Prognostic Value of Inflammatory Indices and the Advanced Lung Cancer Inflammation Index (ALI) for Survival Outcomes in Hemodialysis Patients.

Background and Objectives: Chronic systemic inflammation and malnutrition drive adverse outcomes in maintenance hemodialysis (HD) patients. This study investigated the prognostic utility of four accessible inflammatory indices-systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), atherogenic index of plasma (AIP), and advanced lung cancer inflammation index (ALI)-in predicting survival. Materials and Methods: This retrospective cohort study evaluated electronic health records of 222 incident HD patients in Turkey (2014-2021), followed through December 2024. Baseline biomarkers were calculated prior to HD initiation. Survival outcomes were assessed using Kaplan-Meier curves, and independent predictors of all-cause mortality were determined via multivariable Cox proportional hazards regression models. Results: During a median follow-up of 24.9 months, 106 patients (47.7%) died. Non-survivors presented with significantly higher median SII, NLR, and AIP, and markedly lower ALI than survivors (all p < 0.001). Multivariable analysis revealed that elevated SII (HR: 1.035, 95% CI: 1.020-1.050; p < 0.001) and NLR (HR: 1.081, 95% CI: 1.042-1.122; p < 0.001) were risk factors for mortality. In contrast, higher ALI demonstrated a significant protective effect on survival (HR: 0.975, 95% CI: 0.953-0.998; p = 0.036). Kaplan-Meier analyses confirmed superior overall survival in patients with lower SII, NLR, AIP, and higher ALI. Conclusions: SII, NLR, AIP, and ALI are practical, cost-effective biomarkers for mortality risk stratification in HD patients. ALI, integrating both nutritional and inflammatory dimensions, demonstrates particularly robust prognostic value for predicting survival.