Relationship Between Neutrophil/Lymphocyte Ratio,Monocyte/High Density Lipoprotein Ratio And Nutritional Status Of Peritoneal Dialysis Patients

Objective:To explore the relationship between neutrophil/lymphocyte ratio,monocyte/high density lipoprotein and nutritional status of peritoneal dialysis patients.Methods:The present study aimed to investigate the association between malnutrition and various clinical parameters in peritoneal dialysis(PD)patients.A total of 119 PD patients admitted to the First Clinical Hospital of Shanxi Medical University from November 2020 to August2022 were included in this study.A total of 119 subjects were selected based on MQSGA nutrition score and divided into malnutrition(42 cases)and normal nutrition(77 cases)groups.Clinical general data and laboratory indicators were collected and differences in these parameters were analyzed between the two groups.Spearman correlation or Pearson correlation was employed to examine the relationship between malnutrition and various indices.Multivariate logistic analysis was performed to identify factors influencing malnutrition in peritoneal dialysis patients.Moreover,ROC curve analysis was conducted to determine the predictive efficacy of NLR and MHR for malnutrition in these patients.Results:(1)In this investigation,a comparative analysis of clinical data was performed between two groups of patients suffering from peritoneal dialysis(PD).The study comprised a cohort of 119 PD subjects,35.3%(42 cases)of them suffered from malnutrition,of which 31.1%(37cases)suffered from mild or moderate malnutrition,and 4.2%(5 cases)suffered from severe malnutrition.The study found that the age and dialysis age were significantly higher in the malnutrition group,Conversely,patients in the malnutrition group displayed significantly lower BMI and body weight compared to the normal nutrition group,with a statistically significant difference(P<0.05).(2)The comparison of laboratory data between the malnutrition group and the normal nutrition group revealed significant differences(P<0.05).Specifically,the ma lnutrition group demonstrated elevated levels of MHR,NLR,C-reactive protein,β2micro-globulin,neutrophils and monocytes compared to the normal nutrition group,while the numbers of cystatin C,serum albumin,serum prealbumin,transferrin,trigl yceride,total cholesterol,blood uric acid,blood phosphorus,blood magnesium,seru m iron,and parathyroid hormone were significantly lower than those in the normal nutrition group.(3)The correlation analysis suggests that,Malnutrition and NLR(r=0.382,P<0.01),MHR(r=0.335,P<0.01),C-reactive protein(r=0.291,P=0.034),β 2 microglobulin(r=0.188,P=0.041),age(r=0.198,P=0.031)showed a positive correlation,With body weight(r=-0.191,P=0.041),physical fitness index(r=-0.185,P=0.047),Albumin(r=-0.204,P=0.027),pro-albumin(r=-0.401,P<0.01),transferrin(r=-0.3,P<0.01),blood uric acid(r=-0.402,P<0.01),blood phosphorus(r=-0.287,P<0.01),triglyceride phosphorus(r=-0.278,P<0.01),total cholesterol(r=-0.203,P=0.015),parathyroid hormone(r=-0.221,P=0.018)and cystatin C(r=-0.251,P<0.01)showed a negative correlation.(4)A multi-factor logistic analysis was performed to identify the influencing factors of malnutrition in peritoneal dialysis patients.The analysis revealed that several variables had a significant impact on malnutrition,including body weight(OR=0.942),dialysis age(OR=1.005),serum albumin(OR=0.894),and serum uric acid(OR=0.979),as well as the Creactive protein(OR=1.045),neutrophil to lymphocyte ratio(NLR)(OR=1.258)and the monocyte to high-density lipoprotein cholesterol ratio(MHR)(OR=27.222).(5)Receiver operating characteristic(ROC)curves were constructed to evaluate the sensitivity,specificity,and predictive value of the monocyte to high-density lipoprotein cholesterol ratio(MHR)and neutrophil to lymphocyte ratio(NLR)for predicting malnutrition in peritoneal dialysis patients.The ROC curve analysis revealed that the optimal cutoff value for MHR was 0.498,with a sensitivity of 54.8% and a specificity of 73.7%,and the area under the curve(AUC)was 0.685(P<0.05,95% CI: 0.586-0.783),indicating a moderate predictive value.The optimal cutoff value for NLR was 3.596,with a sensitivity of 71.4% and a specificity of 65.8%,and the AUC was 0.732(P< 0.05,95% CI: 0.643-0.821),indicating a slightly higher predictive value than MHR.Notably,the combined use of MHR and NLR measures had a higher specificity of 89.5%,with a sensitivity of 57.1% in predicting malnutrition in peritoneal dialysis patients.The AUC of the combined indicator was 0.775(P<0.05,95% CI: 0.686-0.864),suggesting that the combination of MHR and NLR may enhance the predictive efficacy for malnutrition in peritoneal dialysis patients.Conclusion:(1)The incidence of combined malnutrition in peritoneal dialysis patients is high.MHR and NLR are closely related to the nutritional status of patients.MHR and NLR are independent risk factors for nutritional status of peritoneal dialysis patients.(2)The combined determination of MHR and NLR levels has a high predictive value for the occurrence of malnutrition in peritoneal dialysis patients.Observing the changes of MHR and NLR in patients may help to identify the occurrence of malnutrition early and intervene in time,thus improving the patients’ life quality.