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Interleukin-6-to-Albumin Ratio as a Superior Predictor of Mortality in End-Stage Kidney Disease Patients
Xiejia Li1,2, Abdul Rashid Qureshi3, Mohamed E Suliman3
1Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden, lixiejia1218@csu.edu.cn.
Insights
The interleukin-6 to albumin ratio (IAR) predicts death risk in dialysis patients. Higher IAR is linked to increased all-cause mortality, offering valuable prognostic insight for chronic kidney disease (CKD) patients.
Area of Science:
- Nephrology
- Biomarkers
- Prognostics
Background:
- High interleukin-6 (IL-6) and low albumin are linked to poor outcomes in chronic kidney disease (CKD).
- The IL-6-to-albumin ratio (IAR) may serve as a prognostic marker in CKD patients.
Purpose of the Study:
- To evaluate the IL-6-to-albumin ratio (IAR) as a predictor of mortality risk in patients initiating dialysis.
- To compare the predictive performance of IAR against individual IL-6 and albumin levels.
Main Methods:
- Assessed plasma IL-6 and albumin to calculate IAR in 428 incident dialysis patients.
- Utilized receiver operating characteristic (ROC) curves and Cox regression to analyze IAR's association with 60-month mortality.
- Employed Fine-Gray analysis and restricted mean survival time (RMST) to assess mortality risk and survival differences across IAR tertiles.
Main Results:
- IAR demonstrated superior discrimination for all-cause mortality (AUC 0.700) compared to IL-6 or albumin alone.
- Higher IAR tertiles were independently associated with significantly increased all-cause mortality risk (HR 2.22 and 1.85).
- Restricted mean survival time analysis confirmed shorter survival in higher IAR tertiles for all-cause mortality.
Conclusions:
- The IL-6-to-albumin ratio (IAR) is an independent predictor of all-cause mortality in incident dialysis patients.
- IAR provides significant prognostic information for patients with chronic kidney disease undergoing dialysis.
Introduction:
In patients with chronic kidney disease (CKD), high interleukin-6 (IL-6) and low albumin circulating concentrations are associated with worse outcomes. We examined the IL-6-to-albumin ratio (IAR) as a predictor of risk of death in incident dialysis patients.
Methods:
In 428 incident dialysis patients (median age 56 years, 62% men, 31% diabetes mellitus, 38% cardiovascular disease [CVD]), plasma IL-6 and albumin were measured at baseline to calculate IAR. We compared the discrimination of IAR with other risk factors for predicting 60-month mortality using receiver operating characteristic curve (ROC) and analyzed the association of IAR with mortality using Cox regression analysis. We divided patients into IAR tertiles and analyzed: (1) cumulative incidence of mortality and the association of IAR with mortality risk in Fine-Gray analysis, taking kidney transplantation as competing risk and (2) the restricted mean survival time (RMST) to 60-month mortality and differences of RMST (∆RMST) between IAR tertiles to describe quantitative differences of survival time.
Results:
For all-cause mortality, the area under the ROC curve (AUC) for IAR was 0.700, which was greater than for IL-6 and albumin separately, while for CV mortality, the AUC for IAR (0.658) showed negligible improvement over IL-6 and albumin separately. In Cox regression analysis, IAR was significantly associated with all-cause mortality but not with CV mortality. Both high versus low and middle versus low tertiles of IAR associated with higher risk of all-cause mortality, subdistribution hazard ratio of 2.22 (95% CI 1.40-3.52) and 1.85 (95% CI 1.16-2.95), respectively, after adjusting for age, sex, diabetes mellitus, CVD, smoking, and estimated glomerular filtration rate. ∆RMST at 60 months showed significantly shorter survival time in middle and high IAR tertiles compared with low IAR tertile for all-cause mortality.
Conclusions:
Higher IAR was independently associated with significantly higher all-cause mortality risk in incident dialysis patients. These results suggest that IAR may provide useful prognostic information in patients with CKD.
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