Biological basis of lymphocyte ratios for survival prediction in hemodialysis patients: a longitudinal study

Balboul, Yoni; Gurshumov, Aliona; Azar, Ada; Stav, Kobi; Efrati, Shai; Beberashvili, Ilia

doi:10.1007/s11255-020-02471-5

Cited by 10 publications

(10 citation statements)

References 42 publications

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“…The association between NLR and clinical outcomes is less well studied in patients with non-dialysis CKD; however, evidence is emerging supporting the association of higher NLR with progression to kidney failure [ 31 , 32 ] as well as adverse cardiovascular outcomes in patients receiving peritoneal dialysis [ 33 , 34 ]. In keeping with our own study, PLR has shown an inconsistent relationship with mortality outcomes in CKD populations [ 6 , 27 , 28 ].…”

Section: Discussionsupporting

confidence: 82%

“…Lymphocyte ratios reflect systemic inflammation and endothelial dysfunction, key pathophysiological processes in CKD and NLR is well-established as an adverse prognostic factor in cancer and cardiovascular disease [1]. In keeping with previous studies, we demonstrate strong evidence in support of an association between NLR and mortality and cardiovascular disease outcomes in the haemodialysis population [6,[20][21][22][23][24][25][26][27][28][29][30]. We believe our study is the largest European cohort studied and the only reported study within the UK [29,30].…”

Section: Participant Characteristicssupporting

confidence: 85%

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Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: associations with mortality in a haemodialysis cohort

Mayne

Lees

Rutherford

et al. 2022

Clinical Kidney Journal

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Background Lymphocyte ratios reflect inflammation and have been associated with adverse outcomes in a range of diseases. We sought to determine any association between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and mortality in a haemodialysis cohort, including a COVID-19 infection subpopulation. Methods A retrospective analysis was performed of adults commencing hospital haemodialysis in the West of Scotland 2010–2021. NLR and PLR were calculated from routine samples around haemodialysis initiation. Kaplan-Meier and Cox proportional hazards analyses assessed mortality associations. Results In 1720 haemodialysis patients over a median of 21.9 (IQR 9.1–42.9) months, there were 840 all-cause deaths. NLR but not PLR was associated with all-cause mortality after multivariable adjustment [adjusted hazard ratio (aHR) for in participants with baseline NLR in quartile 4 (NLR ≥ 8.23) versus quartile 1 (NLR < 3.12) 1.63, 95% confidence interval (CI) 1.32–2.00]. The association was stronger for cardiovascular death (NLR quartile 4 versus 1 aHR 3.06, 95% CI 1.53–6.09) than for non-cardiovascular death (NLR quartile 4 versus 1 aHR 1.85, 95% CI 1.34–2.56). In the COVID-19 subpopulation, both NLR and PLR at haemodialysis initiation were associated with risk of COVID-19-related death after adjustment for age and sex (NLR: aHR 4.69, 95% CI 1.48–14.92 and PLR: aHR 3.40, 95% CI 1.02–11.36; for highest vs lowest quartiles). Conclusions NLR is strongly associated with mortality and specifically COVID-19-related death in haemodialysis patients while the association between PLR and adverse outcomes is weaker. NLR is an inexpensive, readily available biomarker with potential utility in risk stratification of haemodialysis patients.

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Section: Discussionsupporting

confidence: 82%

Section: Participant Characteristicssupporting

confidence: 85%

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: associations with mortality in a haemodialysis cohort

Mayne

Lees

Rutherford

et al. 2022

Clinical Kidney Journal

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“…The neutrophil-to-lymphocyte ratio (NLR), a simple and available index for any type of medical institution, has been recently found to be associated with inflammation, and all-cause 13 , 14 and cardiovascular mortality 14 in hemodialysis patients. Moreover, longitudinal changes in the NLR have been shown to mimic CRP and are consequently associated with survival in hemodialysis populations 15 . We hypothesized that the combined use of CRP and NLR may lower the upper cutoff CRP point in predicting the risk of infectious inflammation and improve the performance of CRP in differentiating between infectious and noninfectious inflammation.…”

