Abstract
Background: Patients with end stage renal disease (ESRD) have elevated levels of inflammatory mediators including Creactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Neutrophil to lymphocyte ratio was introduced as a novel inexpensive indicator that reflects the severity and extension of systemic inflammation and atherosclerosis, and predicts adverse clinical outcomes in cardiac and non-cardiac disorders including ESRD. The aim of this study is to evaluate the frequency of subclinical inflammation using neutrophil to lymphocyte ratio (NLR) and its relation to other biochemical parameters in ESRD patients on maintenance haemodialysis (HD) in comparison to high-sensitivity C-reactive protein (hsCRP). Methods: A cross sectional observational study including 100 clinically stable ESRD patients on regular haemodialysis (mean age 48.25 ± 13.67, 57% were males), NLR was calculated from complete blood count and hsCRP was recorded for all patients where 8.2 mg/L indicated inflammation. Results: NLR was positively correlated to hsCRP, using ROC curve (AUC=0.647) and the best cut off point to detect subclinical inflammation in HD patients was calculated with NLR greater than or equal 1.54, with sensitivity 68.25% and specificity 54%. By using univariate and multiple variate analysis in our work to test for independent predictors of hsCRP levels as an indicator for inflammation, it was found that NLR can be used as an independent predictor of hsCRP as an inflammatory marker, with statistically significant correlation (p=0.015). Spearman coefficient (rs=0.220) shows statistically significant (p=0.028) positive correlation between NLR and hsCRP. Conclusion: NLR is an easy, simple and non-expensive method that can be used as a marker of inflammation in HD patients when compared to hsCRP.
Highlights
End stage renal disease (ESRD) patients on regular hemodialysis (HD) have higher rates of mortality and morbidity compared to general population
It was found that 63 patients (63%) of studied population have subclinical inflammation, where high-sensitivity C-reactive protein (hsCRP) >8200 ng/ml indicates the presence of inflammation despite absence of any overt signs and symptoms of inflammation and 37 patients (37%) have hsCRP
PPV=Positive predictive value, PVT=Negative predictive value. It shows that neutrophil to lymphocyte ratio (NLR) was positively correlated to hsCRP, using Receiver operating characteristic curve (ROC) curve (AUC=0.647) and the best cut off point to detect subclinical inflammation in HD patients was calculated with NLR greater than or equal 1.54, with sensitivity 68.25% and specificity 54% (Figure 2)
Summary
End stage renal disease (ESRD) patients on regular hemodialysis (HD) have higher rates of mortality and morbidity compared to general population. Cardiovascular diseases (CVD) are considered to be the commonest cause of mortality, followed by infections and septicemia as the second most common [2] Both cardiovascular and infectious causes of death are associated with a state of chronic inflammation. It is predicted that early and specific detection of inflammation might improve the quality of life of those patients and decrease rate of mortality and morbidity [3]. The aim of this study is to evaluate the frequency of subclinical inflammation using neutrophil to lymphocyte ratio (NLR) and its relation to other biochemical parameters in ESRD patients on maintenance haemodialysis (HD) in comparison to high-sensitivity C-reactive protein (hsCRP). Conclusion: NLR is an easy, simple and non-expensive method that can be used as a marker of inflammation in HD patients when compared to hsCRP
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