Mengmeng Li1, Shaozhen Feng2, Xiaojiang Zhan3, Fenfen Peng4, Xiaoran Feng5, Qian Zhou6, Xianfeng Wu7, Xiaoyang Wang8, Ning Su9, Xingming Tang10, Zebin Wang1, Yujing Zhang1, Yingsi Zeng1, Liya Zhu1, Yuxin Xie1, Jianbo Liang1, Lingling Liu11, Yueqiang Wen12. 1. Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China. 2. Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. 3. Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. 4. Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou, China. 5. Department of Nephrology, Jiujiang NO.1 people's Hospital, Jiangxi, China. 6. Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. 7. Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China. 8. Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, ZhengZhou, Henan, China. 9. Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. 10. Department of Nephrology, Affiliated Tungwah Hospital, Sun Yet-Sen University, Dongguan, Guangdong, China. 11. Department of General Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. 12. Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China. yueqiangwen@163.com.
Abstract
BACKGROUND: Neutrophil to high-density lipoprotein ratio (NHR), a new inflammatory marker, is associated with poor clinical prognosis. However, the correlation of NHR and adverse outcomes in peritoneal dialysis (PD) patients remains unclear. METHODS: In this retrospective cohort study, a total of 1051 PD patients were recruited from three centers during Jan 1, 2009 to Dec 31, 2017. Eligible patients were distributed according to quartiles of the NHR. Kaplan-Meier cumulative incidence curves, multivariate COX regression, competitive risk analysis and restricted cubic spline (RCS) were applied to analyze the relationship between NHR and all-cause mortality as well as cardiovascular events (CVE). In addition, forest plots were used to calculate the interaction between different subgroups. RESULTS: During follow-up, a total of 240 all-cause mortality and 157 new-onset CVE were recorded. The all-cause mortality in the highest quartile of NHR (> 5.43) were higher than those in the other groups. RCS showed a non-linear relationship between NHR and adverse outcomes. Multivariate COX regression indicated elevated NHR was an independent risk factor for all-cause mortality. Compared to the highest quartile, hazard ratio (HR) of new-onset CVE equals to 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 is 0.551 (95% CI 0.378-0.803) in the third quartile (3.57 < NHR ≤ 5.43). Kaplan-Meier analysis suggested there were significant differences in all-cause mortality and new-onset CVE among four NHR groups. CONCLUSIONS: NHR was a new independent risk factor for all-cause mortality in PD patients.
BACKGROUND: Neutrophil to high-density lipoprotein ratio (NHR), a new inflammatory marker, is associated with poor clinical prognosis. However, the correlation of NHR and adverse outcomes in peritoneal dialysis (PD) patients remains unclear. METHODS: In this retrospective cohort study, a total of 1051 PD patients were recruited from three centers during Jan 1, 2009 to Dec 31, 2017. Eligible patients were distributed according to quartiles of the NHR. Kaplan-Meier cumulative incidence curves, multivariate COX regression, competitive risk analysis and restricted cubic spline (RCS) were applied to analyze the relationship between NHR and all-cause mortality as well as cardiovascular events (CVE). In addition, forest plots were used to calculate the interaction between different subgroups. RESULTS: During follow-up, a total of 240 all-cause mortality and 157 new-onset CVE were recorded. The all-cause mortality in the highest quartile of NHR (> 5.43) were higher than those in the other groups. RCS showed a non-linear relationship between NHR and adverse outcomes. Multivariate COX regression indicated elevated NHR was an independent risk factor for all-cause mortality. Compared to the highest quartile, hazard ratio (HR) of new-onset CVE equals to 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 is 0.551 (95% CI 0.378-0.803) in the third quartile (3.57 < NHR ≤ 5.43). Kaplan-Meier analysis suggested there were significant differences in all-cause mortality and new-onset CVE among four NHR groups. CONCLUSIONS: NHR was a new independent risk factor for all-cause mortality in PD patients.
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