Neutrophil–lymphocyte ratio and monocyte–lymphocyte ratio as predictors of cardiovascular risk and mortality in end-stage renal disease

Background The neutrophil–lymphocyte ratio (NLR) and monocyte–lymphocyte ratio (MLR) in the peripheral blood are used as indicators of systemic inflammation and predictors of cardiovascular (CV) diseases. Aims To study the relation between both NLR and MLR and the prediction of cardiovascular events (CVE) in end-stage renal disease (ESRD) patients on regular hemodialysis. Patients and methods In all, 70 ESRD patients on regular hemodialysis were followed up for 12 months. NLR, MLR, and their individual components were determined at baseline and in the follow-up months. The changes in NLR and MLR after 12 months were compared. High-sensitivity C-reactive protein and echocardiography studies were done at baseline and after 12 months. Major CVE were recorded. Results Total leukocyte, absolute neutrophil, and monocyte counts were significantly increased over time. The presence of valvular calcification was associated with an increase in both NLR and MLR (P=0.004 and 0.001, respectively) after 12 months. The mean monocyte counts were significantly higher in patients with CV complications. The baseline monocyte count was the best to predict CV complications with a cutoff point more than 0.54 × 103/µl (sensitivity 100%, specificity 73.85%) in the receiver-operating characteristic curve. Conclusion In ESRD patients, leukocyte counts are in a dynamic change. There was no significant change in NLR or MLR over time and their changes could not predict the occurrence of CVE. The monocyte count is an excellent predictor of CV diseases. The presence of valvular calcification is associated with increases in both NLR and MLR over time.