Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
VA Eastern Colorado Healthcare System, Aurora, Colorado.
Kidney360. 2022 Feb 3;3(4):657-665. doi: 10.34067/KID.0007922021. eCollection 2022 Apr 28.
Emerging evidence suggests an association of higher monocyte count and monocyte/lymphocyte ratio (MLR) with the risk of cardiovascular disease (CVD) in individuals without chronic kidney disease (CKD); however, limited studies have examined if this association translates to the CKD population. This study examined whether monocyte count and MLR are associated with the risk of CVD, CVD death, and all-cause death in patients with nondialysis CKD who participated in the Chronic Renal Insufficiency Cohort observational study.
Baseline monocyte count and MLR were categorized into tertiles and also modeled continuously. Cox proportional hazards models were used to examine the association between monocyte count (primary predictor) and MLR (secondary predictor) at baseline and time to a composite of CVD events, including heart failure, myocardial infarction, ischemic stroke, and peripheral artery disease (primary outcome). Secondary outcomes were time to CVD death and all-cause death.
The median follow-up time was 9 years for CVD events and 11.7 years for death. In the fully adjusted model, participants with a higher monocyte count and MLR had a greater risk of CVD events (hazard ratio [HR] per doubling of monocyte count=1.2 [95% CI, 1.1 to 1.31]; HR per doubling of MLR=1.26 [95% CI, 1.16 to 1.36]), CVD death (HR=1.18 [95% CI, 0.99 to 1.41]; HR=1.27 [95% CI, 1.1 to 1.48]), and all-cause death (HR=1.17 [95% CI, 1.06 to 1.3]; HR=1.18 [95% CI, 1.09 to 1.29]).
These results suggest that monocyte count and MLR may have the potential to be cost-effective, clinically available indicators of CVD risk in the CKD population.
新出现的证据表明，单核细胞计数和单核细胞/淋巴细胞比值（MLR）与无慢性肾脏病（CKD）个体的心血管疾病（CVD）风险相关；然而，有限的研究检查了这种相关性是否适用于 CKD 人群。本研究检查了单核细胞计数和 MLR 是否与非透析 CKD 患者的 CVD 风险、CVD 死亡和全因死亡相关，这些患者参加了慢性肾功能不全队列观察研究。
将基线单核细胞计数和 MLR 分为三分位，并连续建模。使用 Cox 比例风险模型检查基线时单核细胞计数（主要预测因子）和 MLR（次要预测因子）与 CVD 事件（包括心力衰竭、心肌梗死、缺血性卒中和外周动脉疾病）复合终点之间的关联。次要结局是 CVD 死亡和全因死亡的时间。
CVD 事件的中位随访时间为 9 年，死亡的中位随访时间为 11.7 年。在完全调整的模型中，单核细胞计数和 MLR 较高的参与者发生 CVD 事件的风险更高（单核细胞计数每增加一倍的 HR=1.2 [95%CI，1.1 至 1.31]；MLR 每增加一倍的 HR=1.26 [95%CI，1.16 至 1.36]）、CVD 死亡（HR=1.18 [95%CI，0.99 至 1.41]；HR=1.27 [95%CI，1.1 至 1.48]）和全因死亡（HR=1.17 [95%CI，1.06 至 1.3]；HR=1.18 [95%CI，1.09 至 1.29]）。
这些结果表明，单核细胞计数和 MLR 可能具有成为 CKD 人群 CVD 风险的具有成本效益、临床可用的指标的潜力。
