Correlation Between Neutrophil To High-Density Lipoprotein Ratio And New Onset Cardiovascular Events, All-Cause Mortality In Peritoneal Dialysis Patients

Background: Neutrophil to high-density lipoprotein ratio(NHR),a novel inflammatory marker,is associated with unfavorable clinical prognosis.However,the correlation between NHR and adverse outcomes in peritoneal dialysis patients remains unclear.Methods: In this retrospective cohort study,a total of 1051 peritoneal dialysis patients were recruited from three centers between January 1,2009 and December 31,2016.Eligible patients were categorized into quartiles based on their NHR levels.Kaplan-Meier cumulative incidence curves,multivariate COX regression,competitive risk analysis,and restricted cubic spline(RCS)were utilized to analyze the relationship between NHR and all-cause mortality as well as cardiovascular events.Additionally,forest plots were employed to calculate the interaction between different subgroups.Results: During the follow-up period,a total of 157 new-onset cardiovascular events and 240 all-cause mortalities were recorded.The all-cause mortality and new-onset cardiovascular events in the highest quartile of NHR(>5.43)surpassed those in the other groups.Restricted cubic spline(RCS)showed a non-linear relationship between NHR and adverse outcomes.Multivariate COX regression indicated that elevated NHR was an independent risk factor for adverse outcomes.Compared with the highest quartile,the hazard ratio(HR)of new-onset cardiovascular events(CVE)was 0.522(95%CI,0.321-0.849)in the secondary quartile(2.43<NHR ≤ 3.57),and the HR of all-cause mortality analysis was 0.551(95%CI,0.378-0.803)in the third quartile(3.57<NHR≤5.43).Kaplan-Meier analysis suggested that there were significant differences in all-cause mortality and new-onset cardiovascular events among the four NHR groups.Conclusions: NHR was a novel independent risk factor for new-onset cardiovascular events and all-cause mortality in peritoneal dialysis patients.