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

Yalcin Solak, Mahmut Ilker Yilmaz, Alper Sonmez, Mutlu Saglam, Erdinc Cakir, Hilmi Umut Unal, Mahmut Gok, Kayser Caglar, Yusuf Oguz, Mujdat Yenicesu, Murat Karaman, Seyit Ahmet Ay, Abduzhappar Gaipov, Suleyman Turk, Abdulgaffar Vural, Juan J. Carrero

Research output: Contribution to journalArticle

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Abstract

Background: Increased inflammation is common in patients with chronic kidney disease (CKD) and is associated with increased adverse cardiovascular events (CVE). Neutrophil-to-lymphocyte ratio (NLR) was used to predict survival in patients with acute coronary syndrome. We aimed to evaluate predictive ability of NLR in CKD patients. Methods: 225 subjects with stage 3-5 CKD were followed for a mean of 39 months. Fatal and nonfatal CVE were recorded during this period. NLR at baseline was determined from complete blood count differential. Endothelial dysfunction (flow-mediated dilation, FMD), hsCRP and insulin resistance were determined. We investigated if NLR could predict development of fatal and nonfatal CVE. We also looked at how NLR and its individual components change across CKD stages and whether NLR is related to CRP, insulin resistance and endothelial dysfunction. Results: There were 70, 74 and 81 patients in groups of CKD stage-3, stage-4 and stage-5, respectively. Median NLR was 2.81. NLR showed a significant increase from stage 3 to stage 5. NLR was inversely associated with FMD independent of hsCRP. 14 fatal and 52 nonfatal CVE occurred during follow-up period. NLR could predict composite CVE independent of insulin resistance and hsCRP. Increased NLR over 2.81 was related to a significantly decreased survival time (log-rank Chi-square = 14.833, P < 0.0001). A cutoff value for NLR ≥3.76 could predict development of composite CVE with 80.3 % sensitivity and 91.8 % specificity. Conclusions: 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.

Original languageEnglish
Pages (from-to)532-540
Number of pages9
JournalClinical and Experimental Nephrology
Volume17
Issue number4
DOIs
Publication statusPublished - Aug 1 2013
Externally publishedYes

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Chronic Renal Insufficiency
Neutrophils
Lymphocytes
Insulin Resistance
Dilatation
Survival
Blood Cell Count
Acute Coronary Syndrome
Inflammation

Keywords

  • Cardiovascular events
  • Chronic kidney disease
  • Endothelial dysfunction
  • Neutrophil to lymphocyte ratio

ASJC Scopus subject areas

  • Nephrology
  • Physiology
  • Physiology (medical)

Cite this

Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease. / Solak, Yalcin; Yilmaz, Mahmut Ilker; Sonmez, Alper; Saglam, Mutlu; Cakir, Erdinc; Unal, Hilmi Umut; Gok, Mahmut; Caglar, Kayser; Oguz, Yusuf; Yenicesu, Mujdat; Karaman, Murat; Ay, Seyit Ahmet; Gaipov, Abduzhappar; Turk, Suleyman; Vural, Abdulgaffar; Carrero, Juan J.

In: Clinical and Experimental Nephrology, Vol. 17, No. 4, 01.08.2013, p. 532-540.

Research output: Contribution to journalArticle

Solak, Y, Yilmaz, MI, Sonmez, A, Saglam, M, Cakir, E, Unal, HU, Gok, M, Caglar, K, Oguz, Y, Yenicesu, M, Karaman, M, Ay, SA, Gaipov, A, Turk, S, Vural, A & Carrero, JJ 2013, 'Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease', Clinical and Experimental Nephrology, vol. 17, no. 4, pp. 532-540. https://doi.org/10.1007/s10157-012-0728-x
Solak, Yalcin ; Yilmaz, Mahmut Ilker ; Sonmez, Alper ; Saglam, Mutlu ; Cakir, Erdinc ; Unal, Hilmi Umut ; Gok, Mahmut ; Caglar, Kayser ; Oguz, Yusuf ; Yenicesu, Mujdat ; Karaman, Murat ; Ay, Seyit Ahmet ; Gaipov, Abduzhappar ; Turk, Suleyman ; Vural, Abdulgaffar ; Carrero, Juan J. / Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease. In: Clinical and Experimental Nephrology. 2013 ; Vol. 17, No. 4. pp. 532-540.
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T1 - Neutrophil to lymphocyte ratio independently predicts cardiovascular events in patients with chronic kidney disease

