Neutrophil to Lymphocyte Ratio Predicts Adverse Cardiovascular Outcome in Peritoneal Dialysis Patients Younger than 60 Years Old
Yingsi Zeng, Zijun Chen, Qinkai Chen, Xiaojiang Zhan, Haibo Long, Fenfen Peng, Fengping Zhang, Xiaoran Feng, Qian Zhou, Lingling Liu, Xuan Peng, Guanhua Guo, Yujing Zhang, Zebin Wang, Yueqiang Wen, Jiao Li, Jianbo Liang
Abstract
Background . Neutrophil to lymphocyte ratio (NLR) is a new inflammatory marker; the relationship between NLR and adverse cardiovascular (CV) prognosis has been gradually emphasized in the general population. However, their association in peritoneal dialysis (PD) patients remains unclear. Methods . From January 1, 2010, to May 31, 2017, a total of 1652 patients were recruited. NLR was categorized in triplicates: <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mtext>NLR</mml:mtext><mml:mo>≤</mml:mo><mml:mn>2.74</mml:mn></mml:math>, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mn>2.74</mml:mn><mml:mo><</mml:mo><mml:mtext>NLR</mml:mtext><mml:mo>≤</mml:mo><mml:mn>3.96</mml:mn></mml:math>, and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mtext>NLR</mml:mtext><mml:mo>></mml:mo><mml:mn>3.96</mml:mn></mml:math>. Kaplan-Meier cumulative incidence curve and multivariable COX regression analysis were used to determine the relationship between NLR and the incidence of adverse CV outcome, while a competitive risk model was applied to assess the effects of other outcomes on adverse CV prognosis. Besides, forest plot was investigated to analyze the adverse CV prognosis in different subgroups. Results . During follow-up, 213 new-onset CV events and 153 CV disease (CVD) deaths were recorded. Multivariable COX regression models showed that the highest tertile of NLR level was associated with increased risk of CV events (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mtext>HR</mml:mtext><mml:mo>=</mml:mo><mml:mn>1.39</mml:mn></mml:math>, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mn>95</mml:mn><mml:mi>%</mml:mi><mml:mtext>CI</mml:mtext><mml:mo>=</mml:mo><mml:mn>1.01</mml:mn><mml:mo>‐</mml:mo><mml:mn>1.93</mml:mn></mml:math>, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.046</mml:mn></mml:math>) and CVD mortality (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mtext>HR</mml:mtext><mml:mo>=</mml:mo><mml:mn>1.81</mml:mn></mml:math>, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mn>95</mml:mn><mml:mi>%</mml:mi><mml:mtext>CI</mml:mtext><mml:mo>=</mml:mo><mml:mn>1.22</mml:mn><mml:mo>‐</mml:mo><mml:mn>2.69</mml:mn></mml:math>, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.003</mml:mn></mml:math>), while compared to the lowest tertile. Competitive risk models showed that the differences in CV event (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M10"><mml:mi>P</mml:mi><mml:mo><</mml:mo><mml:mn>0.001</mml:mn></mml:math>) and CVD mortality (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M11"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.004</mml:mn></mml:math>) among different NLR groups were still significant while excluding the effects of other outcomes. In subgroups, with each 1 increased in the NLR level, adjusted HR of new-onset CV event was 2.02 (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M12"><mml:mn>95</mml:mn><mml:mi>%</mml:mi><mml:mtext>CI</mml:mtext><mml:mo>=</mml:mo><mml:mn>1.26</mml:mn><mml:mo>−</mml:mo><mml:mn>3.23</mml:mn></mml:math>, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M13"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.003</mml:mn></mml:math>) and CVD mortality was 2.98 (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M14"><mml:mn>95</mml:mn><mml:mi>%</mml:mi><mml:mtext>CI</mml:mtext><mml:mo>=</mml:mo><mml:mn>1.58</mml:mn><mml:mo>−</mml:mo><mml:mn>5.62</mml:mn></mml:math>, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M15"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.001</mml:mn></mml:math>) in the younger group (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M16"><mml:mtext>age</mml:mtext><mml:mo><</mml:mo><mml:mn>60</mml:mn></mml:math> years). Conclusions . NLR is an independent risk factor for adverse CV prognosis in PD patients younger than 60 years old.