The Diagnostic Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Predicting Mortality Among Patients Undergoing Hemodialysis at Rayong Hospital

Abstract

     This study aimed to determine the optimal cut-off values of NLR and PLR and to identify factors associated with mortality among patients undergoing hemodialysis at Rayong Hospital. A retrospective cohort study included patients with ESRD receiving maintenance hemodialysis at Rayong Hospital. Data were obtained from hospital medical records between January 1, 2020 and December 31, 2021, with follow-up until December 31, 2025 to ascertain survival status. A total of 101 patients were included. Descriptive and inferential statistics were applied. Categorical variables were analyzed using the chi-square test or Fisher’s exact test, and continuous variables were compared using the independent t-test, Mann-Whitney-U test. Optimal cut-off values were determined using diagnostic test analysis. Survival analysis was performed, and factors associated with mortality were identified using stepwise Cox proportional hazards regression.

     The results demonstrated that, among 101 patients, 27 deaths occurred during follow-up (26.7%), with a median survival of 5.9 years. Regarding discriminatory performance for mortality prediction, the neutrophil-to-lymphocyte ratio (NLR) yielded an area under the receiver operating characteristic curve (AUC) of 0.68, with an optimal cut-off value of 4.93 (sensitivity 50.0%, specificity 82.9%). The platelet-to-lymphocyte ratio (PLR) demonstrated an AUC of 0.62, with a cut-off value of 367.31 (sensitivity 41.2%, specificity 80.6%). In multivariable Cox proportional hazards regression analysis, NLR ≥ 4.93 (adjusted HR 2.75; 95% CI 1.26–5.99) and the presence of cardiovascular disease (adjusted HR 3.05; 95% CI 1.11–8.44) were identified as independent predictors of mortality.