Neutrophils to Lymphocytes Ratio is an Easy Non Expensive Marker of Inflammation in Hemodialysis Patients

Background: Patients with end stage renal disease (ESRD) have elevated levels of inflammatory mediators including Creactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Neutrophil to lymphocyte ratio was introduced as a novel inexpensive indicator that reflects the severity and extension of systemic inflammation and atherosclerosis, and predicts adverse clinical outcomes in cardiac and non-cardiac disorders including ESRD.

The aim of this study is to evaluate the frequency of subclinical inflammation using neutrophil to lymphocyte ratio (NLR) and its relation to other biochemical parameters in ESRD patients on maintenance haemodialysis (HD) in comparison to high-sensitivity C-reactive protein (hsCRP).

Methods: A cross sectional observational study including 100 clinically stable ESRD patients on regular haemodialysis (mean age 48.25 ± 13.67, 57% were males), NLR was calculated from complete blood count and hsCRP was recorded for all patients where 8.2 mg/L indicated inflammation.

Results: NLR was positively correlated to hsCRP, using ROC curve (AUC=0.647) and the best cut off point to detect subclinical inflammation in HD patients was calculated with NLR greater than or equal 1.54, with sensitivity 68.25% and specificity 54%. By using univariate and multiple variate analysis in our work to test for independent predictors of hsCRP levels as an indicator for inflammation, it was found that NLR can be used as an independent predictor of hsCRP as an inflammatory marker, with statistically significant correlation (p=0.015). Spearman coefficient (rs=0.220) shows statistically significant (p=0.028) positive correlation between NLR and hsCRP.

Conclusion: NLR is an easy, simple and non-expensive method that can be used as a marker of inflammation in HD patients when compared to hsCRP.


Abdelbassit Shaarawy, Aber Halim Baki, Nahla Mohamed Teama, Rania M Abdel Halim, Noha Alaa Eldin Fahim and Reem Ahmed Sultan

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