Platelet Indices and Neutrophil-to-Lymphocyte Ratio as Markers of Vascular Complications in Type 2 Diabetes Mellitus

Type 2 diabetes mellitus; vascular complications; platelet indices; mean platelet volume; neutrophil-tolymphocyte ratio; predictive biomarkers.

Hawar Mohammed Saeed
Department of Nursing, College of
Health and Medical Technology–
Shekhan, Duhok Polytechnic
University, Duhok, Iraq
[email protected]

Received-12-05-2026
Revised-17-06-2026
Accepted-22-06-2026

European Journal of Prosthodontics and Restorative Dentistry (2026) 34 (04s), 313–322

Platelet Indices and
Neutrophil-to-Lymphocyte
Ratio as Markers of Vascular
Complications in Type 2
Diabetes Mellitus

Among patients with type 2 diabetes mellitus (T2DM), vascular complications represent a leading contributor to overall morbidity and mortality. Current research increasingly indicates that the underlying pathogenesis of diabetic vascular disease is heavily driven by a combination of platelet activation and chronic low-grade inflammation.

To evaluate the predictive utility of platelet indices—mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (PLCR)—together with the neutrophil-to-lymphocyte ratio (NLR) for identifying vascular complications in patients with T2DM.

This cross-sectional study included 140 adults with T2DM, comprising 60 patients with vascular complications and 80 without complications. Complete blood count parameters were analyzed to determine platelet indices and NLR. Binary logistic regression analysis was performed to evaluate associations with vascular complications, and receiver operating characteristic (ROC) curve analysis was used to assess discriminative performance.

Patients with vascular complications exhibited significantly higher MPV (11.62 ± 1.34 fL vs 10.41 ± 1.00 fL), PDW (14.99 ± 2.55% vs 13.68 ± 1.76%), P-LCR (33.89 ± 5.66% vs 26.47 ± 4.65%), and NLR (2.70 ± 0.80 vs 1.90 ± 0.68) compared with patients without complications (all p < 0.01). In the multivariable logistic regression model, MPV, P-LCR, and NLR remained significantly associated with vascular complications after adjustment for the variables included in the model, whereas PDW did not retain statistical significance. The combined biomarker model demonstrated excellent discriminative performance (AUC = 0.936), outperforming the individual hematological markers.

The combined assessment of platelet activation markers and inflammatory indices may provide a simple, accessible, and cost-effective approach for vascular risk stratification in patients with T2DM. These routinely available hematological parameters demonstrated strong discriminatory performance and may help identify patients at increased risk of vascular complications. Further prospective studies with broader adjustment for clinical risk factors are needed to validate these findings.

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