Clinical Study Of Neutrophil To Lymphocyte Ratio(NLR) And Pulmonary Hypertension In Patients With Chronic Kidney Disease

ObjectionIn this study,the clinical value of neutrophil‐to‐lymphocyte ratio(NLR)in pulmonary arterial hypertension(PAH)of chronic kidney disease(CKD)patients was investigated.And the predictive value of NLR for PAH in CKD patients was evaluated,to provide clinical basis for early diagnosis and intervention of PAH in patients with CKD.MethodsA total of 201 patients with CKD hospitalized in the Department of Nephrology,the First Affiliated Hospital of Guangdong Pharmaceutical University from January 2015 to June 2021 were selected according to the inclusion and exclusion criteria.General information of patients(gender,age,smoking history,height,weight,BMI,the primary disease of CKD)was recorded.Blood routine and biochemical indexes(including hemoglobin(Hb),neutrophil count,lymphocyte count,platelet count,serum albumin(Alb),creatinine(SCr),uric acid(UA),serum calcium(Ca),phosphorus(P),triglyceride(TG),low density lipoprotein(LDL)),high density lipoprotein(HDL),cholesterol(TC),urea nitrogen(BUN),cystatin C(Cys C),etc.)were recorded.And echocardiographic indexes(left ventricular ejection fraction(LVEF),pulmonary artery pressure(PAP),left ventricular mass index(LVMI),pulmonary artery diameter(PA),pulmonary valve flow rate(PV),ratio of early diastolic mitral valve flow to peak velocity of annular motion(E/e’),Left ventricular end diastolic volume diameter(LVDd),left atrial diameter(LAd),right ventricle diameter(RVd),right atrial diameter(RAd))were recorded.Neutrophil count to lymphocyte count ratio(NLR)was calculated.According to the cardiac ultrasound diagnostic criteria,subjects were divided into PAH group and non‐PAH group.General data and clinical indicators were compared between the two groups,the correlation between NLR,PASP and other clinical indicators was analyzed,and the risk factors for PAH were analyzed.The predictive value of NLR was evaluated by ROC and AUC.Results1.A total of 201 patients were enrolled,including 36 patients with CKD1～3,27 patients with CKD4,and 138 patients with CKD5.55 of the 201 patients with CKD had pulmonary hypertension,with prevalence rate of 27.4%.This study found that pulmonary hypertension could exist in all stages of CKD.2.A total of 146 patients in the normal pulmonary artery pressure group were aged(67±16)years.The average age of 55 patients in PAH group was(70±13)years.There were significant differences between the two groups in the incidence of coronary heart disease,BMI,NLR,neutrophil count,platelet count,lymphocyte count,hemoglobin,triglyceride,high‐density lipoprotein,ferritin,creatinine,and e GFR(P < 0.05).3.There were statistically significant differences between the two groups in PSAP,E/e’,PA,PV,LVMI,LVEF,RVd,RAd,LVDd and LVd(P < 0.05).4.According to Spearman correlation analysis,PASP,E/ E ’,RVd,RAd,LAd,PA,PV,white blood cell count,neutrophil count,phosphorus,Ca XP,parathyroid hormone,urea nitrogen,C‐reactive protein,creatinine,cystatin C were positively correlated with NLR.LVEF,hemoglobin,lymphocyte count,triglyceride,cholesterol and low density lipoprotein were negatively correlated with NLR.5.Multivariate regression analysis showed that NLR,LAd,E/ e’ and HDL were independent risk factors for PAH.6.ROC curve analysis showed that the area under curve(AUC),sensitivity and specificity of NLR in predicting PAH were 0.673,87.3% and 61.0% respectively.ConclusionsCKD patients are prone to pulmonary hypertension,and NLR has certain value in predicting pulmonary hypertension in patients with CKD.