Neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio in evaluation of inflammation in end-stage renal disease

Ahbap, Elbis; Şakacı, Tamer; Kara, Ekrem; Şahutoğlu, Tuncay; Koç, Yener; Baştürk, Taner; Sevinc, Mustafa; Akgol, Cuneyt; Kayalar, Arzu Ozdemır; Uçar, Zuhal Atan; Bayraktar, Feyza; Ünsal, Abdülkadir

doi:10.5414/cn108584

Cited by 92 publications

(101 citation statements)

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“…Malhotra et al [24] suggested that NLR could serve as a potential surrogate marker for CRP in hemodialysis patients. Similarly, Ahbap et al [6] found that NLR was significantly positively correlated with hsCRP levels in patients with ESRD on maintenance hemodialysis. In patients on prevalent hemodialysis, NLR was also associated with all-cause mortality [25].…”

Section: Discussionmentioning

confidence: 99%

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High Neutrophil-to-Lymphocyte Ratio is a Significant Predictor of Cardiovascular and All-Cause Mortality in Patients Undergoing Peritoneal Dialysis

Wang

Zhang

et al. 2018

Kidney Blood Press Res

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Background/Aims: Chronic inflammation is associated with increased risk of cardiovascular death in patients with end-stage renal disease (ESRD). Although elevated neutrophil-tolymphocyte ratio (NLR), a novel inflammatory marker, has been shown to predict cardiovascular disease and all-cause mortality in the general population, limited evidence is available for its role in ESRD. Methods: We enrolled 86 patients undergoing peritoneal dialysis (PD) for a 36-month follow-up to investigate the association between the NLR and arterial stiffness markers, namely, carotid-femoral pulse wave velocity (cfPWV) and carotid augmentation index (AIx), and mortality in PD patients. The primary endpoints were cardiovascular mortality and all-cause mortality. Kaplan-Meier curves were used to show the cumulative incidence of cardiovascular mortality and all-cause mortality. Results: High NLR was found to be a predictor of increased cfPWV (β = 1.150; P < 0.001) and AIx (β = 3.945; P < 0.001) in patients on PD. Patients with higher NLR had lower survival during follow-up. Kaplan-Meier curves showed that the cumulative incidences of both cardiovascular mortality and all-cause mortality were significantly higher in patients with NLR ≥ 4.5 (both P < 0.01). Conclusion: Our results suggest that high NLR is independently associated with arterial stiffness and predicts cardiovascular and all-cause mortality in PD patients.

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Section: Discussionmentioning

confidence: 99%

“…Recently, NLR has been recognized as a novel inflammatory marker for assessing cardiovascular disease severity and poor prognosis in the general population [4] and in patients with ESRD [5,6].…”

Section: Introductionmentioning

confidence: 99%

High Neutrophil-to-Lymphocyte Ratio is a Significant Predictor of Cardiovascular and All-Cause Mortality in Patients Undergoing Peritoneal Dialysis

Wang

Zhang

et al. 2018

Kidney Blood Press Res

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“…However, this research did not find a correlation between the CRP level and the parameters calculated. In a recent study, Ahbap et al [32] found that hemodialysis had a significant relationship to the NLR, PLR, and CRP in end-stage renal disease (ESRD) patients on maintenance hemodialysis. Similarly, they reported that the relationship was too small to draw a conclusion that the NLR and PLR were good substitutes for CRP in ESRD patients on maintenance hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Relationship between CRP, systemic immune-inflammation index and routine hemogram related inflammatory markers in low grade inflammation

