Lymphocyte-to-monocyte ratio is associated with all‑cause and cardiovascular mortality among individuals with diabetes mellitus in the National Health and Nutrition Examination Survey 2003-2018 cohort.
Level 3 - non-randomized controlled study
Prospective cohort study linking NHANES survey data to National Death Index mortality records
PubMed 41034706 · doi:10.1186/s12872-025-05088-7
What was done
Researchers analyzed 2,327 participants with diabetes mellitus from the 2003–2018 National Health and Nutrition Examination Survey (NHANES) linked to National Death Index records over a median follow-up of 76 months. Using Maximally Selected Rank Statistics, they identified an optimal lymphocyte-to-monocyte ratio (LMR) cutoff of 2.62 to classify participants into low (≤ 2.62) and high (> 2.62) groups. Multivariate Cox regression, restricted cubic splines, subgroup analyses, and time-dependent ROC curves were used to evaluate associations with all-cause and cardiovascular mortality.
What was found
Over follow-up, 585 of 2,327 participants died, including 180 cardiovascular deaths. In multivariate Cox regression, the high LMR group had significantly lower all-cause mortality (HR 0.62, 95% CI 0.50–0.76, P < 0.001) and cardiovascular mortality (HR 0.55, 95% CI 0.38–0.81, P = 0.003) compared to the low LMR group. Restricted cubic spline regression showed non-linear relationships with both outcomes (both P non-linear < 0.05). Time-dependent ROC AUCs ranged from 0.802 to 0.858 for all-cause mortality and 0.800 to 0.864 for cardiovascular mortality across 1-, 3-, 5-, and 10-year survival.
Why it matters
This study indicates that LMR, an easily accessible marker from routine blood counts, is independently associated with long-term survival in people with diabetes and may aid risk stratification.
Limits
The observational design cannot prove causality. LMR was measured only at a single baseline time point, precluding assessment of longitudinal changes or acute fluctuations. Residual confounding from unmeasured clinical factors or specific diabetes treatments cannot be excluded.