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. 2022 Nov 18;16(3):512-520.
doi: 10.1093/ckj/sfac248. eCollection 2023 Mar.

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

Kaitlin J Mayne  1   2   3 , Jennifer S Lees  1   2 , Elaine Rutherford  1   4 , Peter C Thomson  2 , Jamie P Traynor  2 , Vishal Dey  5 , Ninian N Lang  1 , Patrick B Mark  1   2
Affiliations

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

Kaitlin J Mayne et al. Clin Kidney J. .

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 coronavirus disease 2019 (COVID-19) infection subpopulation.

Methods: A retrospective analysis was performed of adults commencing hospital haemodialysis in the West of Scotland during 2010-21. NLR and PLR were calculated from routine samples around haemodialysis initiation. Kaplan-Meier and Cox proportional hazards analyses were used to assess mortality associations.

Results: In 1720 haemodialysis patients over a median of 21.9 (interquartile range 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 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.

Keywords: COVID-19; haemodialysis; inflammation; lymphocyte; mortality.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Kaplan–Meier cumulative survival plots for all-cause mortality by baseline NLR.
Figure 2:
Figure 2:
COVID-19 infection timelines. Reinfection: n=9, median 9 (6-14) months between infections, figure presents time to first infection & time from reinfection to death. *Participants no longer on haemodialysis at first infection were excluded (transplant n=105, peritoneal dialysis n=11, transfer of care n=1). †Death within 28 days of COVID-19 infection. ‡22 patients died more than 28 days after COVID-19 infection.
Figure 3:
Figure 3:
Kaplan–Meier cumulative survival plot in COVID-19 subpopulation by baseline NLR.
See this image and copyright information in PMC

References

    1. Valga F, Monzón T, Henriquez Fet al. . Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as biological markers of interest in kidney disease. Nefrologia 2019;39:243–9. 10.1016/j.nefro.2018.11.005 - DOI - PubMed
    1. Hung SC, Lai YS, Kuo KLet al. . Volume overload and adverse outcomes in chronic kidney disease: clinical observational and animal studies. J Am Heart Assoc 2015;4:e001918. 10.1161/JAHA.115.001918 - DOI - PMC - PubMed
    1. Kalantar-Zadeh K, Ikizler TA, Block Get al. . Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 2003;42:864–81. 10.1016/j.ajkd.2003.07.016 - DOI - PubMed
    1. Sarnak MJ. Cardiovascular complications in chronic kidney disease. Am J Kidney Dis 2003;41:11–7. 10.1016/S0272-6386(03)00372-X - DOI - PubMed
    1. Obi Y, Qader H, Kovesdy CPet al. . Latest consensus and update on protein-energy wasting in chronic kidney disease. Curr Opin Clin Nutr Metab Care 2015;18:254–62. 10.1097/MCO.0000000000000171 - DOI - PMC - PubMed