title: Monocyte/lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study.
abstract: Patients with chronic kidney disease, especially those with end-stage renal disease, have an increased risk of death. Previous studies have suggested neutrophil/lymphocyte ratio (NLR) was related to worse outcome in patients undergoing hemodialysis (HD). However, monocyte/lymphocyte ratio (MLR) has not been evaluated in HD patients. In this study, we prospectively studied the predictive value of MLR for all-cause and cardiovascular mortality in HD patients and compared it with NLR.
  
  
  
  Patients who had been on a HD treatment for at least 6 months were enrolled. MLR was calculated by dividing the monocyte count by the lymphocyte count. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic impact of MLR and other clinical factors on all-cause and cardiovascular mortality.
  
  
  
  Mortality rates for the lowest, middle, and highest MLR tertile group were 3.65, 7.02, and 11.15, respectively per 100 patient-years. The Kaplan-Meier analysis revealed that survival rates were significantly different among three MLR groups (P < 0.001). In multivariate Cox regression analyses, MLR was independently associated with all-cause mortality (HR 4.842; 95% CI, 2.091-11.214; P < 0.001) and cardiovascular mortality (HR 6.985, 95% CI 1.943-25.115, P = 0.003) as continuous variables. NLR was not an independent predictor of all-cause nor cardiovascular mortality after adjusted with MLR.
  
  
  
  The main finding of the study suggest that higher MLR was a strong and independent predictor of all-cause and cardiovascular mortality and overwhelmed NLR among HD patients.
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Xiang
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Key Lab of Kidney and Blood Purification, Shanghai, China.
authors.forename: Rongyi
authors.initials: R
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Xuesen
authors.initials: X
authors.lastname: Cao
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Shen
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Tan
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Institute of Kidney and Dialysis, Shanghai, China.
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.|Shanghai Key Lab of Kidney and Blood Purification, Shanghai, China.
authors.forename: Jianzhou
authors.initials: J
authors.lastname: Zou
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis*; D015996:Survival Rate
keywords: Hemodialysis; cardiovascular disease; inflammation; monocyte/lymphocyte ratio; mortality