Carollo Caterina, Sorce Alessandra, Mancia Ettore, Cirafici Emanuele, Ciuppa Maria Elena, De Biasio Benedetto, Mulè Giuseppe, Brunori Giuliano
Unit of Nephrology and Dialysis, Hypertension Excellence Centre, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, PA, Italy.
Nephrology and Dialysis, Santa Chiara Regional Hospital, APSS Trento, 38123 Trento, TN, Italy.
J Clin Med. 2025 May 13;14(10):3411. doi: 10.3390/jcm14103411.
The neutrophil-to-lymphocyte ratio (NLR) has emerged as a readily available marker of systemic inflammation and immune dysregulation. In patients undergoing hemodialysis, inflammation is a known contributor to erythropoietin resistance. However, the relationship between the NLR and the erythropoietin resistance index (ERI) has not been extensively characterized. A total of 317 hemodialysis patients were retrospectively evaluated and stratified into tertiles based on NLR levels. Biochemical, inflammatory, and anthropometric variables were compared across groups. Spearman's rank correlation was used to assess the relationship between the NLR and the ERI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive ability of the NLR for erythropoietin resistance, defined as ERI > 10. Subsequently, linear and logistic regression models were employed to examine the independent association between the NLR and the ERI, adjusting for relevant covariates. Higher NLR tertiles were significantly associated with increased CRP, lower serum iron, and elevated ERI ( = 0.002). Spearman's analysis revealed a modest but significant correlation between the NLR and the ERI (ρ = 0.31, < 0.0001). ROC analysis identified an NLR threshold of 4.4 for detecting ERI > 10. In multivariable analysis, the NLR was independently associated with the ERI both as a continuous variable (β = 0.848, = 0.046) and as a binary outcome (OR = 1.22, 95% CI: 0.95-1.24, = 0.0021), while serum iron and hemoglobin also emerged as significant predictors. In this cohort of hemodialysis patients, a higher NLR was independently associated with increased erythropoietin resistance, suggesting its potential utility as an accessible inflammatory biomarker in anemia management. These findings add to the limited but growing body of evidence supporting the prognostic role of the NLR in dialysis populations and warrant further validation in prospective studies.
中性粒细胞与淋巴细胞比值（NLR）已成为一种易于获得的全身炎症和免疫失调标志物。在接受血液透析的患者中，炎症是已知的促红细胞生成素抵抗的一个因素。然而，NLR与促红细胞生成素抵抗指数（ERI）之间的关系尚未得到广泛描述。对317例血液透析患者进行回顾性评估，并根据NLR水平分为三分位数。对各组的生化、炎症和人体测量变量进行比较。采用Spearman等级相关分析评估NLR与ERI之间的关系。进行受试者工作特征（ROC）曲线分析，以评估NLR对促红细胞生成素抵抗的预测能力，促红细胞生成素抵抗定义为ERI>10。随后，采用线性和逻辑回归模型，在调整相关协变量的情况下，检验NLR与ERI之间的独立关联。较高的NLR三分位数与CRP升高、血清铁降低和ERI升高显著相关（P=0.002）。Spearman分析显示NLR与ERI之间存在适度但显著的相关性（ρ=0.31，P<0.0001）。ROC分析确定检测ERI>10的NLR阈值为4.4。在多变量分析中，NLR作为连续变量（β=0.848，P=0.046）和二元结果（OR=1.22，95%CI：0.95-1.24，P=0.0021）均与ERI独立相关，而血清铁和血红蛋白也成为显著预测因素。在这组血液透析患者中，较高的NLR与促红细胞生成素抵抗增加独立相关，表明其在贫血管理中作为一种可获得的炎症生物标志物具有潜在用途。这些发现补充了有限但不断增加的证据，支持NLR在透析人群中的预后作用，并有待在前瞻性研究中进一步验证。
