The Relationship Between Monocyte-to-lymphocyte Ratio And Prognosis In Patients Undergoing Peritoneal Dialysis

BackgroundInflammation plays a key role in the pathophysiology of end-stage renal disease(ESRD).This paper will discuss the the application of hematological indices in ESRD patients:neutrophil to lymphocyte ratio(NLR),red cell distribution width(RDW),platelet to lymphocyte ratio(PLR).Many studies have pointed at their effective prognostic value in inflammation,all-cause mortality,cardiovascular event,and malnutrition in ESRD patients.However,no reports have been found on the relationship between Monocyte-to-lymphocyte ratio(MLR)and prognosis in patients undergoing peritoneal dialysis.ObjectivesThis study was designed to retrospectively analyze the predictive value of MLR for all-cause and CVD-related death risk in continuous ambulatory peritoneal dialysis patients.SubjectsWe recruited 317 CAPD patients between 1 January 2015 and 1 January 2018 from the the nephrology department of zhujiang hospital;all the patients were followed up from initation of observation to all-cause and CVD-related death or switching to hemodialysis or renal transplantation,or until 30 June 2018.MethodThis study is a retrospective cohort study in which all CAPD patients were followed up from initation to death;or switching to HD or renal transplantation;or until 30 June 2018.Joint use of electronic medical record system,laboratory test report system and national peritoneal dialysis information registration system to collect baseline demographic data and related clinical laboratory data,survival outcomes.According to the median MLR(0.30),all the patients were divided into high MLR group and low MLR group.Differences between baseline characteristics of the two groups were observed and compared.Spearman,s bivariate correlation analysis suggested a correlation between MLR and various factors.Kaplan-Meier survival curve was used to compare the difference in all-cause and CVD survival between the high MLR group and low MLR group.Univariate and multivariate Cox regression models were used to analyze the independent predictive value of MLR level of all-cause and CVD mortality of CAPD patients.Bilateral statistical standard p-value<0.05 was considered statistically significant.This study used SPSS23.0 statistical software for statistical analysis.Results1.This study cohort included 317 patients.There were statistically significant differences in the level of age,neutrophil count,lymphocyte count,monocyte count,uric acid,and brain natriuretic peptide.2.Spearman correlation analysis showed that MLR was positively related to age,total white blood cell count,neutrophil count,monocyte count,platelet count,urea nitrogen,uric acid,brain natriuretic peptide;MLR was negatively related to lymphocyte count.3.Kaplan-Meier survival curve showed that the all-cause and CVD survival rate of low MLR group was significantly higher than that of high MLR group(p=0.006,P=0.037,respectively).The overall survival rate of low MLR group and high MLR group were 84.4%vs66.6%,respectively,and the difference between the two group was statistically significant(log Rank=7.608,P=0.006);the CVD survival rate of low MLR group and high MLR group were 91.4%vs83.6%,respectively,and the difference between the two group was statistically significant(log Rank=4.365,P=0.037).5.Univariate and fully adjusted model of multivariate Cox regression analysis showed that high MLR level was a independent risk factor for all-cause(HR=3.184,95%Cl:1.484-6.832,P=0.003)and CVD mortality(HR=2.9775 95%Cl:0.999-8.874,P=0.05)in CAPD patients.Conclusion1.MLR was positively related to age,total white blood cell count,neutrophil count,monocyte coxunt,platelet count,urea nitrogen,uric acid,brain natriuretic peptide,MLR was negatively related to lymphocyte count.2.MLR was significantly associated with all-cause and CVD mortality of CAPD patients;MLR can be used as an independent predictor of all-cause and CVD mortality in CAPD patients.