Background. Neutrophil to lymphocyte ratio (NLR) is a new inflammatory marker; the relationship between NLR and adverse cardiovascular (CV) prognosis has been gradually emphasized in the general population. However, their association in peritoneal dialysis (PD) patients remains unclear. Methods. From January 1, 2010, to May 31, 2017, a total of 1652 patients were recruited. NLR was categorized in triplicates: NLR≤2.74, 2.74<NLR≤3.96, and NLR>3.96. Kaplan-Meier cumulative incidence curve and multivariable COX regression analysis were used to determine the relationship between NLR and the incidence of adverse CV outcome, while a competitive risk model was applied to assess the effects of other outcomes on adverse CV prognosis. Besides, forest plot was investigated to analyze the adverse CV prognosis in different subgroups. Results. During follow-up, 213 new-onset CV events and 153 CV disease (CVD) deaths were recorded. Multivariable COX regression models showed that the highest tertile of NLR level was associated with increased risk of CV events (HR=1.39, 95%CI=1.01‐1.93, P=0.046) and CVD mortality (HR=1.81, 95%CI=1.22‐2.69, P=0.003), while compared to the lowest tertile. Competitive risk models showed that the differences in CV event (P<0.001) and CVD mortality (P=0.004) among different NLR groups were still significant while excluding the effects of other outcomes. In subgroups, with each 1 increased in the NLR level, adjusted HR of new-onset CV event was 2.02 (95%CI=1.26−3.23, P=0.003) and CVD mortality was 2.98 (95%CI=1.58−5.62, P=0.001) in the younger group (age<60 years). Conclusions. NLR is an independent risk factor for adverse CV prognosis in PD patients younger than 60 years old.

Background. Although mean platelet volume (MPV) appears to be associated with poor outcome of pneumonia, the relationship between MPV and in-hospital mortality is unclear in severe pneumonia (SP) patients. Methods. In this retrospective cohort study, 115 SP patients from June 1st, 2016, to September 29th, 2019, were included and divided into two groups. The primary outcome was in-hospital mortality. The receiver operating characteristic (ROC) curve was performed to assess the predictive ability for in-hospital mortality. Kaplan-Meier cumulative incidence curves were applied to observe the incidence of mortality. Multivariable Cox regression analyses were used to evaluate the hazard ratios (HRs). Besides, a formal test for interaction was investigated to analyze the relationship between MPV and sex. Results. During the course of hospitalization, 63 cases of mortality were recorded. ROC analysis suggested that MPV had a modest power for predicting in-hospital mortality (AUC=0.723, 95% CI: 0.628-0.818, P<0.001). Yet the cutoff value of MPV was 10.5 (sensitivity=73.02%; specificity=73.08%). Compared to the low-MPV group, the high-MPV group had significantly increased in-hospital mortality (log-rank test=13.501, P<0.001), while the adjusted Cox model indicated that the high-MPV group was associated with an elevated risk of in-hospital mortality (HR: 2.267, 95% CI: 1.166-4.406, P=0.016). Moreover, analyses of in-hospital mortality suggested a significant interaction between optimal MPV level and sex (P=0.011). In a multivariate Cox model which included females only, a high MPV level was associated with increased risk of in-hospital mortality (HR: 11.387, 95% CI: 1.767-73.380, P=0.011). Conclusion. High MPV level is an independent risk factor for in-hospital mortality in patients with SP.

Malnutrition and inflammation are associated with mortality in peritoneal dialysis (PD) patients. Serum albumin and non-high-density lipoprotein cholesterol (non-HDL-C) are independently associated with mortality in PD patients. Combining albumin and non-HDL-C with mortality may be more plausible in clinical practice. This retrospective cohort study included 1954 Chinese PD patients from 1 January 2009 to 31 December 2016. Kaplan-Meier curve was used to determine the relationship between albumin to non-HDL-C ratio and all-cause mortality. Cox regression analysis was applied to assess the independent predictive value while adjusting for confounding factors. Competitive risk analysis was used to examine the effects of other outcomes on all-cause mortality prognosis. In the 33-month follow-up period, there were 538 all-cause deaths. Kaplan-Meier analysis presented significant differences in all-cause mortality. Multivariate Cox regression showed that the risk of all-cause mortality was lower in the moderate group (9.36-12.79) (HR, 0.731; 95% CI, 0.593-0.902, p = 0.004) and the highest group (>12.79) (HR, 0.705; 95% CI, 0.565-0.879, p = 0.002) compared to the lowest group (≤9.36). Competitive risk analysis revealed significant differences for all-cause mortality (p < 0.001), while there was no statistical significance for other competing events. Low albumin to non-HDL-C ratio was associated with a high risk of all-cause mortality in PD patients. It may serve as a potential prognostic biomarker in PD patients.

In individuals receiving continuous ambulatory peritoneal dialysis (CAPD), remnant cholesterol (RC) and high-density lipoprotein cholesterol (HDL-C) levels significantly influence clinical outcomes. Current clinical practice might benefit from assessing these two lipid markers in combination when evaluating cardiovascular disease (CVD) and all-cause mortality. Therefore, this research sought to examine how the RC/HDL-C ratio correlates with both CVD and all-cause mortality rates among individuals receiving CAPD treatment. Between January 1, 2005 and December 31, 2016, a multi-center retrospective analysis of 2006 CAPD patients from five peritoneal dialysis hospitals in China was conducted. Participants were split into two subgroups in accordance with the baseline serum RC/HDL-C ratio restricted cubic spline cutoff value. The correlations between mortality and RC/HDL-C ratio were examined through case-specific hazard modeling. The observation period documented 549 all-cause fatalities, with cardiovascular deaths accounting for 269 cases. The Kaplan-Meier analysis revealed statistically significant divergence in both all-cause mortality (log rank test P < 0.001) and CVD mortality (log rank test P = 0.003). Elevated RC/HDL-C ratios showed increased hazard ratios (HR) for all-cause mortality (1.335, 95% CI, 1.112–1.603, P = 0.002) and CVD mortality (1.319, 95% CI, 1.013–1.717, P = 0.040) compared to lower ratio counterparts. Nevertheless, no statistically meaningful association was found between CVD mortality and either RC (HR: 1.296, 95% CI, 0.992–1.691, P = 0.057) or HDL-C (HR: 0.887, 95% CI, 0.680–1.157, P = 0.376). The RC/HDL-C ratio independently predicts mortality in CAPD patients, persisting as a significant prognostic marker after multivariable adjustment.