Study On Mechanism Of Association Of RDW And MHR With Cardiovascular Events In Maintenance Hemodialysis Patients

Objective: To study the influencing factors of adverse vascular events in maintenance hemodialysis(MHD)patients in our hospital,and to explore red blood cell distribution width(RDW)and Mononuclear cell high density lipid ratio(MHR)are associated with cardiovascular events in MHD patients,and their effects on the occurrence and prognosis of cardiovascular events in MHD patients are analyzed to guide clinical prevention and treatment.Methods: A single-center retrospective study was used.Patients with MHD in the blood Purification Center of our hospital from January 1,2017 to December 31,2019 were selected.Researchers were screened strictly according to inclusion and exclusion criteria.Cut-off time for follow-up:Patients with cardiovascular events were cut-off time,and patients without cardiovascular events were followed up until June 30,2022.Patients were grouped according to the RDW and MHR quantiles at baseline,and COX regression proportional risk model was used to analyze independent risk factors for CVD in MHD patients,which were considered statistically significant when P<0.05.ROC curve was used to compare the sensitivity of RDW,MHR,CRP/ALB,NLR and other clinical indicators to predict cardiovascular events in MHD patientsResults: A total of 210 patients were subjected to long-term regular hemodialysis in the dialysis center of our hospital from January 1,2017 to December 31,2019.According to the inclusion criteria and exclusion criteria,166 patients were finally included into the study.(1)The average age of patients enrolled in the study was 59.04 13.24,including 114males(68.7%)and 52 females(31.3%)88 cases(53%)of diabetic nephropathy,diabetes mellitus as a primary disease or comorbidity accounted for relatively high in the study population,and P<0.05,the difference was statistically significant;106 patients with cardiovascular events during the follow-up period;Median follow-up time was 6 months.(2)Basic diseases: 88 cases(53%)with history of diabetes,130 cases(80.1%)with history of hypertension,62 cases(37.3%)with history of cardiovascular diseases,and 42 cases(25.3%)with previous cerebrovascular diseases.(3)Correlation with inflammation,nutritional status,and blood lipid:RDW posi-ti vely correlated with CRP(r=0.171,P<0.05),TG(r=0.178,P<0.05),and TP(r=0.181,P<0.05);MHR positively correlated with WBC(r=0.569,P<0.01),Mono(r=0.603,P<0.01),and A LB(r=0.603,P<0.01).(4)With cardiovascular events as the endpoint,a single-factor COX risk proportion model shows that:age,previous cardiovascular disease,MHR,CRP,LYM,LYM,TIBC,PTH,ALB,TC,TG,SCr,BUN,EF,high RDW group and high MHR group P<0.05,the difference is statistically significant.After multivariate adjustment for the above meaningful indicators(P<0.05),compared with the other two groups,the high RDW group and the high MHR group had significantly increased risks of cardiovascular events(RDW:HR 1.638,95%CI:0.394-0.632,P=0.048;MHR:HR 1.592,95%CI:0.436-0.927,P=0.032).(5)RDW,MHR,NLR,CRP/ALB were compared under the ROC curve at the same time,and the result showed that the area under the MHR curve was the largest(AUC = 0.836,95% CI: 0.681-0.781,P < 0.01),which indicated that the diagnostic value of MHR was higher than that of NLR and MLR.The optimal diagnostic value for MHR is 0.737,with a sensitivity of 73.8% and a specificity of 64.1%.Conclusion: 1.Red blood cell distribution width(RDW)and Monocyte/high density lipoprotein ratio(MHR)are independent risk factors for cardiovascular events in dialysis patients.2.Lipid and albumin are also independent risk factors for cardiovascular events in maintenance hemodialysis patients.