Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease

Solak, Yalçın; Yılmaz, Mahmut İlker; Sönmez, Alper; Sağlam, Mutlu; Çakır, Erdinç; Ünal, Hilmi Umut; Gök, Mahmut; Çağlar, Kayser; Oğuz, Yusuf; Yenicesu, Müjdat; Karaman, Murat; Ay, Seyıt Ahmet; Gaipov, Abduzhappar; Türk, Süleyman; Vural, Abdülgaffar; Carrero, Juan Jesús

doi:10.1007/s10157-012-0728-x

Cited by 82 publications

(77 citation statements)

References 33 publications

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“…10,11 Despite this, few studies have investigated the prognostic value of NLR in patients with chronic kidney disease, with none focusing solely on hemodialysis patients. 12,13 The aims of this study were to explore the relationship between NLR and other biochemical parameters, and to examine the value of NLR as a predictor of cardiovascular and all-cause mortality in hemodialysis patients.…”

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confidence: 99%

Neutrophil–lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients

et al. 2015

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Neutrophil-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been shown to predict mortality in patients with malignancies, ischemic heart disease and peripheral vascular disease. Its prognostic value in hemodialysis patients is unclear. The aims of this study were to: (i) explore the relationship between NLR and other biochemical parameters and (ii) to examine the value of NLR as a predictor of cardiovascular and all-cause mortality in hemodialysis patients. The study included all the incident hemodialysis patients from a single center between 2007 and 2012. NLR was calculated using samples obtained 3 months after commencing hemodialysis. One hundred seventy hemodialysis patients were included with a median follow-up of 37 months. There were 54 deaths (32%). NLR was positively correlated with C-reactive protein (r ¼ 0.24, p ¼ 0.0023) and negatively correlated with hemoglobin (r ¼ À0.27, p ¼ 0.00048), albumin (r ¼ À0.23, p ¼ 0.0034) and total cholesterol (r ¼ À0.17, p ¼ 0.049) levels. In multivariate Cox regression, NLR was independently associated with both all-cause mortality (adjusted hazard ratio [HR] 1.4; 95% confidence interval [CI], 1.2-1.6; p 0.0001) and cardiovascular death (HR 1.3, 95% CI 1.1-1.6, p ¼ 0.0032). Other predictors of all-cause mortality were age (HR 1.6 per decade; 95% CI, 1.2-2.1; p ¼ 0.0017), body mass index (HR 0.93; 95% CI, 0.88-0.98; p ¼ 0.0047), albumin (HR 0.91; 95% CI, 0.86-0.97; p ¼ 0.0035) and peripheral vascular disease (HR 2.7; 95% CI, 1.4-5.1; p ¼ 0.0023). NLR is a practical, cost-efficient and easy to use predictor of cardiovascular and all-cause mortality in incident hemodialysis patients.

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Section: Introductionmentioning

confidence: 99%

Neutrophil–lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients

et al. 2015

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“…[8][9][10] The N/R ratio has been shown to be independently associated with the severity of coronary artery disease in patients with non-ST segment elevation myocardial infarction, and the ability of the N/L ratio to predict cardiovascular risk in various patient groups has been analyzed in several studies, including in patients with CKD. 7,[11][12][13][14][15][16] However, to date, the N/L ratio has not been investigated in elderly patients with CHF. In our study, we evaluated the association between the N/L ratio and the future risk of major cardiovascular events (MCE) in elderly patients admitted with CHF.…”

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Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting Adverse Events in Elderly Patients With Chronic Heart Failure

Yan

et al. 2016

Int. Heart J.

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SummaryThe neutrophil-to-lymphocyte (N/L) ratio has been associated with poor outcomes in patients with cardiovascular diseases, but it has not been studied in elderly patients with chronic heart failure (CHF).In this study, we analyzed 1355 elderly patients admitted with CHF. A multivariate logistic regression model was used to assess the independent association of the N/L ratio with chronic kidney disease (CKD). The patients were then divided into tertiles according to the N/L ratios. We used Cox regression analysis to assess the association between the N/L ratio and subsequent major cardiovascular events (MCE), including cardiac death and rehospitalization for heart failure.In the multiple logistic regression analysis, the N/L ratio was identified as a risk factor for CKD in elderly patients with CHF (odds ratio [OR] = 1.170, 95% confidence interval [CI] 1.054 to 1.298, P = 0.003). The median follow-up period was 18 months. In a multivariate analysis with the lowest tertile as the reference, the highest tertile of the N/L ratio remained significantly associated with MCE (hazard ratio [HR] = 1.425, 95% CI 1.109 to 1.832, P = 0.006), cardiac death (HR = 1.747, 95% CI 1.032 to 2.958, P = 0.038), and rehospitalization for heart failure (HR = 1.461, 95% CI 1.108 to 1.927, P = 0.007).In elderly patients with CHF, the N/L ratio is one of the important risk factors for CKD and the highest tertile of the N/L ratio is associated with an increased risk for MCE. (Int Heart J 2016; 57: 615-621)

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“…The possibility that THP regulates systemic inflammation could explain the generalized inflammatory phenotype and neutrophilia observed in "THP-deficient states," such as what is reported with advanced CKD. [22][23][24][25] This study was designed to investigate the effect of THP deficiency on systemic neutrophil homeostasis. We hypothesized that THP deficiency causes systemic neutrophilia through the production of growth factors by the kidney that stimulate granulopoiesis.…”

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Tamm-Horsfall Protein Regulates Granulopoiesis and Systemic Neutrophil Homeostasis

Micanovic¹,

Chitteti

Dagher³

et al. 2015

Journal of the American Society of Nephrology

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Tamm-Horsfall protein (THP) is a glycoprotein uniquely expressed in the kidney. We recently showed an important role for THP in mediating tubular cross-talk in the outer medulla and in suppressing neutrophil infiltration after kidney injury. However, it remains unclear whether THP has a broader role in neutrophil homeostasis. In this study, we show that THP deficiency in mice increases the number of neutrophils, not only in the kidney but also in the circulation and in the liver, through enhanced granulopoiesis in the bone marrow. Using multiplex ELISA, we identified IL-17 as a key granulopoietic cytokine specifically upregulated in the kidneys but not in the liver of THP 2/2 mice. Indeed, neutralization of IL-17 in THP 2/2 mice completely reversed the systemic neutrophilia. Furthermore, IL-23 was also elevated in THP 2/2 kidneys. We performed real-time PCR on laser microdissected tubular segments and FACS-sorted renal immune cells and identified the S3 proximal segments, but not renal macrophages, as a major source of increased IL-23 synthesis. In conclusion, we show that THP deficiency stimulates proximal epithelial activation of the IL-23/IL-17 axis and systemic neutrophilia. Our findings provide evidence that the kidney epithelium in the outer medulla can regulate granulopoiesis. When this novel function is added to its known role in erythropoiesis, the kidney emerges as an important regulator of the hematopoietic system.

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Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease

Abstract: NLR is independently related to endothelial dysfunction and could predict composite cardiovascular endpoints independent of traditional confounding factors in patients with moderate to severe CKD.

Cited by 82 publications

References 33 publications

Neutrophil–lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients

Neutrophil–lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients

Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting Adverse Events in Elderly Patients With Chronic Heart Failure

Tamm-Horsfall Protein Regulates Granulopoiesis and Systemic Neutrophil Homeostasis

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