Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients

Int Urol Nephrol. 2016 Aug;48(8):1343-1348. doi: 10.1007/s11255-016-1301-4. Epub 2016 Apr 27.


Purpose: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were established showing the poor prognosis in some diseases, such as cardiovascular diseases and malignancies. The risk of mortality in patients with end-stage renal disease (ESRD) was higher than normal population. In this study, we aimed to investigate the relationship between NLR, PLR, and all-cause mortality in prevalent hemodialysis (HD) patients.

Methods: Eighty patients were enrolled in study. NLR and PLR obtained by dividing absolute neutrophil to absolute lymphocyte count and absolute platelet count to absolute lymphocyte count, respectively. The patients were followed prospectively for 24 months. The primary end point was all-cause mortality.

Results: Mean levels of neutrophil, lymphocyte, and platelet were 3904 ± 1543/mm(3), 1442 ± 494/mm(3), 174 ± 56 × 10(3)/mm(3), respectively. Twenty-one patients died before the follow-up at 24 months. Median NLR and PLR were 2.52 and 130.4, respectively. All-cause mortality was higher in patients with high NLR group compared to the patients with low NLR group (18.8 vs. 7.5 %, p = 0.031) and in patients with higher PLR group compared to patients with lower PLR group (18.8 vs. 7.5 %, p = 0.022). Following adjusted Cox regression analysis, the association of mortality and high NLR was lost (p = 0.54), but the significance of the association of high PLR and mortality increased (p = 0.013).

Conclusion: Although both NLR and PLR were associated with all-cause mortality in prevalent HD patients, only PLR could independently predict all-cause mortality in these populations.

Keywords: Hemodialysis; Inflammation; Mortality; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Leukocyte Count
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neutrophils / metabolism
  • Platelet Count
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Renal Dialysis / adverse effects*
  • Renal Dialysis / methods
  • Renal Dialysis / mortality
  • Renal Insufficiency, Chronic / blood*
  • Renal Insufficiency, Chronic / mortality*
  • Renal Insufficiency, Chronic / therapy
  • Retrospective Studies
  • Survival Analysis


  • Biomarkers