Relation of Leukocytes and Its Subsets Counts with the Severity of Stable Coronary Artery Disease in Patients with Diabetic Mellitus

<div><p>Background</p><p>Both coronary artery disease (CAD) and diabetes mellitus (DM) are associated with inflammation. However, whether and which leukocytes can predict the presence and extent of CAD in patients with DM has not been investigated. The aim of the present study was to examine the association of leukocyte and its subsets counts with the severity of CAD in patients with DM.</p><p>Methods and Findings</p><p>Three hundred and seventy-three diabetic patients who were scheduled for coronary angiography due to typical stable angina pectoris were enrolled in this study. They were classified into the three groups according to tertiles of Gensini score (GS, low group <8, n = 143; intermediate group 8∼28, n = 109; high group >28, n = 121). The relationship between the leukocyte and its subsets counts with the severity of CAD were evaluated. The data indicated that there were significant correlations between leukocyte and neutrophil counts with GS (r = 0.154 and 0.156, respectively, all P<0.003 for Pearson's correlation). Similarly, area under the receivers operating characteristic curve of leukocyte and neutrophil counts were 0.61 and 0.60 respectively (95%CI: 0.55–0.67, all P = 0.001) for predicting high GS. Multivariate logistic regression analysis demonstrated that leukocyte count was an independent predictor for high GS patients with DM (OR = 1.20, 95%CI 1.03–1.39, P = 0.023) after adjusting for conventional risk factors of CAD.</p><p>Conclusions</p><p>Compared with its subsets, leukocyte count appeared to be an independent predictor for the severity of CAD and the optimal cut-off value for predicting high GS (>28 points) was 5.0×10⁹ cells/L in diabetic patients.</p></div

The results of leukocyte (A), neutrophil (B), lymphocyte (C) and monocyte (D) counts according to the Gensini Score.

<p>The results of leukocyte (A), neutrophil (B), lymphocyte (C) and monocyte (D) counts according to the Gensini Score.</p

Baseline demographic, clinical and laboratory characteristics based on tertiles of Gensini score.

<p>BMI = Body mass index; PVD = Peripheral vascular disease; CAD = Coronary artery disease; LVFE  =  Left ventricular ejection fraction; NT-pro-BNP = N-terminal pro-Brain natriuretic peptide; hs-CRP = high sensitivity C-reactive protein; N/L ratio  = Neutrophil count to lymphocyte count ratio; HbA1c = Glycosylated hemoglobinA1C; FBG = Fasting blood glucose; ALP = Alkaline phosphatase; AST = Aspartate aminotransferase; ALT = Alanine aminotransferase; TC = Total cholesterol; LDL-C = Low density lipoprotein cholesterol; HDL-C = High density lipoprotein cholesterol; ACE-I = Angiotensin converting enzyme inhibitors; ARB = Angiotensin receptor blocker.</p>a<p>P-value obtained from analysis of variance, Kruskal-Wallis test, or chi-squared test.</p>b<p>P-value for high GS versus non-high (low and intermediate) GS.</p