ELEVATED neutrophil to lymphocyte ratio is strongly associated with the occurrence and progression of diabetic nephropathy, according to a comprehensive meta-analysis evaluating its prognostic value across clinical stages of disease.
Background and Study Design
Diabetic nephropathy is a major cause of chronic kidney disease and mortality among people with diabetes, creating an urgent need for accessible biomarkers that support early risk stratification. The neutrophil to lymphocyte ratio, a marker of systemic inflammation derived from routine blood tests, has attracted interest but its predictive role across the disease spectrum has remained unclear. Investigators conducted a systematic review and meta-analysis of cohort and case control studies published up to May 28, 2025. Data were pooled using odds ratio (OR) and standardised mean difference (SMD) estimates. Subgroup and sensitivity analyses were performed to explore heterogeneity. The review was prospectively registered in PROSPERO.
Neutrophil to Lymphocyte Ratio and Disease Occurrence
Across 39 studies including 14,300 participants, patients with diabetic nephropathy had significantly higher neutrophil to lymphocyte ratio values than diabetic controls without nephropathy. The association with disease occurrence was consistent and robust: SMD=1.31; 95% CI: 0.96–1.66; p<0.00001 and OR=2.16; 95% CI: 1.85–2.52; p<0.00001. These findings indicate that elevated neutrophil to lymphocyte ratio is linked to more than a twofold increase in the likelihood of diabetic nephropathy, supporting its role as a potential inflammatory biomarker in routine clinical assessment.
Progression, Mortality, and Clinical Implications
Among patients with diabetic nephropathy, higher neutrophil to lymphocyte ratio levels were also associated with kidney function deterioration compared with stable disease: SMD=1.02; 95% CI: 0.77–1.26; p<0.00001 and OR=2.12; 95% CI: 1.04–4.31; p=0.04. The association with all-cause mortality did not reach statistical significance: OR=1.21; 95% CI: 0.99–1.48; p=0.06. Subgroup analyses demonstrated stronger associations in individuals aged 60 years or older and those with a body mass index of 25 kg/m² or higher. While these data support the neutrophil to lymphocyte ratio as a promising tool for identifying higher risk patients with regard to disease occurrence and progression, the authors emphasised that heterogeneity and possible publication bias warrant cautious interpretation and confirmation in future large scale standardised studies.
Reference
Liu H et al. The predictive value of neutrophil-to-lymphocyte ratio for the occurrence, progression, and mortality of diabetic nephropathy: a systematic review and meta-analysis. Scientific Reports. 2026; https://doi.org/10.1038/s41598-025-30680-4.
