Prognostic value of inflammatory markers for mortality in hemodialysis patients: a retrospective study with over 3-year follow-up

Year 2023, Volume: 6 Issue: 5, 1010 - 1015, 28.09.2023

Raziye Yazıcı , İbrahim Güney

https://doi.org/10.32322/jhsm.1311565

Abstract

Aims: In chronic kidney disease (CKD), chronic systemic inflammation contributes to premature ageing and morbidity; it is a predictor of overall mortality. In this study, we aimed to investigate prognostic value of inflamatory markers including systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for mortality outcomes in hemodialysis patients.
Methods: In this retrospective study, CKD patients on maintenance hemodialysis between January 1, 2020 and January 31, 2020 were included. SII, PIV, NLR, PLR values of the patients were calculated. SII was calculated by (neutrophil count x platelet count)/lymphocyte count; PIV was calculated by (neutrophil count x platelet count x monocyte count)/lymphocyte count. Mortality rate of the study population during approximately 38-month follow-up period was calculated. The relationships of inflamatory markers and other variables with mortality were analysed.
Results: Of 162 patients, 53.1% were male and 46.9% were female (mean age: 61.6±13.5). During 38-month follow-up period, a total of 60 patients (37%) died. Compared with surviving group, NLR values, mean age and the rate of diabetes mellitus (DM) and coronary artery disease (CAD) comorbidities were higher (p=0.012, p <0.001, p=0.008, p <0.001 respectively) and albumin, uric acid and creatinin levels were lower (p <0.001, for each) in the nonsurvivor group. There was no difference between these two groups in terms of PIV and SII values and CRP levels. In Cox regression analysis, presence of CAD (Exp ß: 2.116; 95% CI, 1.222-3.648; p=0.007), age (Exp ß: 1.049; 95% CI, 1.022-1.077; p <0.001), serum uric acid (Exp ß: 0.721; 95% CI, 0.559-0.929; p=0.011) and albumin levels (Exp ß: 0.395;95% CI, 0.158-0.984, p=0.046), NLR (Exp ß: 1.345; 95% CI, 1.152-1.1570; p <0.001) and PLR (Exp ß: 0.993; 95% CI, 0.989-0.997; p=0.002) were found to be associated with mortality.
Conclusion: There was no difference between nonsurviving and surviving group in terms of PIV and SII values and CRP levels. Age, presence of CAD, serum uric acid and albumin levels and NLR and PLR values were associated with all-cause mortality, independently. Prospective studies with larger number of hemodialysis patients and serial measurements of inflammatory markers are needed.

Keywords

Hemodialysis, systemic immune-inflammation index, pan-immune-inflammation value, mortality, inflammatory markers

References

• Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2019 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2020;75(1 Suppl 1):A6-A7.
• Alanlı R, Küçükay MB, Mürsel Ş, et al. Hemodiyaliz hastalarında mortaliteye etkisi olan kan parametreleri ve ekokardiyografi bulguları. Ankara Eğitim ve Araştırma Hastanesi Tıp Derg. 2022; 55(2):74-77.
• 3.Henrich WL, Burkart JM.Patient survival and maintenance dialysis. UpToDate. Updated October 05, 2020. Accessed May 10, 2023. http://www.uptodate.com
• Cobo G, Lindholm B, Stenvinkel P. Chronic inflammation in end-stage renal disease and dialysis. Nephrol Dial Transplant. 2018;33(suppl_3):iii35-iii40.
• Kato A, Tsuji T, Sakao Y, et al. A comparison of systemic inflammation-based prognostic scores in patients on regular hemodialysis. Nephron Extra. 2013;3(1):91-100.
• Liao J, Wei D, Sun C, Yang Y, Wei Y, Liu X. Prognostic value of the combination of neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio and platelet-to-lymphocyte ratio on mortality in patients on maintenance hemodialysis. BMC Nephrol. 2022;23(1):393.
• Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-6222.
• Zhong JH, Huang DH, Chen ZY. Prognostic role of systemic immune-inflammation index in solid tumors: A systematic review and meta-analysis. Oncotarget. 2017;8(43):75381-75388.
• Tutan D, Eskin F. Role of systemic immune-inflammation index in predicting mortality in cancer patients in palliative care units. J Health Sci Med. 2023; 6(2):223-227.
• Zhang F, Li L, Wu X, et al. Pan-immune-inflammation value is associated with poor prognosis in patients undergoing peritoneal dialysis. Ren Fail. 2023;45(1):2158103.
• Sevinc C, Demirci R, Timur O. Predicting hospital mortality in COVID-19 hemodialysis patients with developed scores. Semin Dial. 2021;34(5):347-359.
• Ran Y, Wu QN, Long YJ, et al. Association of systemic immune-inflammation index with protein-energy wasting and prognosis in patients on maintenance hemodialysis. Zhonghua Yi Xue Za Zhi. 2021;101(28):2223-2227.
• Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474-488.
• Yousif DE, Ye X, Stuard S, et al. Biphasic dynamics of inflammatory markers following hemodialysis initiation: results from the International MONitoring Dialysis Outcome Initiative. Kidney Int Rep. 2022;8(1):75-80.
• Oguz EG, Yeter HH, Akcay OF, et al. Predictive value of neutrophil-to-lymphocyte ratio in terms of need for intensive care unit and mortality in maintenance hemodialysis patients with COVID-19. Hemodial Int. 2022;26(3): 377-385.
• Li M, Ye ZC, Li CM, et al. Low serum uric acid levels increase the risk of all-cause death and cardiovascular death in hemodialysis patients. Ren Fail. 2020;42(1):315-322.
• Murea M, Tucker BM. The physiology of uric acid and the impact of end-stage kidney disease and dialysis. Semin Dial. 2019;32(1):47-57.
• Kazan DE, Kazan S. Systemic immune inflammation index and pan-immune inflammation value as prognostic markers in patients with idiopathic low and moderate risk membranous nephropathy. Eur Rev Med Pharmacol Sci. 2023;27(2): 642-8.