BACKGROUND: Increased inflammation is common in patients with chronic kidney disease (CKD) and is associated with increased adverse cardiovascular events (CVE). Neutrophil-to-lymphocyte ratio (NLR) was used to predict survival in patients with acute coronary syndrome. We aimed to evaluate predictive ability of NLR in CKD patients. METHODS: 225 subjects with stage 3-5 CKD were followed for a mean of 39 months. Fatal and nonfatal CVE were recorded during this period. NLR at baseline was determined from complete blood count differential. Endothelial dysfunction (flow-mediated dilation, FMD), hsCRP and insulin resistance were determined. We investigated if NLR could predict development of fatal and nonfatal CVE. We also looked at how NLR and its individual components change across CKD stages and whether NLR is related to CRP, insulin resistance and endothelial dysfunction. RESULTS: There were 70, 74 and 81 patients in groups of CKD stage-3, stage-4 and stage-5, respectively. Median NLR was 2.81. NLR showed a significant increase from stage 3 to stage 5. NLR was inversely associated with FMD independent of hsCRP. 14 fatal and 52 nonfatal CVE occurred during follow-up period. NLR could predict composite CVE independent of insulin resistance and hsCRP. Increased NLR over 2.81 was related to a significantly decreased survival time (log-rank Chi-square = 14.833, P < 0.0001). A cutoff value for NLR ≥3.76 could predict development of composite CVE with 80.3 % sensitivity and 91.8 % specificity. CONCLUSIONS: NLR is independently related to endothelial dysfunction and could predict composite cardiovascular endpoints independent of traditional confounding factors in patients with moderate to severe CKD.
BACKGROUND: Increased inflammation is common in patients with chronic kidney disease (CKD) and is associated with increased adverse cardiovascular events (CVE). Neutrophil-to-lymphocyte ratio (NLR) was used to predict survival in patients with acute coronary syndrome. We aimed to evaluate predictive ability of NLR in CKDpatients. METHODS: 225 subjects with stage 3-5 CKD were followed for a mean of 39 months. Fatal and nonfatal CVE were recorded during this period. NLR at baseline was determined from complete blood count differential. Endothelial dysfunction (flow-mediated dilation, FMD), hsCRP and insulin resistance were determined. We investigated if NLR could predict development of fatal and nonfatal CVE. We also looked at how NLR and its individual components change across CKD stages and whether NLR is related to CRP, insulin resistance and endothelial dysfunction. RESULTS: There were 70, 74 and 81 patients in groups of CKD stage-3, stage-4 and stage-5, respectively. Median NLR was 2.81. NLR showed a significant increase from stage 3 to stage 5. NLR was inversely associated with FMD independent of hsCRP. 14 fatal and 52 nonfatal CVE occurred during follow-up period. NLR could predict composite CVE independent of insulin resistance and hsCRP. Increased NLR over 2.81 was related to a significantly decreased survival time (log-rank Chi-square = 14.833, P < 0.0001). A cutoff value for NLR ≥3.76 could predict development of composite CVE with 80.3 % sensitivity and 91.8 % specificity. CONCLUSIONS: NLR is independently related to endothelial dysfunction and could predict composite cardiovascular endpoints independent of traditional confounding factors in patients with moderate to severe CKD.
Authors: Takahiko Naruko; Makiko Ueda; Kazuo Haze; Allard C van der Wal; Chris M van der Loos; Akira Itoh; Ryushi Komatsu; Yoshihiro Ikura; Masayuki Ogami; Yoshihisa Shimada; Shoichi Ehara; Minoru Yoshiyama; Kazuhide Takeuchi; Junichi Yoshikawa; Anton E Becker Journal: Circulation Date: 2002-12-03 Impact factor: 29.690
Authors: Mi Ran Jung; Young Kyu Park; Oh Jeong; Jang Won Seon; Seong Yeob Ryu; Dong Yi Kim; Young Jin Kim Journal: J Surg Oncol Date: 2011-05-25 Impact factor: 3.454
Authors: Maik Drechsler; Remco T A Megens; Marc van Zandvoort; Christian Weber; Oliver Soehnlein Journal: Circulation Date: 2010-10-18 Impact factor: 29.690
Authors: David L Battin; Sheharyar Ali; Atta U Shahbaz; J Daniel Massie; Ahmad Munir; Richard C Davis; Kevin P Newman; Karl T Weber Journal: Am J Med Sci Date: 2010-01 Impact factor: 2.378
Authors: D S Celermajer; K E Sorensen; V M Gooch; D J Spiegelhalter; O I Miller; I D Sullivan; J K Lloyd; J E Deanfield Journal: Lancet Date: 1992-11-07 Impact factor: 79.321
Authors: Radmila Micanovic; Brahmananda R Chitteti; Pierre C Dagher; Edward F Srour; Shehnaz Khan; Takashi Hato; Allison Lyle; Yan Tong; Xue-Ru Wu; Tarek M El-Achkar Journal: J Am Soc Nephrol Date: 2015-01-02 Impact factor: 10.121