High Neutrophil‐to‐Lymphocyte Ratio and Platelet‐to‐Lymphocyte Ratio Are Associated with Poor Survival in Patients with Hemodialysis

Abstract

Background. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers for systemic inflammation condition. Although NLR has emerged as a risk factor for poor survival in end-stage renal disease (ESRD) patients, the relationship between PLR and mortality is still unknown. We aimed to explore the interaction of NLR and PLR in predicting mortality in hemodialysis (HD) patients. Method. We enrolled 360 HD patients for a 71-month follow-up. The endpoint was all-cause and cardiovascular (CV) mortality. Pearson correlation analysis was conducted to evaluate the relationship between factors and NLR or PLR. Kaplan-Meier curves and Cox proportional analysis were used to assess the prognostic value of NLR and PLR. Results. NLR was positively correlated with neutrophil and negatively correlated with lymphocyte, hemoglobin, and serum albumin. PLR was positively correlated with neutrophil and platelet and negatively correlated with lymphocyte and hemoglobin. In multivariate Cox regression, a higher NLR level was independently associated with all-cause mortality (OR 2.011, 95% CI 1.082-3.74, p = 0.027 ), while a higher PLR level might predict CV mortality (OR 2.768, 95% CI 1.147-6.677, p = 0.023 ) in HD patients. Conclusion. NLR and PLR are cheap and reliable biomarkers for all-cause and CV mortality to predict survival in HD patients.

Comparing Humoral and Cellular Adaptive Immunity during Convalescent Phase of COVID-19 in Hemodialysis Patients and Kidney Transplant Recipients

“…Generally, hemodialysis patients are characterized by uremia-related immunological abnormalities, such as decreased general blood counts and malfunction of immune cells [ 40 ]. Blood morphology-derived parameters obtained from five-part differential blood count were shown to be altered in various inflammatory states, including COVID-19 [ 41 ], which was also observed for CKD COVID-19 patients [ 42 , 43 , 44 ]. Renal dysfunction is associated with an increase in endothelial injury-related BNP and NT-pro-BNP markers that were found to be associated with disease severity and mortality in COVID-19 patients [ 45 ].…”

The Predictive Value of NLR, MLR, and PLR in the Outcome of End-Stage Kidney Disease Patients

“…The establishment of the predictive role of the biomarkers for both the progression of CKD and the negative outcome is an intensely discussed topic in recent years’ literature. High NLR and PLR values have been associated with the evolution of CKD towards ESKD and with a high mortality rate in numerous studies [ 29 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

“…Similarly, the article published by Zhang et al showed the association of high NLR values with all causes of mortality. In contrast, high PLR values are a predictive factor for cardiovascular mortality [ 44 ]. In the paper published by Xiang et al, which included 355 patients on dialysis for at least 6 months, high MLR values were found to be independent factors of adverse prognosis [ 56 ].…”

Immune System Dysfunction and Inflammation in Hemodialysis Patients: Two Sides of the Same Coin

“…Prothrombin fragment analyses, thrombin-antithrombin III complex, and d-dimer evaluation can assess the "pre-clotting" stages, as well as platelet-to-lymphocyte ratio, obtained by dividing the absolute platelet count by the absolute lymphocyte count, which could represent a novel marker of inflammation in HD patients [30][31][32].…”