. Association of monocyte/high density lipoprotein cholesterol ratio and the carotid intima media thickness in diabetic patients. BMC Endocrine Disorders. 2022; 22:323
Chen H, Xiong C, Shao X, J Ning, Gao P, Xiao H et al., Lymphocyte To High-Density Lipoprotein Ratio As A New Indicator Of Inflammation And Metabolic Syndrome. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2019:12 2117–2123
Guo J, Mutailipu K, Wen X, Yin J, You H, Qu S et al., Association between lymphocyte to high-density lipoprotein cholesterol ratio and insulin resistance and metabolic syndrome in US adults: results from NHANES 2007–2018. Lipids in Health and Disease. 2025; 24:9
Chen HL, Wu C, Cao L, Wang R, Zhang TY, He Z. The association between the neutrophil-to lymphocyte ratio and type 2 diabetes mellitus: a cross-sectional study. BMC Endocrine Disorders. 2024; 24:107
Xu T, Weng Z, Pei C, Yu S, Chen Y, Guo W et al., The relationship between neutrophil-to lymphocyte ratio and diabetic peripheral neuropathy in Type 2 diabetes mellitus. Medicine. 2017; 96:45(e8289)
Madhavi Kemba, Suguna S. Neutrophil-Lymphocyte Ratio: A Risk Predictor in Patients with Type 2 Diabetes Mellitus. International Journal of Physiology. 2017;5(1): 166-170.
Zhang K, Ding S, Lyu X, Tan Q, Wang Z. Correlation between the platelet-to-lymphocyte ratio and diabetic foot ulcer in patients with type 2 diabetes mellitus. J Clin Lab Anal. 2021;35:e23719.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
