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Meta-Analysis
. 2025 Aug 18:16:1532682.
doi: 10.3389/fendo.2025.1532682. eCollection 2025.

Association of immune-inflammation indexes with incidence and prognosis of diabetic nephropathy: a systematic review and meta-analysis

Yijue Wang #  1   2   3 , Yan Liu #  4 , Wenling Gu  5 , Boyu Cai  5 , Min Lei  1   3 , Yingyu Luo  1   3 , Nannan Zhang  1   3
Affiliations
Meta-Analysis

Association of immune-inflammation indexes with incidence and prognosis of diabetic nephropathy: a systematic review and meta-analysis

Yijue Wang et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: The significance of immune-inflammation indexes in diabetic nephropathy (DN) was assessed in this meta-analysis to offer guidance for clinical diagnosis and treatment for DN.

Methods: We performed a meta-analysis on the association between immune-inflammation indexes and the incidence and prognosis of DN, specifically focusing on the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI). We thoroughly searched PubMed, Web of Science, Embase, and Cochrane from inception to September 2024. The statistical analysis was performed using R 4.2.3 software.

Results: 56 studies were ultimately included, comprising 50 that examined the association between DN incidence and immune-inflammation indexes and 8 that examined the association between DN prognosis and immune-inflammation indexes. The levels of NLR, MLR, PLR, and SII were significantly higher in DN patients than in non-DN ones. Besides, high NLR, MLR, SII, and SIRI were associated with elevated incidence of DN. Moreover, the high NLR group was more prone to a poor prognosis than the low NLR group (OR: 1.372, 95% CI: 1.160-1.624).

Conclusions: Immune-inflammation indexes can, to a certain extent, serve as a biomarker to predict the occurrence of DN. In addition, high NLR has a potential association with the occurrence of poor prognosis in DN.

Keywords: biomarkers; diabetic nephropathy; diagnostic techniques; immune-inflammation index; meta-analysis; prognosis; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis showing the method of identifying trials and reasons for exclusion.
Figure 2
Figure 2
Forest plots illustrating the outcomes of the connection between NLR and DN incidence. (A) Forest plots for NLR levels in DN patients; (B) Forest plots for incidence of DN in high NLR and low NLR. NLR, Neutrophil-to-Lymphocyte Ratio.
Figure 3
Figure 3
Forest plots illustrating the outcomes of the connection between PLR and DN incidence. (A) Forest plots for PLR levels in DN patients; (B) Forest plots for incidence of DN in high PLR and low PLR. PLR, Platelet-to-Lymphocyte Ratio.
Figure 4
Figure 4
Forest plots illustrating the outcomes of the connection between MLR and DN incidence. (A) Forest plots for MLR levels in DN patients; (B) Forest plots for incidence of DN in high MLR and low MLR. MLR, Monocyte-to-Lymphocyte Ratio.
Figure 5
Figure 5
Forest plots illustrating the outcomes of the connection between SII and DN incidence. (A) Forest plots for SII levels in DN patients; (B) Forest plots for incidence of DN in high SII and low SII. SII, Systemic Immune-Inflammation Index.
Figure 6
Figure 6
Funnel plot of publication bias between immune-inflammation index and DN incidence. (A) Funnel plot for NLR continues (3.2.1); (B) Funnel plot for NLR categorical (3.2.2); (C) Funnel plot for PLR continuous (3.2.3).
See this image and copyright information in PMC

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