Neutrophil-Lymphocyte ratio and Monocyte-Lymphocyte ratio as predictors of cardiovascular risk and mortality in End Stage Renal disease

Abstract

Seventy ESRD patients on regular hemodialysis (HD) were followed up for 12 months. NLR,MLR, their individual components were determined at baseline and in the follow up months. The changes in NLR and MLR after 12 months were compared. High sensitivity C-reactive protein (hs-CRP) and echocardiography studies were done at baseline and after 12 months. Major cardiovascular events (CVE) were recorded. We investigated if changes in NLR or MLR could predict CVE. Total leucocytic, absolute neurophil and monocyte counts were significantly increased over time. There was no significant relation between either changes in NLR or MLR after 12 months with baseline characteristics except for valvular calcification which its presence is significantly related to an increase in both NLR and MLR(p 0.004 and 0.001 respectively). The mean monocyte counts at baseline, after 6 months and after 12 months were significantly higher in the patients with CV complications (0.69±0.17, 0.72±0.11, 0.73±0.20) 103/ul respectively compared to those with no CV complications (0.47±0.18, 0.52±0.17, 0.52 ±0.18) 103/ul respectively (p 0.010, 0.010 and 0.015 respectively).Based on the ROC curve, we found the monocyte baseline count the best to predict CV complications with an area under the curve of 0.857 and the best cut off point was >0.54 103/ul (100% sensitivity and 73.85% specificity).