Association between complex indices of blood cell types and lipid levels with all-cause, cardiovascular mortality in hemodialysis patients: A multicenter retrospective study.

BACKGROUND

Hemodialysis (HD) is significantly affected by cardiovascular diseases (CVD), immune dysfunction, and inflammation, involving interactions of inflammatory cells and lipid metabolism disorders. This study aimed to investigate the association between the complex indices and all-cause and cardiovascular mortality, as well as to compare the prognostic efficacy of the complex indices in the prediction of all-cause and cardiovascular mortality.

METHODS

This retrospective study analyzed data from 1236 patients undergoing HD in four blood purification centers in China. It investigated the association between complex indices including the pan-immune-inflammation value (PIV), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), monocyte-to-high-density lipoprotein-cholesterol ratio (MHR), and neutrophil-to-lymphocyte ratio (NLR) with all-cause and cardiovascular mortality. ROC curve analysis was employed to evaluate prognostic efficacy.

RESULTS

It was found that there were significantly positive correlations between the investigated indices (PIV, SIRI, SII, MHR, and NLR) and both all-cause and cardiovascular mortality in HD patients. MHR emerged as a stronger independent risk factor in mortality compared to the other indices, both with all-cause mortality (OR 8.80; 95%CI 1.22-63.49) and cardiovascular mortality (OR 191.65; 95%CI 43.52-843.88). PIV showed superior prognostic efficacy for all-cause (AUC 0.93; 95%CI 0.92-0.95) and cardiovascular mortality (AUC 0.93; 95%CI 0.91-0.95).

CONCLUSION

Complex indices of PIV, SIRI, SII, MHR, and NLR are significantly associated with mortality in patients under hemodialysis. MHR, as a potent independent predictor, and PIV, with its high diagnostic efficacy, played a critical role in systemic inflammation and altered lipid metabolism over the risk of mortality.