Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
Department of Molecular Medicine, School of Medicine, University of Colima, Av. Universidad 333, Colonia las Viboras, Colima, Mexico.
Int Urol Nephrol. 2019 Jul;51(7):1239-1247. doi: 10.1007/s11255-019-02166-6. Epub 2019 May 14.
Adverse outcomes in hemodialysis patients have been attributed, in part, to the pro-inflammatory state prevalent in this population. This study examines the relationship between blood neutrophil-to-lymphocyte ratio (NLR) with nutrition markers and health outcomes in hemodialysis (HD) patients.
This is a 12-month prospective cohort study that recruited 77 participants from May to Jun 2017.
Patients receiving maintenance hemodialysis.
Hospitalization, transplants and mortality.
Of the 77 participants, 63.8% were hospitalized, 10 (13%) died of cardiovascular diseases and 6 (7.8%) had a kidney transplant. Spearman correlations using baseline values showed an inverse significant correlation between the total number of hospitalizations and BMI kg/m (BMI rho = - 0.37, P <0.001); a significant inverse correlation between NLR and albumin (rho = - 0.22, P = 0.028); and a significant direct correlation between baseline NLR and BMI kg/m (rho = 0.22, P = 0.028). Participants were grouped by their NLR value into quartiles for outcomes analysis: quartile 1 (NLR ≤ 1.75), quartile 2 (NLR 1.76-2.6), quartile 3 (NLR 2.7-3.9) and quartile 4 (NLR ≥ 4). The percentage of patients with the lowest level of inflammation (NLR ≤ 1.75) was greater for not hospitalized patients than for hospitalized (39.3% vs 16.3%, P = 0.025) and not hospitalized participants had higher BMI kg/m (mean ± SD) at baseline compared to those hospitalized (29.11 ± 5.4 vs 26.22 ± 5.34, P = 0.026). In a multivariate cox regression analysis, participants in the lowest quartile (NLR ≤ 1.75) were compared to the rest on hospitalization, mortality and transplant. Years in dialysis, BMI kg/m and NLR ≤ 1.75 were significant predictors of hospitalization after adjustment (P = 0.021, P = 0.005, P = 0.039; respectively) and we observed an association of low NLR with a hazard ratio (HR 0.44, 95% CI 0.20-0.96, P = 0.039), BMI (HR 0.90, 95% CI 0.85-0.97, P = 0.005) and years in dialysis (HR 0.90, 95% CI 0.83-0.98, P = 0.021) for hospitalization in overall participants. In a further analysis comparing the effect of low NLR in the subgroup of diabetic vs non-diabetics, it was observed that BMI kg/m was a significant predictor for hospitalization in the non-diabetic subgroup (P = 0.040) but not significant in the case of diabetics (P = 0.128) after adjustments. Years in dialysis and NLR ≤ 1.75 were significant predictors of hospitalizations in the subgroup of diabetic before and after adjustment (P = 0.049, P = 0.044; respectively). Having a low NLR decreased 73% the risk for hospitalization (HR 0.27 95% CI 0.07-0.96, P = 0.044) in this subgroup. Survival and hospitalization curves were analyzed by comparing all participants and the diabetic subgroup, in the lowest inflammation quartile vs the rest (NLR ≤ 1.75 vs NLR > 1.75). Participants with NLR ≤ 1.75 had 100% survival rate (log-rank test, P = 0.059) and lower hospitalization rate (log-rank test, P = 0.025); participants with diabetes had lower hospitalization rate (log-rank test, P = 0.039).
NLR at baseline was associated with nutritional markers (albumin, BMI). Low NLR at baseline was a predictor of lower risk for hospitalizations in HD patients with diabetes.
血液中性粒细胞与淋巴细胞比值（NLR）与营养标志物和血液透析（HD）患者的健康结果之间的关系。
这是一项前瞻性队列研究，于 2017 年 5 月至 6 月招募了 77 名参与者。
接受维持性血液透析的患者。
住院、移植和死亡率。
77 名参与者中，63.8%住院，10 人（13%）死于心血管疾病，6 人（7.8%）接受了肾脏移植。使用基线值进行 Spearman 相关性分析显示，总住院次数与 BMI kg/m 呈显著负相关（BMI rho=-0.37，P<0.001）；NLR 与白蛋白呈显著负相关（rho=-0.22，P=0.028）；NLR 与 BMI kg/m 呈显著正相关（rho=0.22，P=0.028）。根据 NLR 值将参与者分为四组进行结果分析：第 1 组（NLR≤1.75）、第 2 组（NLR 1.76-2.6）、第 3 组（NLR 2.7-3.9）和第 4 组（NLR≥4）。炎症水平最低（NLR≤1.75）的患者中未住院患者的比例大于住院患者（39.3%比 16.3%，P=0.025），未住院患者的 BMI kg/m 基线值高于住院患者（29.11±5.4 vs 26.22±5.34，P=0.026）。在多变量 Cox 回归分析中，将 NLR 最低的四组（NLR≤1.75）与其余组进行比较，观察到住院、死亡和移植。经过调整，透析年限、BMI kg/m 和 NLR≤1.75 是住院的显著预测因素（P=0.021、P=0.005、P=0.039），我们观察到 NLR 与住院的危险比（HR 0.44，95%CI 0.20-0.96，P=0.039）、BMI（HR 0.90，95%CI 0.85-0.97，P=0.005）和透析年限（HR 0.90，95%CI 0.83-0.98，P=0.021）有关。在进一步分析比较 NLR 对糖尿病亚组和非糖尿病亚组住院的影响时，发现 BMI kg/m 是非糖尿病亚组住院的显著预测因素（P=0.040），但在糖尿病亚组中不显著（P=0.128）。调整后，透析年限和 NLR≤1.75 是糖尿病亚组住院的显著预测因素（P=0.049、P=0.044）。在该亚组中，NLR 降低 73%的住院风险（HR 0.27，95%CI 0.07-0.96，P=0.044）。
基线时 NLR 与营养标志物（白蛋白、BMI）相关。基线时 NLR 较低是糖尿病血液透析患者住院风险降低的预测因素。
