title: Neutrophil/lymphocyte ratio as a predictor of cardiovascular events in incident dialysis patients: a Japanese prospective cohort study.
abstract: BACKGROUND
  Previous studies have suggested that high neutrophil/lymphocyte ratios are related to worse outcome in patients with cardiovascular diseases. Patients with end-stage renal disease, especially those with inflammation, are at an increased risk of premature mortality, primarily because of cardiovascular disease. We aimed to clarify if high neutrophil/lymphocyte ratio is associated with increasing cardiovascular events in Japanese patients with end-stage renal disease.
  
  
  METHODS
  We enrolled 86 incident Japanese dialysis patients (58 men, age 58 ± 11 years) in a prospective cohort study. The median follow-up was for 38.7 months. The association between neutrophil/lymphocyte ratio at the start of dialysis therapy and clinical biomarkers was investigated. Relative risks and cumulative cardiovascular disease events were calculated.
  
  
  RESULTS
  The median neutrophil/lymphocyte ratio reported was 3.72. The duration from the start of the dialysis therapy to the first cardiovascular disease event was significantly shorter as a neutrophil/lymphocyte ratio increased (log-rank test, P = 0.003). The relative risk of cardiovascular disease events in patients with neutrophil/lymphocyte ratio > median to cardiovascular events in patients with the ratio < median as a reference was 3.02 (95 % CI 1.32-8.00) in a Cox proportional hazard model. The cumulative cardiovascular disease events during the observational period was higher in patients with neutrophil/lymphocyte ratio > median (23.0 events 100 person-years) than in patients with the ratio < median (6.8 events 100 person-years).
  
  
  CONCLUSIONS
  A higher neutrophil/lymphocyte ratio is associated with increased risk of cardiovascular disease events and is a stronger predictor of future events.
authors.affiliation: Department of Nephrology, Nagoya University Graduate School of Medicine, 65, Tsuruma-cho, Showa-ku, Nagoya, Aichi, 464-8550, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Abe
authors.forename: Sawako
authors.initials: S
authors.lastname: Kato
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Tsuruta
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Sugiura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Katsuno
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kosugi
authors.forename: Naotake
authors.initials: N
authors.lastname: Tsuboi
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000276:immunology*; D005260:Female; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000276:immunology / Q000628:therapy; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis