Correlation And Predictive Value Of NLR,PLR And Coronary Artery Calcification In Maintenance Hemodialysis Patients

Objective:Coronary artery calcification（CAC）is very common in patients with end-stage renal disease（ESRD）,and its degree is closely related to the prognosis of cardiovascular disease in patients with ESRD.In recent years,the correlation between neutrophil lymphocyte ratio（NLR）,platelet lymphocyte ratio（PLR）and CAC in maintenance hemodialysis（MHD）patients has attracted much attention,but there is still a lack of evidence-based medical evidence.The purpose of this study was to discuss the correlation and predictive value of NLR,PLR and CAC in MHD patients.Methods:Patients who got MHD treatment in the blood sanitization focus of the Department of Nephrology of the Affiliated Hospital of Yan’an University from January 2015 to December 2021 and had gone through 256 slice dual source spiral CT in our clinic were chosen.108 patients with MHD were finally included as the research object according.The degree of CAC was stratified according to the rumberger method.CACS < 10 were divided into non CAC group（48 cases）,CACS ≥ 10 were divided into CAC group（60 cases）,of which 10 ≤ CACS < 400 were divided into non severe CAC group（34 cases）,and CACS ≥ 400 were divided into severe CAC group（26 cases）.The degree of CAC was stratified according to the rumberger method.CACS < 10 were divided into non CAC group（48 cases）,CACS ≥ 10 were divided into CAC group（60 cases）,of which 10 ≤ CACS < 400 were divided into non severe CAC group（34 cases）,and CACS ≥ 400 were divided into severe CAC group（26 cases）.The indexes of age、dialysis age、C-reactive protein、serum calcium、serum phosphorus、parathyroid hormone、serum albumin、hemoglobin、serum creatinine、NLR、PLR of the two groups were statistically analyzed.Spearman correlation was used to analyze the factors related to CAC and severe CAC,ROC curve was utilized to decide the optimal critical values of PLR and NLR,and kappa consistency test was used to analyze the accuracy of NLR and PLR in screening CAC.P < 0.05,the difference was considered to be statistically significant.Results:1.The dialysis age（z=-2.122,P=0.034）,CRP（z=-2.239,P=0.025）,NLR（t=5.952,P<0.001）,PLR（t=4.418,P<0.001）in CAC group were significantly higher than those in non CAC group,while ALB was significantly lower than that in non CAC group（t=-2.144,P=0.034）,the difference was statistically significant（P<0.05）.There was no massive distinction in the proportion of male patients,age,smoking proportion,prevalence of diabetes,prevalence of hypertension,BMI,SBP and DBP between the two groups.2.The dialysis age（Z=-2.276,P=0.023）and NLR（t=2.680,P=0.01）in extreme CAC bunch were altogether higher than those in the non serious CAC bunch,while there was no measurably massive distinction in male proportion,smoking proportion,age,BMI,diabetes prevalence and prevalence of hypertension.3.Spearman correlation analysis showed that dialysis age（r=0.205,P=0.033）,age（r=0.421,P<0.001）,CRP（r=0.216,P=0.024）,NLR（r= 0.498,P < 0.001）,PLR（r=0.386,P<0.001）were positively correlated with CAC;ALB（r=-0.218,P=0.023）was negatively correlated with the occurrence of CAC;NLR（r=0.322,P=0.012）and dialysis age（r=0.296,P=0.022）were positively correlated with severe CAC.4.When the best cut-off values of NLR and PLR in ROC curve analysis were3.54 and 160.895 respectively,the sensitivity for screening MHD patients with CAC was 76.7% and 65.0% respectively,The specificity was 72.9% and 75.0%respectively.The coincidence rates were 75.0%,69.44%,the positive predictive values were 77.97%,76.47% and the negative predictive values were 71.43% and 63.16% respectively.When parallel diagnostic test was used,the combined sensitivity and specificity were 91.8% and 54.6% respectively.5.Kappa consistency test analyzed that the kappa coefficients of CAC in MHD patients screened by NLR and PLR were 0.495 and 0.393 respectively.Conclusions:1.NLR and PLR were positively correlated with CAC in MHD patients,age,dialysis age and CRP were also positively correlated with CAC,and ALB was negatively correlated with CAC.2.NLR in MHD patients was emphatically corresponded with the seriousness of CAC,and dialysis age was likewise adversely connected with the seriousness of CAC.3.NLR and PLR in MHD patients can be used to screen CAC.