The Clinical Significance Of Neutrophil/Lymphocyte Ratio In Patients With Hemodialysis Complicated With Lung Infection

Objective:To investigate the potential significant of neutrophils/lymphocytes ratio(NLR)in peripheral blood of patients with maintenance hemodialysis(MHD),and assess the predictive value for pulmonary infection,and thereby provide a simple inflmmatory marker for early detection of pulmonary infection.Methods:Retrospectively analysis was performed for the electronic medical records of 100 patients with end-stage renal failure and receiving MHD treatment in the blood purification center of the department of renal medicine(From March 1,2017 to February 28,2019).All objects met the inclusion criteria and underwent follow-up,and the follow-up deadline was February 29,2020.Baseline data of patients were collected including general projects(age,gender.weight,primary disease,etc.),and Laboratory results before dialysis:Red blood cell(RBC),White blood cell(WBC),Hemoglobin(Hb),Lymphocyte(LYM),Neutrophile granulocyte(NEUT),Albumin(Alb),and hypersensitive c-reactive protein(hs-CRP),calcitonin(PCT),serum creatinine(Cr),blood calcium(Ca),phosphorus(P),iron(Fe),intact parathyroid hormone(iPTH),triglycerides(TG),and other indicators,imaging examination(chest CT,etc.),as well as the length of hospitalization for pulmonary infection,the number of acute exacerbations in 1 year after discharge,and other indicators.The NLR was calculated and all patients were divided into infected group and non-infected group based on the pulmonary infection.Differences in each indicator between the two groups were compared.Spearman correlation was used to explore the correlation between NLR and other indicators.Risk factors for pulmonary infection were detected by Logistic regression.The optimal cut-off value for NLR?hs-CRP?PCT diagnosis of pulmonary infection was determined by the ROC curve,and the threshold value was utilized to investigate the potential significance of NLR combined CRP and PCT in diagnosing pulmonary infection.p<0.05 there were significant differences.Results:1.The results showed that the expression of WBC,NEU,NLR,PCT,hs-CRP and TG were significantly increased,while the level of RBC,Hb,LYM,and Alb was decreased in infected group compared with non-infected group(P<0.05).2.NLR was positively correlated with age(r=0.249,P<0.05),PCT(r=0.466,P<0.05),hs-CRP(r=0.432,P<0.05),but negatively correlated with Hb(r=-0.372,P<0.01),RBC(r=-0.379,P<0.01),and Alb(r=-0.318,P<0.01).3.NLR was positively correlated with hospital stays(r=0.388,P<0.001).but not significantly correlated with number of acute exacerbations 1 year after discharge(r=0.019,P>0.05).4.Meanwhile,The expression levels of PCT,hs-CRP and NLR in infected group were significantly decreased than those before treatment(P<0.05).5.Multiple regression analysis shows that NLR is an important independent risk factor for MHD patients with pulmonary infection(OR=1.46,95%CI=1.14-1.86,P<0.05).6.ROC analysis found that the optimal threshold value for NLR to predict pulmonary infection in MHD patients was 5.52,the sensitivity and specificity were 65.31%and 94.12%,respectively,and the Area under the curve(AUC)was 0.829(95%CI:0.74-0.897,P<0.0001).7.Moreover,the sensitivity,specificity,and area under the curve were 87.76%,100%,and 0.920 when using NLR combined hs-CRP to predict the pulmonary infection in MHD patients,and which were 87.76%,96.08%and 0.944 using NLR combined PCT,respectively.Conclusions:1.NLR is an important risk factor for pulmonary infection in MHD patients.2.The higher the NLR value,the longer the hospital stays of dialysis patients.3.NLR could effectively predict the pulmonary infection,and evaluate clinical condition and curative effects.Moreover,the sensitivity and specificity were enhanced when using NLR combined with PCT/hs-CRP to predict pulmonary infection in MHD patients,which provide early detection means for improving the quality of life and accelerate the recovery.