Association Of C-Reactive To Prealbumin Ratio With Cardiovascular And All-cause Mortality In Peritoneal Dialysis Patients

Objective To explore the association of c-reactive protein to prealbumin ratio with cardiovascular disease and all-cause mortality in peritoneal dialysis patients.Methods A cohort study was performed in peritoneal dialysis patients from the Peritoneal Dialysis Center of Shaoxing People’s Hospital from January 1,2013 to December 31,2020.The main outcome was cardiovascular diseases and all-cause mortality.According to the median of CRP/PAlb ratio(CPr,0.006),the patients were divided into high CPr group(CPr≥0.006)and low CPr group(CPr<0.006).The baseline clinical data,biochemical indicators,comorbidities and clinical outcomes of the two groups were compared.Spearman correlation analysis to explore the correlation between CPr and other indicators.Kaplan-Meier for survival analysis.Cox regression model to analyze prognostic factors.Results A total of 320 patients with peritoneal dialysis were included.Among them,167 patients were in high CPr group and 153 patients in low CPr group(n=153),the age of first peritoneal dialysis was(57.77±13.78)years,and the median follow-up time was 30(18,49.5)months.There were significant differences in the first peritoneal dialysis age,gender,Kt/V,serum C-reactive protein,prealbumin,hemoglobin,serum albumin,blood calcium,blood chlorine,uric acid,total cholesterol,HDL-C,LDL-C,red blood cell count,white blood cell count,monocyte count,lymphocyte count,NLR,and MLR(all P<0.05).The Spearman correlation analysis showed that CPr was positively correlated with NLR(r=0.254,P<0.001),MLR(r=0.361,P<0.001),WBC(r= 0.220,P<0.001)and age(r=0.334,P<0.001),and negatively correlated with Alb(r=-0.230,P<0.001)and Kt/V(r=-0.146,P=0.010).The main cause of death in peritoneal dialysis patients is cardiovascular disease,accounting for 50.9% of the total deaths.The high and low CPr groups accounted for 14.4% and 3.3% of the total number of deaths due to cardiovascular disease,respectively,and all-cause deaths accounted for 26.3% and 8.5% of the total number of deaths,respectively.The Kaplan-Meier survival curve showed that the survival rate of patients in the low CPr group was significantly higher than that in the high CPr group(Log-rank P<0.001).The 1-year,3-year,and 5-year survival rates of patients in the high-CPr group and low-CPr group were 97.5% vs.97.2%,81.7% vs.90.8%,and 55.5% vs.87.5%,respectively.Incorporating variables such as CPr into the multivariate Cox proportional hazards model,it was found that the risk of all-cause mortality in the high CPr group was 1.995 times that of the patients in the low CPr group(HR=1.995,95%CI 1.012～3.932,P=0.046).The risk of death due to CVD was 4.643 times higher in the high CPr group than in the low CPr group(HR=4.643,95%CI 1.282～16.812,P=0.019).Conclusions CPr is an independent risk factor for cardiovascular and all-cause mortality in peritoneal dialysis patients,and because of its simple and cheap measurement method,it can be used as an effective prognostic indicator for peritoneal dialysis patients.