Objective Malnutrition, accompanied by an inflammatory profile, is a risk factor for poor prognosis in hemodialysis patients. The purpose of this study was to investigate the predictive value of NLR combined with GNRI for all-cause and cardiovascular mortality in hemodialysis patients. Methods A total of 240 maintenance hemodialysis (MHD) patients in hemodialysis centers were enrolled in this retrospective study. The influencing factors of all-cause death in hemodialysis patients were analyzed by COX regression. The cut-off values of GNRI and NLR for predicting mortality in enrolled MHD patients were 89.01 and 4, respectively. Based on these cut-off values, the patients were divided into four groups: G1: high GNRI (≥ 89.01) + high NLR (≥ 4) group; G2: high GNRI (≥ 89.01) + low NLR (<4) group, G3: low GNRI (< 89.01) + high NLR (≥4) group; G4: low GNRI (< 89.01) + low NLR (<4). Results During the follow-up period (average: 58 months), the all-cause mortality was 20.83%(50/240) and the cardiovascular mortality was 12.08%(29/240). Both NLR and GNRI were independent risk factors for the prognosis of MHD patients (P<0.05). Survival analysis showed that patients with low GNRI had a lower survival rate than those with high GNRI, whereas patients with high NLR had a lower survival rate than those with low NLR. Kaplan-Meier curve for all-cause mortality revealed that compared to G1, G2, and G4, G3 had the lowest survival rate, while G2 had the highest survival rate among all groups (P < 0.05). Kaplan-Meier curve for cardiovascular mortality showed that G3 had lower survival than G1, G2, and G4 (P < 0.001). Conclusions Our study demonstrates that bothGNRI and NLR are associated with all-cause mortality and cardiovascular mortality in MHD patients. Combining these two factorsmay contribute to a prognostic evaluation for MHD patients.

Background: Secondary hemophagocytic lymphohistiocytosis (sHLH) is a pathologic immune activation syndrome characterized by immune-mediated multiple organ system damage. Pleural effusion can occur as a specific manifestation of sHLH, however, has rarely been evaluated. This study aimed to describe the clinical characteristics of pleural effusion in sHLH and assesse whether it affects prognosis.Methods: We retrospectively analysed 203 newly diagnosed sHLH patients from July 2015 to July 2019 according to the HLH-2004 protocol. Baseline characteristics, laboratory results, and imaging materials were reviewedResults: Pleural effusion was found in 58.6% of the studied sHLH population, and imaging findings were characterized by minimal amounts and bilaterality. Multivariate analyses showed that sCD25 level and PLT ≤65×109/L were significant risk factors for developing pleural effusion in sHLH. Regarding prognostic value, survival analysis showed a lower survival probability for patients with pleural effusion than for those without pleural effusion (median OS, 90 vs. 164 days, p = 0.028). In the multivariate analysis, pleural effusion was an independent prognostic factor for OS (HR = 2.68; 95% CI 1.18–6.11, p = 0.019). Conclusions: Pleural effusion is frequently found in patients with sHLH and is associated with a higher inflammatory state and worse outcomes.