Prognostic value of inflammatory markers for mortality in hemodialysis patients: a retrospective study with over 3-year follow-up

Abstract

Aims: In chronic kidney disease (CKD), chronic systemic inflammation contributes to premature ageing and morbidity; it is a predictor of overall mortality. In this study, we aimed to investigate prognostic value of inflamatory markers including systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for mortality outcomes in hemodialysis patients. Methods: In this retrospective study, CKD patients on maintenance hemodialysis between January 1, 2020 and January 31, 2020 were included. SII, PIV, NLR, PLR values of the patients were calculated. SII was calculated by (neutrophil count x platelet count)/lymphocyte count; PIV was calculated by (neutrophil count x platelet count x monocyte count)/lymphocyte count. Mortality rate of the study population during approximately 38-month follow-up period was calculated. The relationships of inflamatory markers and other variables with mortality were analysed. Results: Of 162 patients, 53.1% were male and 46.9% were female (mean age: 61.6±13.5). During 38-month follow-up period, a total of 60 patients (37%) died. Compared with surviving group, NLR values, mean age and the rate of diabetes mellitus (DM) and coronary artery disease (CAD) comorbidities were higher (p=0.012, p <0.001, p=0.008, p <0.001 respectively) and albumin, uric acid and creatinin levels were lower (p <0.001, for each) in the nonsurvivor group. There was no difference between these two groups in terms of PIV and SII values and CRP levels. In Cox regression analysis, presence of CAD (Exp ß: 2.116; 95% CI, 1.222-3.648; p=0.007), age (Exp ß: 1.049; 95% CI, 1.022-1.077; p <0.001), serum uric acid (Exp ß: 0.721; 95% CI, 0.559-0.929; p=0.011) and albumin levels (Exp ß: 0.395;95% CI, 0.158-0.984, p=0.046), NLR (Exp ß: 1.345; 95% CI, 1.152-1.1570; p <0.001) and PLR (Exp ß: 0.993; 95% CI, 0.989-0.997; p=0.002) were found to be associated with mortality. Conclusion: There was no difference between nonsurviving and surviving group in terms of PIV and SII values and CRP levels. Age, presence of CAD, serum uric acid and albumin levels and NLR and PLR values were associated with all-cause mortality, independently. Prospective studies with larger number of hemodialysis patients and serial measurements of inflammatory markers are needed.

Keywords

• Hemodialysis
• systemic immune-inflammation index
• pan-immune-inflammation value
• mortality
• inflammatory markers

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