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The Relationship Between the Monocyte-to-High-Density Lipoprotein Cholesterol Ratio and Platelet Volume Indices With
Firdevs Pelin Eskin1, Pusem Patir1, Ustun Yilmaz2
1Department of Hematology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, TUR.
Insights
The monocyte count-to-HDL cholesterol ratio (MHR) and plateletcrit (PCT) show potential for predicting diabetic retinopathy (DR) in type 2 diabetes patients. Longer diabetes duration and higher HbA1c correlate with increased MHR, suggesting its role in DR progression.
Area of Science:
- Endocrinology
- Hematology
- Ophthalmology
Background:
- Diabetic retinopathy (DR) is a major complication of type 2 diabetes mellitus (DM).
- Early prediction of DR is crucial for timely intervention and preventing vision loss.
- Hematological parameters like platelet volume indices (PVI) and monocyte count-to-HDL cholesterol ratio (MHR) are being investigated as potential biomarkers.
Purpose of the Study:
- To evaluate the predictive roles of MHR and PVI in diabetic retinopathy (DR) among type 2 diabetes mellitus (DM) patients.
- To explore novel methods for the early prediction of retinopathy in DM.
- To assess the association of MHR and PVI with DR severity and duration.
Main Methods:
- A prospective study involving 120 type 2 DM patients and 40 healthy controls.
- Patients were categorized into groups: no retinopathy, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR).
- Analysis included complete blood counts, PVI (MPV, PDW, PCT, PLCR), lipid profiles, inflammatory markers, MHR, renal function, and glucose metabolism markers.
Main Results:
- Patients with PDR had significantly longer DM duration, higher mean platelet volume (MPV), and platelet large cell ratio (PLCR) compared to NPDR patients.
- Receiver Operating Characteristic (ROC) analysis identified cut-off values for MHR (>11.9) and plateletcrit (PCT <0.29%) as predictive indicators for DR.
- MHR showed a greater area under the curve (AUC) than PCT for DR prediction (p<0.05).
- MHR correlated positively with glycosylated hemoglobin (HbA1c) and DM duration, with each unit increase in DM duration increasing MHR 1.13-fold and HbA1c increasing MHR 1.9-fold.
Conclusions:
- Longer DM duration is associated with increased PDR severity.
- Elevated MPV and PLCR levels are observed in PDR patients.
- MHR and PCT emerge as significant predictive indicators for diabetic retinopathy, with MHR demonstrating superior predictive capability.
Abstract:
Aim This study aims to evaluate the roles of monocyte count-to-high-density lipoprotein (HDL) cholesterol ratio (MHR) and platelet volume indices (PVI) in predicting diabetic retinopathy (DR) in patients diagnosed with type 2 diabetes mellitus (DM) and to explore new methods for early prediction of retinopathy. Methods This prospective study included 120 patients aged over 18 years with type 2 DM diagnosed according to the American Diabetes Association criteria, along with a control group of 40 healthy individuals. Patients with type 2 DM were divided into three groups: 40 without retinopathy, 40 with non-proliferative diabetic retinopathy (NPDR), and 40 with proliferative diabetic retinopathy (PDR). Parameters such as complete blood count, PVI (mean platelet volume, platelet distribution width, plateletcrit, platelet large cell ratio), lipid profile, inflammatory markers (sedimentation rate, C-reactive protein), MHR, renal function tests, and glucose metabolism markers were analyzed alongside demographic, clinical, and laboratory data to assess their associations with DR in both patient and control groups. Results This study investigated the relationship between DR and hematological parameters (PVI, MHR). Hypertension, hyperlipidemia, and chronic kidney disease were common comorbidities. NPDR patients more frequently used metformin and dipeptidyl peptidase (DPP)-4 inhibitors, while PDR patients more often used insulin (p<0.05). Diabetic neuropathy and nephropathy were more prevalent in the PDR group. PDR patients had a significantly longer DM duration. Mean platelet volume (MPV) and platelet large cell ratio (PLCR) were higher in the PDR group. ROC analysis identified MHR (>11.9, 65% sensitivity, 35% specificity) and plateletcrit (PCT<0.29%, 61% sensitivity, 80% specificity) cut-offs for DR prediction. MHR's area under the curve (AUC) was greater than PCT's (p<0.05). MPV differed between PDR and NPDR, but MHR did not differ among DR groups or between DR/non-DR individuals. Glycosylated hemoglobin (HbA1c) and DM duration correlated positively with MHR, which also correlated with leukocyte count. HbA1c and glucose correlated with platelet distribution width (PDW). Each unit increase in DM duration increased MHR 1.13-fold, and each unit increase in HbA1c increased MHR 1.9-fold. Conclusions The duration of DM was significantly longer in patients with PDR compared to those with NPDR and those without retinopathy. MPV and PLCR levels were significantly higher in PDR patients than in NPDR patients. In evaluating the relationship between PVI and MHR for predicting diabetic retinopathy, significant cut-off values of MHR and PCT were found to be predictive indicators of diabetic retinopathy.
