The Relationship of Neutrophil Lymphocyte Ratio (NLR), Nutritional Status and Length of Hemodialysis to The Incidence of Inpatient Community Pneumonia in Regular Hemodialysis Patients

Abstract

Background: Pneumonia, a leading cause of death worldwide, is common in chronic kidney disease (CKD) patients undergoing hemodialysis due to pulmonary infections and poor nutritional status. Prolonged hemodialysis worsens nutritional disorders, increasing pneumonia risk. Biomarkers like the neutrophil-lymphocyte ratio (NLR) and low albumin can indicate infection and inflammation. This study explores the relationship between NLR, nutritional status, and hemodialysis duration with pneumonia in CKD patients. Methods: This study was an observational analytic study with a cross-sectional design. Using SPSS to univariate analysis in the form of tables with frequency, mean and media; bicariat analysis using chi square test and multivariate analysis with logistic regression. Results: 72 patients undergoing regular hemodialysis, ROC analysis obtained an NLR cut off value of 6.09. Chi Square test results showed a significant association between NLR and pneumonia (OR 2.04; p < 0.05; CI 95% 1.26-3.33) and Hemeodyalisis (HD) duration with pneumonia (OR 4.71 times; CI 95% 1.72-12.93; p 0.004), while there was no significant difference in nutritional status between community pneumonia and non-community pneumonia. Based on the results of multivariate analysis, it was found that NLR levels > 6.09, HD duration > 1 year, and the presence of comorbid heart failure were risk factors that significantly increased the incidence of community pneumonia in patients undergoing regular HD. Conclusion: There is a significant association between NLR >6.09 and HD duration and comorbid heart failure with community pneumonia in patients undergoing regular HD at Prof. I.G.N.G. Ngoerah Hospital.