Zeng Guixing, Lin Yujie, Xie Peirui, Lin Jiarong, He Yaxing, Wei Junping
Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China.
The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
J Multidiscip Healthc. 2024 May 21;17:2461-2473. doi: 10.2147/JMDH.S465317. eCollection 2024.
To investigate the association between the NLR and the risk of all-cause and cardiovascular mortality in US adults with diabetic kidney disease (DKD).
The data utilized for this analysis were sourced from ten National Health and Nutrition Examination Survey cycles (1999-2018) with mortality data (up to 31 December 2019) via linkage to the National Death Index. The optimum NLR threshold for predicting survival outcomes was determined through the maximally selected rank statistics. Restricted cubic spline (RCS), weighted Cox proportional hazard regression, stratified analyses, and time-dependent receiver-operating characteristic curve (ROC) were employed to delineate the prospective correlations of the NLR with both all-cause and cardiovascular mortality.
In this investigation, a cohort comprising 2581 patients diagnosed with DKD was examined, encompassing 624 individuals with a higher NLR (≥3.07) and 1957 subjects with a lower NLR (<3.07). Over a median follow-up of 79 months (interquartile range, 44-128 months), 1103 deaths occurred, including 397 from cardiovascular causes and 706 from non-cardiovascular causes. The RCS analysis elucidated the positive linear correlation (both nonlinear > 0.05). In the multivariable analyses, each one-unit increase in the NLR value was correlated with a 51% increased risk of all-cause mortality (1.51(1.28, 1.77)) and a 71% increased risk of cardiovascular mortality (1.71(1.32, 2.21)). The results were largely consistent across stratified analyses encompassing variables such as age, sex, race/ethnicity, marital status, family income, education levels, BMI, drinking status, smoking status, hypertension, CVD, and anti-infective drugs ( for interaction >0.05 for all). Time-dependent ROC analyses underscored the NLR's credible predictive efficacy for both short-term and extended durations in forecasting both all-cause and cardiovascular mortality.
The findings emphasize the promising use of the NLR in stratifying and prognosticating the risk of mortality in DKD in clinical practice.
研究美国糖尿病肾病（DKD）成人患者中性粒细胞与淋巴细胞比值（NLR）与全因死亡率和心血管死亡率风险之间的关联。
本分析所使用的数据来自十个国家健康与营养检查调查周期（1999 - 2018年），通过与国家死亡指数链接获取死亡率数据（截至2019年12月31日）。通过最大选择秩统计确定预测生存结果的最佳NLR阈值。采用受限立方样条（RCS）、加权Cox比例风险回归、分层分析和时间依赖性受试者工作特征曲线（ROC）来描述NLR与全因死亡率和心血管死亡率之间的前瞻性相关性。
在本次调查中，对一个由2581例诊断为DKD的患者组成的队列进行了检查，其中包括624例NLR较高（≥3.07）的个体和1957例NLR较低（<3.07）的个体。在中位随访79个月（四分位间距，44 - 128个月）期间，发生了1103例死亡，其中397例死于心血管原因，706例死于非心血管原因。RCS分析阐明了正线性相关性（两者非线性>0.05）。在多变量分析中，NLR值每增加一个单位，全因死亡率风险增加51%（1.51(1.28, 1.77)），心血管死亡率风险增加71%（1.71(1.32, 2.21)）。在涵盖年龄、性别、种族/民族、婚姻状况、家庭收入、教育水平、体重指数、饮酒状况吸烟状况、高血压、心血管疾病和抗感染药物等变量的分层分析中，结果基本一致（所有交互作用>0.05）。时间依赖性ROC分析强调了NLR在预测全因死亡率和心血管死亡率的短期和长期方面具有可靠的预测效力。
研究结果强调了NLR在临床实践中对DKD患者死亡风险进行分层和预后评估方面的潜在应用价值。