AU - Solak, Yalcin

AU - Yilmaz, Mahmut Ilker

AU - Sonmez, Alper

AU - Saglam, Mutlu

AU - Cakir, Erdinc

AU - Unal, Hilmi Umut

AU - Gok, Mahmut

AU - Caglar, Kayser

AU - Oguz, Yusuf

AU - Yenicesu, Mujdat

AU - Karaman, Murat

AU - Ay, Seyit Ahmet

AU - Gaipov, Abduzhappar

AU - Turk, Suleyman

AU - Vural, Abdulgaffar

AU - Carrero, Juan J.

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N2 - Background: Increased inflammation is common in patients with chronic kidney disease (CKD) and is associated with increased adverse cardiovascular events (CVE). Neutrophil-to-lymphocyte ratio (NLR) was used to predict survival in patients with acute coronary syndrome. We aimed to evaluate predictive ability of NLR in CKD patients. Methods: 225 subjects with stage 3-5 CKD were followed for a mean of 39 months. Fatal and nonfatal CVE were recorded during this period. NLR at baseline was determined from complete blood count differential. Endothelial dysfunction (flow-mediated dilation, FMD), hsCRP and insulin resistance were determined. We investigated if NLR could predict development of fatal and nonfatal CVE. We also looked at how NLR and its individual components change across CKD stages and whether NLR is related to CRP, insulin resistance and endothelial dysfunction. Results: There were 70, 74 and 81 patients in groups of CKD stage-3, stage-4 and stage-5, respectively. Median NLR was 2.81. NLR showed a significant increase from stage 3 to stage 5. NLR was inversely associated with FMD independent of hsCRP. 14 fatal and 52 nonfatal CVE occurred during follow-up period. NLR could predict composite CVE independent of insulin resistance and hsCRP. Increased NLR over 2.81 was related to a significantly decreased survival time (log-rank Chi-square = 14.833, P < 0.0001). A cutoff value for NLR ≥3.76 could predict development of composite CVE with 80.3 % sensitivity and 91.8 % specificity. Conclusions: 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.

AB - Background: Increased inflammation is common in patients with chronic kidney disease (CKD) and is associated with increased adverse cardiovascular events (CVE). Neutrophil-to-lymphocyte ratio (NLR) was used to predict survival in patients with acute coronary syndrome. We aimed to evaluate predictive ability of NLR in CKD patients. Methods: 225 subjects with stage 3-5 CKD were followed for a mean of 39 months. Fatal and nonfatal CVE were recorded during this period. NLR at baseline was determined from complete blood count differential. Endothelial dysfunction (flow-mediated dilation, FMD), hsCRP and insulin resistance were determined. We investigated if NLR could predict development of fatal and nonfatal CVE. We also looked at how NLR and its individual components change across CKD stages and whether NLR is related to CRP, insulin resistance and endothelial dysfunction. Results: There were 70, 74 and 81 patients in groups of CKD stage-3, stage-4 and stage-5, respectively. Median NLR was 2.81. NLR showed a significant increase from stage 3 to stage 5. NLR was inversely associated with FMD independent of hsCRP. 14 fatal and 52 nonfatal CVE occurred during follow-up period. NLR could predict composite CVE independent of insulin resistance and hsCRP. Increased NLR over 2.81 was related to a significantly decreased survival time (log-rank Chi-square = 14.833, P < 0.0001). A cutoff value for NLR ≥3.76 could predict development of composite CVE with 80.3 % sensitivity and 91.8 % specificity. Conclusions: 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.

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KW - Chronic kidney disease

KW - Endothelial dysfunction

KW - Neutrophil to lymphocyte ratio

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