关键词: 维持性血液透析, 中性粒细胞/淋巴细胞比值, C反应蛋白/白蛋白, 全因死亡

Abstract: Objective To explore the predictive value of neutrophil to lymphocyte ratio(NLR) combined with C-reactive protein to albumin ratio(CAR) for all-cause death of maintenance hemodialysis (MHD) patients, and to provide evidence for improving the quality of life of MHD. Methods 175 MHD patients in the blood purification center of Hainan Provincial People's Hospital in January 2017 were selected as the research objects, and their clinical data and biochemical indicators were analyzed. The end point was all-cause death, and the deadline for follow-up was December 31, 2021.According to the ROC curve, the cutoff values of NLR and CAR were determined, and the patients were divided into NLR≦4.93 and NLR>4.93 groups, CAR≦0.795 and CAR>0.795 groups, and the differences of clinical data and laboratory examination between the two groups were compared. The predictive value of NLR, CAR and NLR combined with CAR in all-cause death of MHD patients was evaluated by drawing ROC curve. Kaplan-Meier survival curve was used to compare the cumulative survival rate between the two groups. Cox regression analysis was used to analyze the independent risk factors of 5-year all-cause death in MHD patients. Results ①Compared with the NLR≦4.93 group, the mortality rate of patients in the NLR>4.93 group is higher, the previous history of coronary heart disease and cerebrovascular accident is higher, the dialysis age is younger, the age is older, and the white blood cells (WBC), NLR and CAR are significantly higher. Ferritin (Fer), 25-(OH)VD3, hemoglobin (HB), triglyceride (TG), total cholesterol (TC) and uric acid (UA) were significantly lower, and the difference was statistically significant (P < 0.05). ② Compared with CAR≦0.795 group, patients in CAR>0.795 group have a higher mortality rate, a higher proportion of previous history of coronary heart disease and cerebrovascular accident, younger dialysis age, older patients, an increased proportion of diabetic nephropathy, and significantly higher corrected calcium, alkaline phosphatase (ALP), WBC, NLR and CAR. Fer, 25-(OH)VD3, HB, TG, TC, UA, blood phosphorus (P5+) and blood potassium (K1+) were significantly lower, and the difference was statistically significant (P < 0.05). ③ROC curve analysis showed that the AUC of NLR for predicting all-cause death in MHD patients was 0.743 (95%CI=0.669 ～0.817, P < 0.001). The AUC for all-cause death in MHD patients predicted by CAR was 0.710 (95%CI= 0.627～0.794, P < 0.001). The AUC for predicting all-cause death in MHD patients with NLR combined with CAR was 0.799 (95%CI= 0.732～0.867, P < 0.001). ④ The results of Kaplan⁃Meier survival curve analysis showed that to the end of follow-up, the cumulative survival rate during follow-up in the NLR>4.93 group was significantly lower than that in the NLR≦4.93 group, with statistical significance (X2=32.753, P < 0.001). The cumulative survival rate in the CAR>0.795 group was significantly lower than that in the CAR≦0.795 group, the difference was statistically significant (X2=38.091, P < 0.001). (5) Cox multivariate analysis suggested that the increase of dialysis age and the increase of Fer, 25-(OH)VD3 and TG were protective factors for poor prognosis in MHD patients; Both high NLR and CAR were independent risk factors for all-cause death in MHD patients (P < 0.05). HR values were 2.071 and 1.903. Conclusion NLR and CAR have predictive value for all-cause death of MHD patients, and their combined predictive value is higher. At the same time, the increase of NLR and CAR are independent risk factors for all-cause death of MHD patients in 5 years.

Key words: Maintenance hemodialysis, Neutrophil to lymphocyte ratio, C-reactive protein to albumin ratio, All-cause death