Department of Nephrology, General Hospital of Thessaloniki Papageorgiou, Periferiaki Odos Thessalonikis, Nea Efkarpia, 56403, Thessaloniki, Greece.
Center for Bioelectronic Medicine & Biomedical Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA.
Int Urol Nephrol. 2020 Apr;52(4):783-790. doi: 10.1007/s11255-020-02431-z. Epub 2020 Mar 10.
It is unclear whether normal white blood cell (WBC) counts are predictive of subsequent mortality in hemodialysis patients.
All patients aged 17 years or more, who initiated hemodialysis at a tertiary Hospital from January 2000 to August 2017 with a dialysis vintage of greater than 90 days and normal median WBC count of their first dialysis year were included in the study. They were followed until they died, transferred to other dialysis facilities, switched to peritoneal dialysis, received a renal transplant or reached the end of the study (August 31, 2018). Cox regression was used to estimate hazard ratios for mortality of tertiles of WBC counts, adjusting for baseline demographic, clinical and laboratory variables.
611 patients [median (interquartile range) age 65.2 (53.3-72.6) years, 62.4% male] were studied. During a median follow-up of 3.9 (1.6-7.2) years, 270 participants died. Patients in the mid- (6.25-7.73 × 10/μL, n = 203) and top-tertile (7.73-10.50 × 10/μL, n = 203) of normal WBC counts had significantly higher mortality than patients in the bottom-tertile (3.50-6.25 × 10/μL, n = 205). The adjusted hazard ratio for mortality relative to the bottom-tertile was 1.54, 95% confidence interval (CI) 1.05-2.25 and 2.20, 95% CI 1.46-3.32, for the mid- and top-tertiles, respectively.
In hemodialysis patients, higher WBC count within the normal range is associated with increased long-term mortality. This finding is described for the first time and provides further insight into the clinical significance of a "normal" WBC count result in dialysis patients.
目前尚不清楚白细胞计数（WBC）正常是否可预测血液透析患者的后续死亡率。
本研究纳入了 2000 年 1 月至 2017 年 8 月期间在一家三级医院开始血液透析、透析龄大于 90 天且首年 WBC 计数中位数正常的年龄在 17 岁及以上的所有患者。对他们进行随访，直至死亡、转至其他透析机构、转为腹膜透析、接受肾移植或研究结束（2018 年 8 月 31 日）。使用 Cox 回归估计 WBC 计数三分位组的死亡率风险比，同时调整基线人口统计学、临床和实验室变量。
共纳入 611 例患者[中位（四分位间距）年龄 65.2（53.3-72.6）岁，62.4%为男性]。中位随访 3.9（1.6-7.2）年后，有 270 例患者死亡。中值（6.25-7.73×10/μL，n=203）和高值（7.73-10.50×10/μL，n=203）WBC 计数正常的患者死亡率明显高于低值（3.50-6.25×10/μL，n=205）。与低值相比，中值和高值的死亡风险调整后比值比分别为 1.54（95%置信区间 1.05-2.25）和 2.20（95%置信区间 1.46-3.32）。
在血液透析患者中，正常范围内较高的 WBC 计数与长期死亡率增加相关。这一发现尚属首次报道，进一步深入了解了透析患者“正常”WBC 计数结果的临床意义。
