Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju, South Korea.
Ren Fail. 2022 Dec;44(1):1401-1408. doi: 10.1080/0886022X.2022.2110894.
We evaluated whether the neutrophil-to-lymphocyte ratio (NLR) could aid dialysis decision-making in combination with the clinical presentation and biochemical findings. We retrospectively evaluated the medical records of 279 patients who commenced chronic maintenance hemodialysis. We compared the laboratory findings at 6 months before dialysis to those at dialysis initiation. NLR cutoffs and risk factors for each of six uremic symptoms were determined. Mean age was 60.7 years and mean estimated glomerular filtration rate (eGFR) was 5.7 ± 2.5 mL/min/1.73 m at the time of hemodialysis and 7.7 ± 3.8 mL/min/1.73 m 6 months earlier ( < 0.001). The mean NLR increased significantly from 2.5 ± 1.0 to 4.9 ± 2.8 ( < 0.001). The NLR was positively correlated with the C-reactive protein level ( = 0.202, = 0.009) and negatively correlated with those of albumin ( = -0.192, = 0.001) and total CO ( = -0.134, = 0.023). The NLR cutoffs for neurological and gastrointestinal symptoms as determined using receiver operator curve analysis were 2.4 (area under the curve [AUC] 0.976; 95% confidence interval [CI] 0.960-0.993; sensitivity 92.2%; specificity 94.7%) and 3.6 (AUC 0.671; 95% CI 0.588-0.755; sensitivity 68.1%; specificity 63.5%), respectively. On multiple linear regression analysis of neurological symptoms, the NLR was a significant predictor ( = -0.218, = 0.017), as was age ( = 0.314, = 0.037). In conclusion, the NLR may serve as a supplementary marker predicting uremic symptoms and a need for hemodialysis in stage 5 CKD patients.
我们评估了中性粒细胞与淋巴细胞比值（NLR）是否可以结合临床表现和生化检查结果来辅助透析决策。我们回顾性评估了 279 名开始接受慢性维持性血液透析的患者的病历。我们比较了透析前 6 个月和开始透析时的实验室检查结果。确定了六个尿毒症症状的 NLR 截止值和危险因素。血液透析时的平均年龄为 60.7 岁，估计肾小球滤过率（eGFR）为 5.7 ± 2.5 mL/min/1.73 m，6 个月前为 7.7 ± 3.8 mL/min/1.73 m（ < 0.001）。NLR 从 2.5 ± 1.0 显著增加到 4.9 ± 2.8（ < 0.001）。NLR 与 C 反应蛋白水平呈正相关（ = 0.202， = 0.009），与白蛋白（ = -0.192， = 0.001）和总二氧化碳（ = -0.134， = 0.023）水平呈负相关。使用接收器操作曲线分析确定的 NLR 截止值分别为神经和胃肠道症状为 2.4（曲线下面积 [AUC] 0.976；95%置信区间 [CI] 0.960-0.993；敏感性 92.2%；特异性 94.7%）和 3.6（AUC 0.671；95% CI 0.588-0.755；敏感性 68.1%；特异性 63.5%）。在对神经症状进行的多元线性回归分析中，NLR 是一个显著的预测因子（ = -0.218， = 0.017），年龄也是一个显著的预测因子（ = 0.314， = 0.037）。总之，NLR 可作为预测 5 期 CKD 患者尿毒症症状和血液透析需求的辅助标志物。
