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Meta-Analysis
. 2020 Nov;42(1):1059-1066.
doi: 10.1080/0886022X.2020.1832521.

Neutrophil-to-lymphocyte ratio in relation to the risk of all-cause mortality and cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis

Wen-Man Zhao  1 , Shu-Man Tao  1 , Gui-Ling Liu  1
Affiliations
Meta-Analysis

Neutrophil-to-lymphocyte ratio in relation to the risk of all-cause mortality and cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis

Wen-Man Zhao et al. Ren Fail. 2020 Nov.

Abstract

Aim: To systematically evaluate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the risk of all-cause mortality or cardiovascular events in patients with chronic kidney disease (CKD).

Methods: PubMed, Embase, and Web of Science databases were searched for cohort studies that were published since the databases were launched, until 1 April 2020. We selected papers according to specific inclusion and exclusion criteria, extracted data, and evaluated the quality of the citations. Data from eligible studies were used to calculate the combined hazard ratios (HRs) and 95% confidence intervals (CI).

Results: The search identified 1048 potentially eligible records, and 10 studies (n = 1442) were selected. Eight studies reported all-cause mortality, and two studies reported cardiovascular events. The combined HR of all-cause mortality was 1.45 (95% CI 1.20-1.75) and the HR of cardiovascular events was 1.52 (95% CI 1.33-1.72) when NLR was considered as a categorical variable. Similarly, the association between NLR and all-cause mortality was confirmed (HR 1.35; 95% CI 1.23-1.48) when NLR was used as a continuous variable.

Conclusion: NLR is a predictor of all-cause mortality and cardiovascular events in patients with chronic kidney disease.

Keywords: All-cause mortality; cardiovascular events; meta-analysis; neutrophil-to-lymphocyte ratio.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flowchart of the study selection process.
Figure 2.
Figure 2.
The combined prevalence of all-cause death in CKD patients.
Figure 3.
Figure 3.
Forest plot for the association between NLR and all-cause mortality in CKD (NLR used as a categorical variable).
Figure 4.
Figure 4.
Forest plot for the association between NLR and cardiovascular events.
Figure 5.
Figure 5.
Funnel plot of results of five studies based on the result of NLR and risk of all-cause mortality.
See this image and copyright information in PMC

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