title: Systemic inflammation-based scores and mortality for all causes in HIV-infected patients: a MASTER cohort study.
abstract: Two biomarkers, the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR), have been shown to be indicative of systemic inflammation and predictive of mortality in general population. We aimed to assess the association of NLR and PLR, with risk of death in HIV-infected subjects when also taking account of HIV-related factors.
  
  
  
  We conducted a multicenter Italian cohort study from 2000 to 2012 including HIV-infected subjects naïve at antiretroviral treatment. The associations of NLR and PLR with all-cause mortality were tested by univariate and multivariate analyses using both time independent and dependent Cox proportional hazard models. We also fitted models with a cubic-spline for PLR and NLR to evaluate the possible non-linear relationship between biomarkers values and risk of death.
  
  
  
  Eight-thousand and two hundred thirty patients (73.1% males) with a mean age of 38.4 years (SD 10.1) were enrolled. During a median follow-up of 3.9 years, 539 patients died. PLR < 100 and ≥ 200, as compared to PLR of 100-200, and NLR ≥ 2, as compared to < 2, were associated with risk of death at both univariate and multivariate analyses. Using multivariate models with restricted cubic-splines, we found a linear relationship of increasing risk of death with increasing values for NRL over 1.1, and an U-shape curve for PLR, with higher mortality risk for values higher or lower than 120.
  
  
  
  Our data suggest that NLR and PLR can reflect the severity of the underlying systemic disturbance of the inflammatory process and coagulation leading to augmented mortality in HIV positive subjects.
authors.affiliation: Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, Italy. elena.raffetti@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Raffetti
authors.affiliation: Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Donato
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Casari
authors.affiliation: Hospital Division of Infectious and Tropical Diseases, Spedali Civili General Hospital, Brescia, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Castelnuovo
authors.affiliation: Clinical Infectious Diseases of "Azienda Ospedaliera S. Anna" of Ferrara, Ferrara, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Sighinolfi
authors.affiliation: Clinic of Infectious Diseases, San Gerardo de' Tintori Hospital, Monza, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bandera
authors.affiliation: Clinical Infectious Diseases of "Ospedale Papa Giovanni XXIII" of Bergamo, Bergamo, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Maggiolo
authors.affiliation: Clinic of Infectious Diseases, University of Bari, Bari, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Ladisa
authors.affiliation: Clinical Infectious Diseases of "Azienda Ospedaliera S. Anna" of Ferrara, Ferrara, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: di Pietro
authors.affiliation: Clinical Infectious Diseases of "Istituti Ospitalieri" of Cremona, Cremona, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fornabaio
authors.affiliation: Institute of Clinical Infectious Diseases of Catholic University of Rome, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Digiambenedetto
authors.affiliation: University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Quiros-Roldan
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000276:immunology* / Q000401:mortality*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000821:virology*; D007558:Italy / Q000453:epidemiology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D010976:Platelet Count; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers
keywords: Inflammation; Mortality for all-causes; Neutrophil to lymphocyte ratio; Platelet to lymphocyte ratio