Xiang Fangfang, Chen Rongyi, Cao Xuesen, Shen Bo, Liu Zhonghua, Tan Xiao, Ding Xiaoqiang, Zou Jianzhou
Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Kidney and Dialysis, Shanghai, China.
Hemodial Int. 2018 Jan;22(1):82-92. doi: 10.1111/hdi.12549. Epub 2017 Apr 12.
Patients with chronic kidney disease, especially those with end-stage renal disease, have an increased risk of death. Previous studies have suggested neutrophil/lymphocyte ratio (NLR) was related to worse outcome in patients undergoing hemodialysis (HD). However, monocyte/lymphocyte ratio (MLR) has not been evaluated in HD patients. In this study, we prospectively studied the predictive value of MLR for all-cause and cardiovascular mortality in HD patients and compared it with NLR.
Patients who had been on a HD treatment for at least 6 months were enrolled. MLR was calculated by dividing the monocyte count by the lymphocyte count. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic impact of MLR and other clinical factors on all-cause and cardiovascular mortality.
Mortality rates for the lowest, middle, and highest MLR tertile group were 3.65, 7.02, and 11.15, respectively per 100 patient-years. The Kaplan-Meier analysis revealed that survival rates were significantly different among three MLR groups (P < 0.001). In multivariate Cox regression analyses, MLR was independently associated with all-cause mortality (HR 4.842; 95% CI, 2.091-11.214; P < 0.001) and cardiovascular mortality (HR 6.985, 95% CI 1.943-25.115, P = 0.003) as continuous variables. NLR was not an independent predictor of all-cause nor cardiovascular mortality after adjusted with MLR.
The main finding of the study suggest that higher MLR was a strong and independent predictor of all-cause and cardiovascular mortality and overwhelmed NLR among HD patients.
慢性肾脏病患者，尤其是终末期肾病患者，死亡风险增加。既往研究表明，中性粒细胞/淋巴细胞比值（NLR）与接受血液透析（HD）患者的不良预后相关。然而，单核细胞/淋巴细胞比值（MLR）在HD患者中尚未得到评估。在本研究中，我们前瞻性地研究了MLR对HD患者全因死亡率和心血管死亡率的预测价值，并将其与NLR进行比较。
纳入接受HD治疗至少6个月的患者。MLR通过单核细胞计数除以淋巴细胞计数计算得出。使用Kaplan-Meier法估计生存结局，并通过对数秩检验进行比较。进行单因素和多因素分析，以评估MLR和其他临床因素对全因死亡率和心血管死亡率的预后影响。
最低、中等和最高MLR三分位数组的死亡率分别为每100患者年3.65、7.02和11.15。Kaplan-Meier分析显示，三个MLR组的生存率存在显著差异（P < 0.001）。在多因素Cox回归分析中，MLR作为连续变量与全因死亡率（HR 4.842；95% CI，2.091 - 11.214；P < 0.001）和心血管死亡率（HR 6.985，95% CI 1.943 - 25.115，P = 0.003）独立相关。在用MLR调整后，NLR不是全因死亡率或心血管死亡率的独立预测因素。
该研究的主要发现表明，较高的MLR是HD患者全因死亡率和心血管死亡率的强大独立预测因素，且在HD患者中其预测能力超过NLR。
