Blood Neutrophil-to-Lymphocyte Ratio and Urine IL-8 Levels Predict the Type of Bacterial Urinary Tract Infection in Type 2 Diabetes Mellitus Patients

Figures & data

Figure 1 Patient recruitment and flow through study.

Table 1 Demographic and Clinical Characteristics of Patients with ESBL-Positive UTIs

Characteristic	E. coli (n=344)	K. pneumoniae (n=122)	P-value*
Age, mean (SD), y	67 (21)	74 (18)	0.001
Female	210 (61)	72 (59)	0.668
T2DM	179 (63)	85 (77)	0.421
CKD	64 (19)	53 (43)	0.205
Laboratory data
HbA1C, mean (SD), %	7.25 (3)	7.29 (2)	0.959
Albumin, mean (SD), g/dL	28.54 (5)	28.28 (5)	0.706
Hemoglobin, mean (SD), g/dL	10.94 (1)	10.85 (1)	0.544
Leukocyte, mean (SD)	10.09 (4)	9.76 (4)	0.512
Neutrophils, mean (SD)	7.30 (5)	7.00 (6)	0.741
Lymphocytes, mean (SD)	1.98 (3)	2.82 (6)	0.051
Procalcitonin, mean (SD)	0.16 (0.1)	0.15 (0.1)	0.712
Platelet count, mean (SD)	269 (108)	274 (141)	0.696
Antibiotic sensitivity
β-lactam/β-lactamase inhibitor
Amoxicillin-clavulanate	224 (65)	64 (52)	0.015
Piperacillin-tazobactam	315 (92)	101 (83)	0.026
Carbapenem
Meropenem	336 (98)	119 (97)	0.640
Ertapenem	323 (94)	108 (88)	0.196
Other
Ciprofloxacin	93 (27)	49 (40)	0.000
Nitrofurantoin	324 (94)	57 (47)	0.000
Gentamycin	218 (63)	95 (78)	0.000
Trimethoprim/Sulfamethoxazole	146 (42)	34 (28)	0.005

Notes: *Statistical significance: P ≤ 0.05.

Figure 2 Comparison of circulatory inflammatory markers, including CRPs and NLR between two ESBL-positive UTI groups in accordance with T2DM status. (A, B) Serum CRP and blood NLR levels between E. coli and K. pneumonia in all ESBL-UTI cases. Representative data showing that patients with ESBL-E. coli UTIs had lower serum CRP levels and higher blood NLR compared to ESBL-K. pneumoniae UTIs. (C, D) Serum CRP and blood NLR between E. coli and K. pneumonia in T2DM ESBL-UTI cases. Representative data showing that T2DM patients with ESBL-E. coli UTIs had lower serum CRP levels and higher blood NLR compared to ESBL-K. pneumoniae UTIs. (E, F) Serum CRP and blood NLR between E. coli and K. pneumonia in non-T2DM ESBL-UTI cases. Representative data showing that non-T2DM patients with ESBL-E. coli UTIs had both lower serum CRP levels and blood NLR compared to ESBL-K. pneumoniae UTIs.The values of serum CRP and blood NLR levels were reported in median and IQR. Two-way comparison was done using Mann–Whitney test. * P<0.05, ** P<0.001, ns= non-significant.

Figure 3 Association of circulatory inflammatory markers, including CRPs and NLR, in the two ESBL-positive UTI groups in accordance with T2DM status. (A) Risk of CRP ≥ 35 mg/dL in all ESBL-UTI cases, T2DM, and non-T2DM. Representative data showing that T2DM patients with serum CRP ≥ 35 mg/dL were at higher risk for ESBL-E. coli UTIs than for ESBL-K. pneumoniae UTIs. (B) Risk of NLP ≥ 35 mg/dL in all ESBL-UTI cases, T2DM, and non-T2DM. Representative data showing that T2DM patients with blood NLR ≥ 3.5 were at higher risk for ESBL-E. coli UTIs than for ESBL-K. pneumoniae UTIs. Adjusted for age, gender, serum albumin, hemoglobulin, leukocytes, and platelet counts.

Figure 4 Comparison of urinary IL-8 level between the two ESBL-positive UTI groups in T2DM. *** P<0.0001.

Figure 5 Hazard ratios and cumulative survival curve in the two ESBL-positive UTI groups in accordance with T2DM status. (A) Risk estimate for all-cause mortality between E. coli and K. pneumonia in all ESBL-UTI cases. Representative data showing that the risk was non-significant for ESBL-E. coli and K. pneumoniae uropathogens in all ESBL-UTI cases. (B) Risk estimate for all-cause mortality between E. coli and K. pneumonia in T2DM ESBL-UTI cases. Representative data showing that T2DM with ESBL-E. coli had higher risk of all-cause mortality than those with ESBL-K. pneumoniae. (C) Risk estimate for all-cause mortality between E. coli and K. pneumonia in non-T2DM ESBL-UTI cases. Representative data showing that the risk was non-significant for ESBL-E. coli and K. pneumoniae uropathogens in non-T2DM.