Neutrophil Gelatinase‐Associated Lipocalin and Neutrophil‐to‐Lymphocyte Ratio as Indicators of Nephropathy in Type 2 Diabetic Mellitus Patients in Ghana: A Case‐Control Study

Abstract

ABSTRACT Introduction Serum neutrophil gelatinase‐associated lipocalin (sNGAL), a renal tubular marker, and neutrophil‐to‐lymphocyte ratio (NLR), a hematological inflammatory marker are two biomarkers that have recently received attention, because of their association with kidney disease. This study examined the diagnostic value sNGAL and NLR in type 2 diabetes mellitus (T2DM) patients with nephropathy. Materials and Methods In this hospital‐based case‐control research, 97 T2DM participants and 70 healthy subjects were included. Participants' information was documented using a structured questionnaire and patient case records. Venous blood was drawn from each participant and early morning midstream urine samples were collected for blood and urine measurements respectively. Results The prevalence of nephropathy among type 2 diabetics was 20.6%. sNGAL had a good performance (AUC = 0.793, p < 0.001) and NLR had a poor performance (AUC = 0.632, p = 0.082) for predicting diabetic nephropathy. An sNGAL cut‐off of 8.87 µg/L had 80.0% sensitivity and NLR threshold of 2.34 had 60.0% sensitivity and 72.8% specificity. In the multivariate binary logistic model, sNGAL showed a modest independent association, (aOR 1.25, 95% CI: 0.71–2.21, p = 0.014). In contrast, NLR was not significantly associated with nephropathy in the adjusted model (NLR: aOR 1.16, 95% CI: 0.60–2.24, p = 0.663). Conclusions Whiles sNGAL showed superiority and is recommended, NLR showed no significant group difference and poor, non‐significant discrimination, indicating it is not a reliable standalone marker of diabetic nephropathy in this study.