title: Relationship of Neutrophil-to-Lymphocyte Ratio and Serum Albumin Levels with C-Reactive Protein in Hemodialysis Patients: Results from 2 International Cohort Studies.
abstract: OBJECTIVE
  The neutrophil-to-lymphocyte ratio (NLR), defined as the neutrophil count divided by lymphocyte count, is an inexpensive and readily available parameter, which may serve as a surrogate for inflammation markers, such as C-reactive protein (CRP). The aim of this study was to determine the utility of NLR in the prediction of elevated CRP levels in hemodialysis (HD) patients.
  
  
  METHODS
  We analyzed 43,272 HD patients from 2 distinct cohorts within the Monitoring Dialysis Outcomes research collaboration in whom contemporaneous measurements of neutrophil and lymphocyte counts, serum albumin and CRP levels were available. Logistic regression was used to determine the relationship of trichotomized NLR (<2.5, 2.5-5 and >5.0) and albumin levels (<3.1, 3.1-4.0 and >4.0 g/dl) with elevated CRP levels (>10.0, >20.0 and >30.0 mg/l). Congruence of the prediction models was examined by comparing the regression parameters and by cross-validating each regression equation within the other cohort.
  
  
  RESULTS
  We found that NLR >5.0 vs. <2.5 (cohort 1: OR 2.3; p < 0.0001 and cohort 2: OR 2.0; p < 0.0001) was associated with CRP levels >10.0 mg/l. Stepwise increase in odds ratio for CRP >10.0 mg/l was observed with the combination of high NLR and low albumin levels (NLR >5.0 and albumin <3.1) (cohort 1: OR 7.6; p < 0.0001 and cohort 2: OR 11.9; p < 0.0001). Cross-validation of the 2 regression models revealed a predictive accuracy of 0.68 and 0.69 in the respective cohorts.
  
  
  CONCLUSIONS
  This study suggests that NLR could serve as a potential surrogate marker for CRP. Our results may add to diagnostic abilities in settings where CRP is not measured routinely in HD patients. NLR is easy to integrate into daily practice and may be used as a marker of systemic inflammation.
authors.affiliation: Renal Research Institute, Mount Sinai Hospital New York, New York, N.Y., USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Malhotra
authors.forename: Daniele
authors.initials: D
authors.lastname: Marcelli
authors.forename: Gero
authors.initials: G
authors.lastname: von Gersdorff
authors.forename: Aileen
authors.initials: A
authors.lastname: Grassmann
authors.forename: Mathias
authors.initials: M
authors.lastname: Schaller
authors.forename: Inga
authors.initials: I
authors.lastname: Bayh
authors.forename: Laura
authors.initials: L
authors.lastname: Scatizzi
authors.forename: Michael
authors.initials: M
authors.lastname: Etter
authors.forename: Adrian
authors.initials: A
authors.lastname: Guinsburg
authors.forename: Claudia
authors.initials: C
authors.lastname: Barth
authors.forename: Cristina
authors.initials: C
authors.lastname: Marelli
authors.forename: Paola
authors.initials: P
authors.lastname: Carioni
authors.forename: Frank
authors.initials: F
authors.lastname: van der Sande
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.forename: Eric
authors.initials: E
authors.lastname: Liu
authors.forename: Ted
authors.initials: T
authors.lastname: Toffelmire
authors.forename: Yuedong
authors.initials: Y
authors.lastname: Wang
authors.forename: Stephan
authors.initials: S
authors.lastname: Thijssen
authors.forename: Len A
authors.initials: LA
authors.lastname: Usvyat
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
mesh_terms: D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000502:physiology*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000188:drug therapy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002097:C-Reactive Protein