Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA.
Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA.
Am J Nephrol. 2017;46(5):408-416. doi: 10.1159/000484177. Epub 2017 Nov 7.
Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been previously suggested as oncologic prognostication markers. These are associated with malnutrition and inflammation, and hence, may provide benefit in predicting mortality among hemodialysis patients.
Among 108,548 incident hemodialysis patients in a large U.S. dialysis organization (2007-2011), we compared the mortality predictability of NLR and PLR with baseline and time-varying covariate Cox models using the receiver operating characteristic curve (AUROC), net reclassification index (NRI), and adjusted R2.
During the median follow-up period of 1.4 years, 28,618 patients died. Median (IQR) NLR and PLR at baseline were 3.64 (2.68-5.00) and 179 (136-248) respectively. NLR was associated with higher mortality, which appeared stronger in the time-varying versus baseline model. PLR exhibited a J-shaped association with mortality in both models. NLR provided better mortality prediction in addition to demographics, comorbidities, and serum albumin; ΔAUROC and NRI for 1-year mortality (95% CI) were 0.010 (0.009-0.012) and 6.4% (5.5-7.3%) respectively. Additionally, adjusted R2 (95% CI) for the Cox model increased from 0.269 (0.262-0.276) to 0.283 (0.276-0.290) in the non-time-varying model and from 0.467 (0.461-0.472) to 0.505 (0.500-0.512) in the time-varying model. There was little to no benefit of adding PLR to predict mortality.
High NLR in incident hemodialysis patients predicted mortality, especially in the short-term period. NLR, but not PLR, added modest benefit in predicting mortality along with demographics, comorbidities, and serum albumin, and should be included in prognostication approaches.
中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）先前被认为是肿瘤预后标志物。这些比值与营养不良和炎症相关，因此可能有助于预测血液透析患者的死亡率。
我们比较了 NLR 和 PLR 在基线和时变协变量 Cox 模型中的死亡率预测能力，使用受试者工作特征曲线（AUROC）、净重新分类指数（NRI）和调整后的 R2。在一个大型美国透析组织（2007-2011 年）的 108548 例新发生的血液透析患者中，我们比较了 NLR 和 PLR 的死亡率预测能力。
在中位随访期 1.4 年内，有 28618 例患者死亡。基线时的中位数（IQR）NLR 和 PLR 分别为 3.64（2.68-5.00）和 179（136-248）。NLR 与更高的死亡率相关，在时变模型中比在基线模型中更强。PLR 在两个模型中均显示出与死亡率的 J 形关联。NLR 除了人口统计学、合并症和血清白蛋白外，还能更好地预测死亡率；1 年死亡率（95%CI）的ΔAUROC 和 NRI 分别为 0.010（0.009-0.012）和 6.4%（5.5-7.3%）。此外，在非时变模型中，Cox 模型的调整 R2（95%CI）从 0.269（0.262-0.276）增加到 0.283（0.276-0.290），在时变模型中从 0.467（0.461-0.472）增加到 0.505（0.500-0.512）。添加 PLR 预测死亡率几乎没有获益。
血液透析患者的高 NLR 可预测死亡率，尤其是在短期内。NLR 与人口统计学、合并症和血清白蛋白一起，可适度改善死亡率预测，应纳入预后评估方法。
