title: Elevated neutrophil to lymphocyte ratio predicts overall and cardiovascular mortality in maintenance peritoneal dialysis patients.
abstract: BACKGROUND
  Neutrophil to lymphocyte ratio (NLR) is widely used as a marker of inflammation and an indicator of cardiovascular outcomes in patients with coronary artery disease. However, its prognostic value in peritoneal dialysis (PD) patients is still unknown.
  
  
  METHODS
  We studied 138 newly started PD patients and 60 healthy controls at the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. Baseline NLR as well as demographic, clinical, and biochemical parameters were recorded. All patients were followed up until March 2011 to evaluate mortality as the primary outcome. Overall and cardiovascular disease-free survival rates were compared according to NLR level. Multivariate analysis was performed to assess the prognostic value of NLR.
  
  
  RESULTS
  Baseline NLR levels (mean 3.5 ± 1.6) were significantly increased in PD patients compared to healthy controls (mean 1.5 ± 0.5; P < 0.001). Patients with higher NLR had a higher mortality rate compared with patients with lower NLR (51.5% vs 22.9%; P = 0.006). The 1-year and 3-year overall survival rates were 86.6% and 65.9% for patients with higher NLR compared with 97% and 85.1% for patients with lower NLR (P = 0.006). Patients with higher NLR also showed a higher cardiovascular mortality rate, compared with patients with lower NLR (38% vs 7.6%; P = 0.003). The 1-year and 3-year cardiovascular event-free survival rates were 90.7% and 81.9% for patients with higher NLR, compared with 98.6% and 95.1% for patients with lower NLR. Multivariate analysis showed high NLR value was an independent risk factor for all-cause and cardiovascular mortality.
  
  
  CONCLUSIONS
  Neutrophil to lymphocyte ratio is a strong predictor for overall and cardiovascular mortality in PD patients.
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People’s Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: An
authors.forename: Hai-Ping
authors.initials: HP
authors.lastname: Mao
authors.forename: Xin
authors.initials: X
authors.lastname: Wei
authors.forename: Jie-Hui
authors.initials: JH
authors.lastname: Chen
authors.forename: Xiao
authors.initials: X
authors.lastname: Yang
authors.forename: Zhi-Bin
authors.initials: ZB
authors.lastname: Li
authors.forename: Xue-Qing
authors.initials: XQ
authors.lastname: Yu
authors.forename: Zhi-Jian
authors.initials: ZJ
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D016022:Case-Control Studies; D003928:Diabetic Nephropathies / Q000150:complications; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D053208:Kaplan-Meier Estimate; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D015415:Biomarkers