Association of Hematologic-Inflammatory Indices and All-Cause Mortality in Adults With Type 2 Diabetes and Hypertension Publisher



Saberi Karimian M ; Shabani N ; Hatamzadeh H ; Kolahi R ; Darroudi S ; Mohammadi Bajgiran M ; Nikoumanesh M ; Rezaeifard H ; Moohebati M ; Esmaily H ; Soflaei S S ; Ghayour Mobarhan M
Source: Journal of Diabetes and Metabolic Disorders Published:2026

Abstract

Background: This study examines the relationship between hematologic-inflammatory indices and all-cause mortality in individuals with type 2 diabetes and hypertension. Methods: Using data from the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study, 1,170 diabetic and 2,022 hypertensive participants were analyzed. The systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte-platelet ratio (NLPR) were calculated from complete blood counts and assessed using Cox regression models and Kaplan-Meier curves. Results: Over 10 years, mortality rates were 11.3% in diabetic and 6.9% in hypertensive participants. In diabetic individuals, SII/100 was associated with mortality in both unadjusted and adjusted models (HR: 1.10, P = 0.006; adjusted HR: 1.15, P = 0.001), while NLR was also significantly associated (HR: 1.38, P < 0.001; adjusted HR: 1.48, P = 0.002). PLR/100 was not significant in the unadjusted model (HR: 1.37, P = 0.174) but became significant after adjustment (HR: 1.86, P = 0.013). In hypertensive patients, NLR was significant only in the unadjusted model (HR: 1.26, P = 0.019) and lost significance after adjustment (adjusted HR: 1.21, P = 0.080). SII/100 was not significantly associated with mortality in either unadjusted or adjusted models (HR: 1.02, P = 0.603; adjusted HR: 1.05, P = 0.297). Among individuals with both diabetes and hypertension, NLR, PLR/100, and SII/100 remained significantly associated with mortality in adjusted models. Kaplan–Meier analysis showed consistent associations for NLR, whereas PLR, SII, and NLPR curves were mostly non-significant. Conclusion: Hematologic-inflammatory indices, particularly NLR, were associated with all-cause mortality mainly among individuals with diabetes and those with both diabetes and hypertension; however, the associations varied by index and disease subgroup. Clinical trial number: Not applicable © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2026.