Association of Neutrophil and Albumin With Mortality Risk in Patients Receiving Peritoneal Dialysis

Abstract

ObjectiveInflammation and nutrition have been recognized in predicting mortality in patients receiving peritoneal dialysis (PD). Serum neutrophils and albumin are crucial factors in inflammation and nutrition status. Up till now, the synergistic effect of neutrophil and albumin on mortality prediction in PD patients is still being determined. Our study sought to assess the effect of the interaction between neutrophils and albumin on the risk of all-cause mortality and CVD mortality in PD patients. MethodsA total of 1229 PD patients were recruited and divided into three categories in this cohort study. Their relationships with all-cause mortality and cardiovascular disease (CVD) mortality were analyzed in Multivariable COX regression models adjusted for confounding factors. ResultsDuring the median follow-up of 34.2 months, 222 (18.1%) patients sadly passed away, 115 (51.8%) of them suffered from cardiovascular events (CVE). Patients with high neutrophil percentage-to-albumin ratio (NPAR) showed increased all-cause mortality and CVD mortality, with adjusted hazard ratios of 1.490 (95%CI, 1.070-2.074, P=0.018) and 1.633 (95%CI, 1.041-2.561, P=0.033) respectively, compared with those with low NPAR. Competitive risk models and sensitivity analyses further confirmed this association. In the ROC analysis, however, there was little evidence that NPAR is a better indicator than albumin and neutrophil count. ConclusionsPatient with high NPAR is linked to a higher risk of mortality, especially for a person of both high neutrophil and low albumin, compared with one without either.