Inflammatory Indices for Overall Survival in Hemodialysis Patients: A multicenter cohort study

Abstract

Objective This study aimed to determine the best inflammation and nutrition-related indicator for overall survival prediction in patients undergoing hemodialysis from 138 dialysis centers of Beijing. Methods This study included six indicators, for which optimal thresholds were calculated using an outcome-driven method. Kaplan-Meier estimator was utilized to evaluate OS, while multivariate Cox proportional hazard models and restricted cubic splines were employed to assess the relationship between these indicators and OS. C-index, receiver operating characteristic curves and decision curve analysis were used to evaluate the predictive ability of the different indicators. Results All indicators except for platelet-to-lymphocyte ratio were identified as independent predictors of OS. Among these indicators, the prognostic nutritional index (PNI) consistently demonstrated superior discriminatory ability in predicting outcomes among hemodialysis patients. The optimal cut-off value for PNI was determined to be 42.3. Each one-unit increase or standard deviation increase in PNI is associated with a 0.956-fold or 0.78-fold decrease in mortality risk. Conclusions PNI has demonstrated superior reliability as a prognostic indicator for hemodialysis patients compared to LCR, CAR, SII, PLR and NLR. The efficient assessment of PNI effectively identifies high-risk individuals and highlights its significance as a valuable prognostic tool in clinical settings.