Neutrophil-to-lymphocyte ratio (NLR) has been shown to have significant predictive value for all-cause mortality risk in patients with maintenance hemodialysis (MHD) in previous studies, however, whether C-reactive protein-to-albumin ratio (CAR) and the combination of NLR and CAR can enhance the predictive value for all-cause mortality risk in patients with MHD has not been investigated.

To investigate the combined predictive value of NLR and CAR for all-cause mortality of MHD patients, and to provide evidence for improving the quality of life of MHD patients.

The case data of 175 MHD patients in the Blood Purification Center of Hainan General Hospital in January 2017 were included, the deadline was December 31, 2021, with the outcome of all-cause death. Receiver operating characteristic (ROC) curves were plotted for the predictive value of NLR+CAR, NLR, and CAR for the risk of all-cause death in MHD patients. 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.

The area under the ROC curve (AUC) of NLR for predicting the risk of all-cause death in MHD patients was 0.743 (95%CI=0.669-0.817, P<0.001). The AUC of CAR for predicting the risk of all-cause death in MHD patients was 0.710 (95%CI=0.627-0.794, P<0.001). The AUC of NLR+CAR for predicting the risk of all-cause death in MHD patients was 0.799 (95%CI=0.732-0.867, P<0.001). Kaplan-Meier survival curve analysis showed that patients with NLR>4.93 had lower cumulative survival than patients with NLR ≤4.93 (χ²=32.753, P<0.001). The patients with CAR>0.795 had a lower cumulative survival than patients with CAR≤0.795 (χ²=38.091, P<0.001). According to the results of the multiple Cox regression equation, dialysis age (HR=0.984, 95%CI=0.976-0.992), ferritin (HR=0.984, 95%CI=0.976-0.992), 25- (OH) D (HR=0.964, 95%CI=0.941-0.987) and triglyceride (HR=0.984, 95%CI=0.976-0.992) were protective factors for all-cause mortality in 5-year MHD patients; NLR>4.93 (HR=2.071, 95%CI=1.226-3.499) and CAR>0.795 (HR=1.903, 95%CI=1.155-3.136) were independent risk factors for all-cause death in 5-year MHD patients (P<0.05) .

Compared with NLR or CAR alone, the combination of NLR and CAR can better predict the risk of all-cause mortality in MHD patients. Increased NLR and CAR were independent risk factors for all-cause mortality in 5-year MHD patients.

已有研究表明中性粒细胞/淋巴细胞比值（NLR）对维持性血液透析（MHD）患者全因死亡有较好的预测价值，少有研究探讨C反应蛋白/白蛋白比值（CAR）对MHD患者全因死亡的预测及NLR联合CAR能否增强对MHD患者全因死亡的预测价值。

探讨NLR联合CAR对MHD患者全因死亡的预测价值，为提高MHD患者生存质量提供依据。

2017年1月选取175例在海南省人民医院血液净化中心治疗的MHD患者为研究对象，收集其基线人口学资料及实验室检查结果。随访终点事件为全因死亡，随访截止日期为2021-12-31。绘制受试者工作特征（ROC）曲线评价NLR、CAR及NLR联合CAR在MHD患者全因死亡中的预测价值，Kaplan-Meier生存曲线比较不同的NLR及CAR患者随访过程中累积生存率的差异；采用Cox比例风险回归模型分析MHD患者5年全因死亡的独立危险因素。

ROC曲线分析结果显示，NLR预测MHD患者全因死亡的ROC曲线下面积（AUC）为0.743（95%CI=0.669~0.817，P<0.001）；CAR预测MHD患者全因死亡的AUC为0.710（95%CI=0.627~0.794，P<0.001）；NLR联合CAR预测MHD患者全因死亡的AUC为0.799（95%CI=0.732~0.867，P<0.001）。Kaplan-Meier生存曲线分析结果显示，至随访终点，基线NLR>4.93的患者随访期间累积生存率低于基线NLR≤4.93的患者（χ²=32.753，P<0.001）。基线CAR>0.795的患者随访期间累积生存率低于基线CAR≤0.795的患者（χ²=38.091，P<0.001）。多因素Cox比例风险回归模型分析结果显示，NLR>4.93（HR=2.071，95%CI=1.226~3.499）、CAR>0.795（HR=1.903，95%CI=1.155~3.136）是MHD患者5年全因死亡的独立危险因素（P<0.05）。透析龄增加（HR=0.984，95%CI=0.976~0.992）及铁蛋白升高（HR=0.998，95%CI=0.998~0.999）、25-羟维生素D[25-（OH）D]升高（HR=0.964，95%CI=0.941~0.987）、三酰甘油（TG）升高（HR=0.695，95%CI=0.506~0.955）是MHD患者5年全因死亡的保护因素（P<0.05）。

NLR、CAR对MHD患者全因死亡有预测价值，两者联合的预测价值更高；同时NLR及CAR升高均是MHD患者5年全因死亡的独立危险因素。