Association Between Platelet/Lymphocyte Ratio And Neutrophils/Lymphocyte Ratio With Cognitive Impairment In Maintenance Hemodialysis Patients

Objective: To investigate the relationship between platelet/lymphocyte ratio(PLR),Neutrophil/lymphocyte ratio(NLR)and cognitive impairment(CI)of maintenance hemodialysis(MHD)patients.Methods:A multicenter cross-sectional study was collected the data of age,gender,underlying diseases,medication history,mini-mental state estimate(MMSE)and biochemical indexes of MHD patients who were treated in 17 hemodialysis center in Guizhou Province between May and August 2019.According to the MMSE score,the research subjects were divided into cognitive impairment group and cognitive normal group,and the differences between the two groups were compared.The included research subjects were divided into four groups according to the quartile of PLR(PLR Q1,Q2,Q3 and Q4 group)and NLR(NLR Q1,Q2,Q3 and Q4 group).The differences among PLR and NLR groups were respectively compared.Spearman correlation,multiple linear regression and logistic regression was used to analyze the relationship between PLR,NLR and cognitive dysfunction in MHD patients.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of PLR,NLR and union indicators for cognitive impairment in MHD patients.Results: 2019 MHD patients were enrolled,including 1,200 males(59.4%)and 819females(40.6%).About 48.0%(970/2019)of MHD patients have cognitive impairment.There were statistically significant differences in age,gender,dialysis age,education level,hypertension,diabetes,PLR,NLR,lymphocytes,platelets,total cholesterol,creatinine,albumin,hemoglobin and urea between the cognitive impairment group and the cognitive normal group(P<0.05).Spearman correlation analysis suggests that cognitive dysfunction in MHD patients is related to age,gender,education level,dialysis age,hypertension,diabetes,hemoglobin,urea,creatinine,albumin,total cholesterol,lymphocytes,platelets,PLR,NLR(P< 0.05).Comparison among PLR groups showed that prevalence of cognitive impairment,age and platelet in PLR Q4 group were higher than those in the other groups.While leukocyte,lymphocytes,albumin,serum creatinine and hemoglobin in PLR Q4 group were lower than those in the other groups.Comparison among NLR groups showed that prevalence of cognitive impairment,age,diabetes and leukocyte in NLR Q4 group were higher than those in the other groups.However,education level,lymphocyte count,platelet,albuminl and hemoglobin NLR Q4 group were lower than those of the other groups.In the uncorrected Logistic regression model,the risk of cognitive dysfunction in MHD patients in PLR Q2,Q3 and Q4 groups was 1.808 times(95%CI: 1.401-2.333,P<0.001),2.330 times(95%CI:1.805-3.008,P<0.001)and 3.055times(95%CI: 2.362-3.952,P<0.001)of that in Q1 group.After adjustic gender,age,correction of further dialysis age,education level,diabetes,high blood pressure,albumin,serum creatinine,leukocyte,hemoglobin,PLR Q2,Q3 and Q4 risk group of cognitive impairment in patients with MHD group of Q1 respectively 1.660 times(95%CI: 1.179 ～2.335,P = 0.004),2.119 times(95%CI:1.481 ～ 3.032,P < 0.001),2.726 times(95% CI:1.900 ～ 3.910,P < 0.001).In the uncorrected Logistic regression model,the risk of cognitive dysfunction in MHD patients in NLR Q4 group was 1.831 times(95%CI:1.426 ～2.351,P<0.001)higher than that in Q1 group,respectively.After further adjustment for gender,age,dialysis age,education,diabetes,hypertension,albumin,serum creatinine,leukocyte,and hemoglobin,the risk of cognitive dysfunction in MHD patients in NLR Q4 group was 1.888 times higher than that in Q1 group(95%CI: 1.313-2.715,P=0.001).ROC curve analysis indicated that the optimal thresholds of PLR for predicting cognitive impairment in MHD patients were 145.757 and the AUC was 0.610(95%CI:0.585～0.634,P<0.001).The optimal threshold of NLR for predicting cognitive impairment in MHD patients was 3.628,and the AUC of NLR was 0.564(95%CI:0.539 ～ 0.589,P<0.001).The optimal threshold of PLR combined with NLR was 0.455,and the area under the curve was0.609(95% CI: 0.584～0.633,P< 0.001).Multiple linear regression suggests that PLR,age,and albumin are the relevant factors of cognitive dysfunction in MHD patients.The optimal threshold of PLR combined with age and albumin to predict cognitive dysfunction in MHD patients was 25.701,and the area under the curve was 0.718(95% CI: 0.692～0.745,P<0.001).Conclusion:1.The prevalence of cognitive dysfunction in MHD patients in Guizhou Province is about 48.0%.2.Higher PLR,old age and lower albumin level are the main factors of cognitive dysfunction in MHD patients.3.Higher PLR level has predictive value for cognitive dysfunction in MHD patients,and PLR combined with age and albumin has greater predictive value for cognitive dysfunction in MHD patients.4.Higher NLR level may be related to cognitive impairment in MHD patients,but its predictive value is not high.