Zhang Lin, Wang Li, Jiang Xiaotian, Yang Xiaoxiao, Yu Xiaofang, Ji Jun, Jiang Wuhua, Ding Xiaoqiang
Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China,
Shanghai Medical Center of Kidney, Shanghai, China,
Blood Purif. 2025 Jul 14:1-11. doi: 10.1159/000547399.
Peritoneal dialysis (PD)-associated peritonitis is a major complication in PD patients, leading to increased morbidity and technique failure. Identifying reliable biomarkers for predicting peritonitis risk is crucial for early intervention. Monocyte-to-lymphocyte ratio (MLR) is an emerging inflammatory marker associated with adverse outcomes in end-stage renal disease, but its predictive value for peritonitis remains unclear.
This retrospective cohort study included PD patients from a single center who had undergone PD for at least 3 months. MLR was assessed at the time of PD catheter insertion, and patients were followed for 36 months. Peritonitis was defined according to the International Society for Peritoneal Dialysis criteria. Cox proportional hazards models were used to analyze the association between MLR (continuous and tertile-based) and peritonitis, adjusting for demographic, clinical, and laboratory factors. Restricted cubic spline (RCS) regression was applied to evaluate nonlinearity, and subgroup analysis was conducted to examine whether the association between MLR and peritonitis was consistent across different subgroups.
A total of 108 patients were included, with 33 (30.6%) developing peritonitis. MLR was significantly higher in the peritonitis group (p = 0.032). Cox regression showed that higher MLR was independently associated with an increased risk of peritonitis (adjusted hazard ratio = 1.85, 95% confidence interval: 1.01-3.40, p = 0.048). Patients in the highest MLR tertile had a sixfold increased peritonitis risk compared to those in the lowest tertile (p for trend = 0.002). RCS analysis revealed a nonlinear association, with a threshold at natural logarithm-transformed MLR = -0.9. Subgroup analysis suggested a stronger association in patients with lower body mass index (<24 kg/m2).
Higher MLR at PD initiation is an independent predictor of long-term peritonitis risk. MLR may serve as a simple, cost-effective biomarker for early peritonitis risk stratification, particularly in leaner patients.
腹膜透析（PD）相关腹膜炎是PD患者的主要并发症，会导致发病率增加和技术失败。识别可靠的生物标志物以预测腹膜炎风险对于早期干预至关重要。单核细胞与淋巴细胞比值（MLR）是一种新兴的炎症标志物，与终末期肾病的不良结局相关，但其对腹膜炎的预测价值仍不明确。
这项回顾性队列研究纳入了来自单一中心且接受PD至少3个月的患者。在PD导管插入时评估MLR，并对患者进行36个月的随访。根据国际腹膜透析学会标准定义腹膜炎。使用Cox比例风险模型分析MLR（连续变量和三分位数分组）与腹膜炎之间的关联，并对人口统计学、临床和实验室因素进行校正。应用限制立方样条（RCS）回归评估非线性关系，并进行亚组分析以检查MLR与腹膜炎之间的关联在不同亚组中是否一致。
共纳入108例患者，其中33例（30.6%）发生腹膜炎。腹膜炎组的MLR显著更高（p = 0.032）。Cox回归显示，较高的MLR与腹膜炎风险增加独立相关（调整后的风险比 = 1.85，95%置信区间：1.01 - 3.40，p = 0.048）。与最低三分位数组的患者相比，最高MLR三分位数组的患者发生腹膜炎的风险增加了六倍（趋势p = 0.002）。RCS分析显示存在非线性关联，自然对数转换后的MLR = -0.9时有一个阈值。亚组分析表明，在体重指数较低（<24 kg/m²）的患者中关联更强。
PD开始时较高的MLR是长期腹膜炎风险的独立预测因素。MLR可作为一种简单、经济有效的生物标志物用于早期腹膜炎风险分层，尤其是在较瘦的患者中。
