Combined evaluation of Geriatric nutritional risk index and Neutrophil to lymphocyte ratio for predicting all-cause and cardiovascular mortality in hemodialysis patients

Jun Wang; Li-Juan Huang; Bei Li; Mei-Chang Xu; Lei Yang; Xu Deng; Xin Li

doi:10.1371/journal.pone.0287696

Combined evaluation of Geriatric nutritional risk index and Neutrophil to lymphocyte ratio for predicting all-cause and cardiovascular mortality in hemodialysis patients

PLoS One. 2023 Jun 29;18(6):e0287696. doi: 10.1371/journal.pone.0287696. eCollection 2023.

Authors

Jun Wang¹, Li-Juan Huang¹, Bei Li², Mei-Chang Xu¹, Lei Yang¹, Xu Deng¹, Xin Li³

Affiliations

¹ Department of Nephrology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210014, Jiangsu Province, China.
² Department of Nephrology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, 210012, Jiangsu Province, China.
³ Department of Science & Education Division, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210014, Jiangsu Province, China.

Abstract

Objective: Malnutrition, accompanied by an inflammatory profile, is a risk factor for poor prognosis in hemodialysis patients. The purpose of this study was to investigate the predictive value of NLR combined with GNRI for all-cause and cardiovascular mortality in hemodialysis patients.

Methods: A total of 240 maintenance hemodialysis (MHD) patients in hemodialysis centers were enrolled in this retrospective study. The influencing factors of all-cause death in hemodialysis patients were analyzed by COX regression. The cut-off values of GNRI and NLR for predicting mortality in enrolled MHD patients were 89.01 and 4, respectively. Based on these cut-off values, the patients were divided into four groups: G1: high GNRI (≥ 89.01) + high NLR (≥ 4) group; G2: high GNRI (≥ 89.01) + low NLR (<4) group, G3: low GNRI (< 89.01) + high NLR (≥4) group; G4: low GNRI (< 89.01) + low NLR (<4).

Results: During the follow-up period (average: 58 months), the all-cause mortality was 20.83%(50/240) and the cardiovascular mortality was 12.08%(29/240). Both NLR and GNRI were independent risk factors for the prognosis of MHD patients (P<0.05). Survival analysis showed that patients with low GNRI had a lower survival rate than those with high GNRI, whereas patients with high NLR had a lower survival rate than those with low NLR. Kaplan-Meier curve for all-cause mortality revealed that compared to G1, G2, and G4, G3 had the lowest survival rate, while G2 had the highest survival rate among all groups (P < 0.05). Kaplan-Meier curve for cardiovascular mortality showed that G3 had lower survival than G1, G2, and G4 (P < 0.001).

Conclusions: Our study demonstrates that bothGNRI and NLR are associated with all-cause mortality and cardiovascular mortality in MHD patients. Combining these two factorsmay contribute to a prognostic evaluation for MHD patients.

Copyright: © 2023 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cardiovascular Diseases*
Humans
Lymphocytes
Neutrophils*
Renal Dialysis
Retrospective Studies

Grants and funding

This research was funded by the Nanjing Administration of Traditional Chinese Medicine, Project name: Nanjing Traditional Chinese Medicine Youth Talent Training Program,(NO.ZYQ20053). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.