Section: Introductionmentioning

confidence: 99%

Combined use of CRP with neutrophil-to-lymphocyte ratio in differentiating between infectious and noninfectious inflammation in hemodialysis patients

Beberashvili

Omar

Nizri

et al. 2023

Sci Rep

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We tested whether CRP combined with the neutrophil-to-lymphocyte ratio (NLR) optimizes the prediction of infectious inflammation in hemodialysis patients. We conducted a retrospective study of 774 (mean age 71.1 ± 12.8 years, 35% women) hemodialysis patients from our institution, hospitalized between 2007 and 2021 for various reasons, with CRP levels available at admission. Infection was defined according to the International Sepsis Definition Conference criteria. An algorithm for the optimal CRP and NLR cutoff points for predicting infection was developed based on a decision tree analysis in the training cohort (n = 620) and then tested in the validation cohort (n = 154). A CRP level above 40 mg/L (obtained as the cutoff point in predicting infections in the training group, using ROC curve analysis) predicted an infection diagnosis with a sensitivity of 75% and a specificity of 76% with an odds ratio (OR) of 9.37 (95% CI: 5.36–16.39), according to a multivariate logistic regression analysis. Whereas, CRP levels above 23 mg/L together with an NLR above 9.7 predicted an infection diagnosis with a sensitivity of 69% and a specificity of 84% with an OR of 25.59 (95% CI: 9.73–67.31). All these results were reproduced in the validation set. Combined use of CRP with NLR may lower the CRP cutoff point in distinguishing between infectious and noninfectious inflammation in hemodialysis patients.

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“…Lymphocytopenia has been confirmed as a marker of poor nutritional condition in MHD patients [ 25 ]. Moreover, the prognostic ability of NLR in MHD patients is assumed to rely on the relationship between inflammation and nutritional status [ 26 ]. Thus, previous evidence for an association between inflammation [ 27 ] and malnutrition [ 28 ] and depression in MHD patients may explain the prognostic ability of NLR in predicting depressive symptoms in this population.…”

Section: Discussionmentioning

confidence: 99%

High neutrophil-to-lymphocyte ratio is a significant predictor of depressive symptoms in maintenance hemodialysis patients: a cross-sectional study

Feng

et al. 2022

BMC Psychiatry

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Background Depression is one of the most important psychiatric disorders in chronic kidney disease patients who undergo maintenance hemodialysis (MHD). Previous studies have shown that low-grade inflammation is involved in the progression of depressive symptoms. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that is inexpensive and easy to measure. However, the association between NLR and depression symptoms in MHD patients has not been examined. Methods In this single-center, cross-sectional study, we included 160 patients undergoing MHD. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. NLR was calculated as the ratio of neutrophils to lymphocytes. Multinomial logistic regression and multivariate linear regression analyses were used to examine the association between NLR and depressive symptoms in MHD patients. Results Depressive symptoms were detected in 36.7% of the 160 MHD patients. Multinomial logistic regression showed that NLR was a significant predictor of mild (odds ratio [OR]: 1.383, 95% confidence interval [CI]: 1.015–1.884, p = 0.04) and moderate/moderately severe depressive symptoms (OR: 1.441, 95% CI: 1.017–2.042, p = 0.04) in MHD patients, adjusted for age, sex, Kt/V, dialysis duration, history of kidney transplantation, history of hypertension, and Charlson comorbidity index score. In addition, multivariate linear regression analysis showed that NLR was an independent influencing factor for PHQ-9 score in MHD patients, after adjusting for confounding factors. Conclusions These findings suggest that NLR can be used as a biomarker for predicting depressive symptoms in MHD patients.

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Biological basis of lymphocyte ratios for survival prediction in hemodialysis patients: a longitudinal study

Cited by 10 publications

References 42 publications

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: associations with mortality in a haemodialysis cohort

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: associations with mortality in a haemodialysis cohort

Combined use of CRP with neutrophil-to-lymphocyte ratio in differentiating between infectious and noninfectious inflammation in hemodialysis patients

High neutrophil-to-lymphocyte ratio is a significant predictor of depressive symptoms in maintenance hemodialysis patients: a cross-sectional study

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