Üstündağ¹

2018

Int J Med Biochem

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Research ArticleR ecent advances in technology led to the quantitation of new parameters with automated hematology analyzers. Some of these parameters have been accepted as additional markers in diagnosing various clinical conditions [1][2][3][4][5]. They are cost effective and easier to perform in a routine setting than tests for some other markers. C-reactive protein (CRP) is a commonly used inflammation marker in both acute and chronic inflammation. Most healthy individuals have a CRP concentration of 3 mg/L or less; a CRP level higher than 10 mg/L indicates a clinically significant inflammatory disease [6]. Low-grade inflammation typically refers to conditions in which Objectives: The term low-grade inflammation is usually used to indicate chronic conditions in which the findings of classic, clinical inflammation are lacking, but there is an elevated C-reactive protein (CRP) level of 3 to 10 mg/L. Recently, the systemic immune-inflammation index (SII) was developed based on lymphocyte, neutrophil, and platelet counts, which can project the inflammatory and immune imbalances. The aim of this study was to examine the SII and new parameters derived from hemograms to determine if they have the potential to detect patients with subclinical lowgrade inflammation in an unselected, elderly, outpatient population. Methods: The CRP level was analyzed with a BN II System nepholometer (Siemens Healthineers, Erlangen, Germany). Participants were stratified according to CRP level: Group 1 had a serum CRP result <3.0 mg/L and Group 2 had a serum CRP result 3.0-9.0 mg/L. Blood samples that had been analyzed with an automated hematology analyzer (Mindray BC-5800; Mindray Biomedical Electronics Co., Ltd., Shenzhen, China) were selected for evaluation of the results. The SII (neutrophil x platelet / lymphocyte), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were calculated. PLR (r=0.773; p<0.001), and the platelet count (r=0.653; p<0.001) was found. However, there was no correlation between the CRP, SII (r=-0.312; p=0.210), and PLR (r=-0.165; p=0.117). Conclusion: A high PLR and SII appears to be associated with subclinical low-grade inflammation. These data do not support hematological screening parameters as a substitute for CRP. These findings are limited to the cohort studied here, and may not be entirely applicable to other ethnic origins. Keywords: C-reactive protein, lymphocyte, neutrophil, platelet Relationship between C-reactive protein, systemic immuneinflammation index, and routine hemogram-related inflammatory markers in low-grade inflammation

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“…15,16 Subsequently higher values in NLR and PLR have been linked to greater inflammatory status and worse prognosis among patients with various disease conditions including cardiovascular disease, 17 chronic obstructive pulmonary disease, 18 liver cirrhosis, 19 and CKD. 20 Furthermore, recent studies have indicated that NLR and PLR were associated with inflammation and may predict mortality among hemodialysis patients as well, 21–26 but their small study sample sizes make it difficult to draw a definite conclusion regarding their detailed associations with mortality and comparative usefulness in mortality-predictability when compared to other clinically accessible markers related to CKD. To address this knowledge gap, we studied a 5-year large national cohort of incident hemodialysis patients in the United States and investigated the relationship of NLR and PLR with all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

Lymphocyte Cell Ratios and Mortality among Incident Hemodialysis Patients

et al. 2017

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Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been previously suggested as oncologic prognostication markers. These are associated with malnutrition and inflammation, and hence, may provide benefit in predicting mortality among hemodialysis patients. Methods: Among 108,548 incident hemodialysis patients in a large U.S. dialysis organization (2007–2011), we compared the mortality predictability of NLR and PLR with baseline and time-varying covariate Cox models using the receiver operating characteristic curve (AUROC), net reclassification index (NRI), and adjusted R². Results: During the median follow-up period of 1.4 years, 28,618 patients died. Median (IQR) NLR and PLR at baseline were 3.64 (2.68–5.00) and 179 (136–248) respectively. NLR was associated with higher mortality, which appeared stronger in the time-varying versus baseline model. PLR exhibited a J-shaped association with mortality in both models. NLR provided better mortality prediction in addition to demographics, comorbidities, and serum albumin; ΔAUROC and NRI for 1-year mortality (95% CI) were 0.010 (0.009–0.012) and 6.4% (5.5–7.3%) respectively. Additionally, adjusted R² (95% CI) for the Cox model increased from 0.269 (0.262–0.276) to 0.283 (0.276–0.290) in the non-time-varying model and from 0.467 (0.461–0.472) to 0.505 (0.500–0.512) in the time-varying model. There was little to no benefit of adding PLR to predict mortality. Conclusions: High NLR in incident hemodialysis patients predicted mortality, especially in the short-term period. NLR, but not PLR, added modest benefit in predicting mortality along with demographics, comorbidities, and serum albumin, and should be included in prognostication approaches.

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Neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio in evaluation of inflammation in end-stage renal disease

Cited by 92 publications

References 0 publications

High Neutrophil-to-Lymphocyte Ratio is a Significant Predictor of Cardiovascular and All-Cause Mortality in Patients Undergoing Peritoneal Dialysis

High Neutrophil-to-Lymphocyte Ratio is a Significant Predictor of Cardiovascular and All-Cause Mortality in Patients Undergoing Peritoneal Dialysis

Relationship between CRP, systemic immune-inflammation index and routine hemogram related inflammatory markers in low grade inflammation

Lymphocyte Cell Ratios and Mortality among Incident Hemodialysis Patients

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