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Relationship between Serial Serum Neutrophil-Lymphocyte Ratio, Cardiovascular Mortality, and All-Cause Mortality in
Lik Fung Sam Lau1, Jack K C Ng1, Winston W S Fung1
1Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong, China.
Insights
Monitoring neutrophil-lymphocyte ratio (NLR) in peritoneal dialysis (PD) patients can predict mortality risk. Persistently high NLR levels in PD patients indicate a significantly higher risk of all-cause mortality.
Area of Science:
- Nephrology
- Cardiology
- Inflammation Research
Background:
- Cardiovascular disease is a major concern for patients undergoing peritoneal dialysis (PD).
- Chronic inflammation is implicated in the increased cardiovascular burden observed in PD patients.
- Neutrophil-lymphocyte ratio (NLR) is a recognized inflammatory marker linked to cardiovascular outcomes.
Purpose of the Study:
- To investigate the prognostic value of serial neutrophil-lymphocyte ratio (NLR) measurements.
- To assess the association of NLR with all-cause mortality and cardiovascular mortality in patients on PD.
Main Methods:
- Serial NLR measurements were taken annually from 225 incident PD patients.
- Patients were stratified into "high" and "low" NLR groups based on the median value.
- All-cause mortality and cardiovascular mortality served as primary and secondary outcome measures.
Main Results:
- Lower baseline NLR correlated with a higher survival rate (p=0.01).
- Patients with persistently high NLR exhibited the lowest survival rates (p=0.03).
- Multivariate analysis indicated that persistently high NLR significantly increased all-cause mortality risk (HR: 1.74, p=0.02), but not cardiovascular mortality.
Conclusions:
- Baseline NLR is an independent predictor of all-cause mortality in PD patients.
- Persistent elevation of NLR amplifies the risk of all-cause mortality.
- Serial monitoring of NLR may aid in identifying high-risk PD patients for adverse outcomes.
Introduction:
It is believed that the excessive cardiovascular (CV) burden of patients on peritoneal dialysis (PD) is closely associated with chronic inflammation. Neutrophil-lymphocyte ratio (NLR) is an inflammatory marker that was shown to correlate with CV outcomes. However, little is known about the significance of serial monitoring of serum NLR. We aimed to determine the prognostic value of serial NLR on all-cause mortality and CV mortality in PD patients.
Methods:
Serial measurement of NLR was obtained from 225 incident PD patients in a single center, with each measurement 1 year apart. Patients were divided into two groups ("high" vs. "low") by the median value of NLR. The primary and secondary outcome measure was all-cause and CV mortality, respectively.
Results:
After a median of follow-up for 43.9 months, patients with lower baseline NLR demonstrated a higher survival rate (p = 0.01). Patients with persistently high NLR values on serial measurement had the lowest survival rate (p = 0.03). Multivariate Cox regression showed that this group of patients had significantly higher all-cause mortality (HR: 1.74, 95% CI: 1.09-2.79, p = 0.02). However, the NLR failed to demonstrate a statistically significant relationship with CV mortality.
Conclusions:
While baseline NLR was an independent predictor of all-cause mortality in PD patients, persistent elevation in NLR appeared to further amplify the risk. Regular monitoring of serial serum NLR may enable early identification of patients who are at risk of adverse outcome.
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