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

Abstract

Background: Chronic kidney disease (CKD) is a global public health problem with a high mortality rate and a rapid progression to end-stage kidney disease (ESKD). Recently, the role of inflammation and the correlation between inflammatory markers and CKD progression have been studied. This study aimed to analyze the predictive value of the neutrophil–lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) in assessing the outcome of ESKD patients. Methods: A retrospective study which included all patients admitted in the Department of Nephrology of the County Emergency Clinical Hospital, Târgu-Mureș, Romania, between January 2016 and December 2019, diagnosed with ESKD. Results: Mortality at 30 days was clearly higher in the case of the patients in the high-NLR groups (40.12% vs. 1.97%; p < 0.0001), high-MLR (32.35% vs. 4.81%; p < 0.0001, and respectively high-PLR (25.54% vs. 7.94%; p < 0.0001). There was also a significant increase in the number of hospital days and the average number of dialysis sessions in patients with high-NLR (p < 0.0001), high-MLR (p < 0.0001), and high-PLR (p < 0.0001). The multivariate analysis showed that a high baseline value for NLR (p < 0.0001), MLR (p < 0.0001), and PLR (p < 0.0001) was an independent predictor of 30-day mortality for all recruited patients. Conclusions: Our findings established that NLR, MLR, and PLR determined at hospital admission had a strong predictive capacity of all-cause 30-day mortality in ESKD patients who required RRT for at least 6 months. Elevated values of the ratios were also associated with longer hospital stays and more dialysis sessions per patient.

Chest CT Severity Score and Systemic Inflammatory Biomarkers as Predictors of the Need for Invasive Mechanical Ventilation and of COVID-19 Patients’ Mortality

“…Apart from well-known biomarkers of inflammation such as C-reactive protein, interleukin-6 (IL-6), and procalcitonin, hematological indices have gained popularity in recent years in the specialized literature due to their inexpensive cost and performance [ 7 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 38 , 39 , 40 , 41 ]. Moreover, hematological indices such as neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), systemic immune inflammation index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI), have been applied to predict the prognosis in patients with the cardiovascular disease [ 42 , 43 , 44 ], acute limb ischemia [ 45 , 46 ], chronic kidney disease [ 47 , 48 ], peripheral artery disease [ 49 ], malignancy [ 50 , 51 , 52 ], and more recently in the case of COVID-19 patients [ 7 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Risks of Carotid Artery Stenosis and Atherosclerotic Cardiovascular Disease in Patients with Calcium Kidney Stone: Assessment of Systemic Inflammatory Biomarkers

“…Accumulating evidence has reported that NLR, MLR, and SIRI, are prognostic indicators in several malignancies [ 20 ]. Given that systemic inflammatory responses participate in multiple diseases other than cancer, a growing body of literature has proposed that NLR, MLR, and SIRI, can also be potential predictors of various diseases, including peripheral arterial disease (PAD) [ 21 ], mortality after coronary artery bypass surgery [ 22 ], outcomes of target vessel restenosis after infrainguinal angioplasty [ 23 ], and end stage renal disease (ESRD) [ 24 , 25 ]. However, very few studies have focused on the role of systemic inflammatory responses in the formation of kidney stones [ 26 ].…”

Genotypes and Variants of BKPyV in Organ Donors after Brain Death

“…Additionally, in our research we used simple and non-invasive methods to calculate cellular indicators of inflammation, such as NLR, dNLR, MLR and the hypercoagulable state (PLR) for all groups of DBDs [ 9 ]. These ratios are correlated with poor prognosis in a variety of conditions, including end-stage kidney disease, heart disease and cancer [ 10 ]. Previous studies have shown there is a relationship between high NLR and PLR values and the onset of acute rejection of the transplanted organ [ 6 ].…”

“…There is increasing interest in better understanding of the indicators of inflammation, such as the neutrophil-to-lymphocyte ratio (NLR) [ 7 , 8 ], or platelet-to-lymphocyte ratio (PLR) which reflect the presence of systemic inflammation [ 9 ]. Both of them have been correlated with poor prognosis in a variety of conditions including end-stage kidney disease, heart disease or cancer [ 9 , 10 , 11 , 12 , 13 ].…”