High Neutrophil-to-Lymphocyte Ratio Predicts Cardiovascular Mortality in Chronic Hemodialysis Patients

Han Li, Xiangxue Lu, Ruifang Xiong, Shixiang Wang, Han Li, Xiangxue Lu, Ruifang Xiong, Shixiang Wang

Abstract

The neutrophil-to-lymphocyte ratio (NLR) is a novel simple biomarker of inflammation. It has emerged as a predictor of poor prognosis in cancer and cardiovascular disease in general population. But little was known of its prognostic value in chronic hemodialysis (HD) patients. Here we investigated the association between NLR and cardiovascular risk markers, including increased pulse pressure (PP), left ventricular mass index (LVMI) and intima-media thickness (IMT), and mortality in HD patients. Two hundred and sixty-eight HD patients were enrolled in this study and were followed for 36 months. The primary end point was all-cause mortality and cardiovascular mortality. Multivariable Cox regression was used to calculate the adjusted hazard ratios for NLR on all-cause and cardiovascular survival. We pinpointed that higher NLR in HD patients was a predictor of increased PP, LVMI, and IMT; HD patients with higher NLR had a lower survival at the end of the study; furthermore, high NLR was an independent predictor of all-cause and cardiovascular mortality when adjusted for other risk factors. In conclusion, higher NLR in HD patients was associated with cardiovascular risk factors and mortality.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
NLR level in HD patients with CVD risk factors. (a) HD patients with higher PP (≥65 mmHg) had higher NLR level. ∗ indicates a significant difference between the PP (≥65 mmHg) group and PP (<65 mmHg) group (P < 0.01); (b) HD patients with higher LVMI (≥50 g/height2.7) had higher NLR level. ∗ indicates a significant difference between the LVMI (≥50 g/height2.7) group and LVMI (<50 g/height2.7) group (P < 0.01); (c) HD patients with higher IMT (≥1.2 mm) had higher NLR level. ∗ indicates a significant difference between the IMT (≥1.2 mm) group and IMT (<1.2 mm) group (P < 0.01).
Figure 3
Figure 3
NLR level in HD patients with CVD and overall death. (a) HD Patients who died from overall causes had higher NLR level. ∗ indicates a significant difference between the all-cause death group and survival group (P < 0.01); (b) HD Patients who died from cardiovascular causes had significantly higher NLR level. ∗ indicates a significant difference between the CVD death group and survival group (P < 0.01).
Figure 4
Figure 4
NLR ≥ 3.5 was associated with higher all-cause and cardiovascular death. (a) NLR ≥ 3.5 had a significant higher 36-month all-cause mortality in HD patients (log rank = 15.28; P < 0.01); (b) NLR ≥ 3.5 had a significant higher 36-month cardiovascular mortality in HD patients (log rank = 43.54; P < 0.01).

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