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

Abstract

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.

Neutrophil-to-lymphocyte ratio is associated with sarcopenia risk in overweight maintenance hemodialysis patients

“…Numerous studies have shown that the NLR is a convenient and cost-effective marker of inflammation 28 and an indicator of sarcopenia risk 15 . Previous research has evaluated the correlation between NLR and the risk of sarcopenia in different populations.…”

“…These inflammatory cytokines inhibit protein synthesis, reduce muscle anabolism and damage energy homeostasis, leading to muscle atrophy and malfunction 11 . The neutrophil-to-lymphocyte ratio (NLR), which is derived from absolute neutrophil and lymphocyte counts, is a convenient and cost-effective measure of systemic inflammation 14 , 15 . A previous study indicated that NLR could offer valuable insights into inflammation among CKD patients, including those undergoing hemodialysis 16 .…”

Effective prognostic and clinical risk stratification in COVID‐19 using multimodality biomarkers

“…Further examples include platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio and eosinophil–lymphocyte ratio, all of which have been tested for prognosticating COVID‐19 patients with varying degrees of success [99]. Recently, both NLR and PLR have shown prognostic value in COVID‐19 patients at haemodialysis initiation [104].…”

Progress in the application of the neutrophil-to-lymphocyte ratio in dialysis-related complications

“…Similar findings have been observed in individuals with chronic kidney disease who contracted COVID-19[ 39 ]. A statistically significant increase in mortality was observed in patients undergoing HD with COVID-19 when NLR thresholds were set at ≥3.0 and ≥3.5[ 40 ]. Therefore, patients undergoing HD who contract COVID-19 require additional care because of their increased risk of death.…”