Abstract Body (Do not enter title and authors here): Background: The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker predicting cardiovascular mortality (CVM) and all-cause mortality (ACM) among the general population. We aim to investigate this association in patients who underwent peritoneal dialysis (PD).
Methods: We systematically reviewed articles from PubMed, Google Scholar, and Scopus until May 2024 on the association of ACM and CVM in patients with NLR following PD. We used a fixed effects model, 95% confidence intervals (CI), and I² statistics to pool unadjusted and adjusted hazard ratios (HR) and measure heterogeneity. Leave-one-out sensitivity analysis was employed to study how each study alters the overall effect of the studies. Multivariate meta-regression was utilized to identify influencing confounding factors. Quality assessment of the studies was done through the Joanna Briggs Institute (JBI) tool. For all results, a P value < 0.05 was considered significant.
Results: Out of 160 articles screened, seven studies spanning from 2011 to 2023 with 4,350 patients, a mean age of 49.9 ± 15, and a median follow-up of four years were included in our meta-analysis. We found that higher NLR (>2.88) was significantly associated with ACM (aHR: 1.09, 95% CI: 1.05–1.12, p<0.0001) (Fig. 1a) and CVM (aHR: 1.08, 95% CI: 1.03–1.13, p=0.002) (Fig.1b) in patients following PD. Sensitivity analysis showed no variations, indicating that no single study influenced the overall results. JBI tool scores revealed low bias among the studies. Multivariate meta-regression revealed a significant relationship between age and ACM outcomes (Coefficient: 0.14, 95% CI: 0.001–0.2905, p=0.04) (Fig.1d).
Conclusion: Our meta-analysis identifies a significant association between higher NLR (>2.88) and outcomes such as ACM and CVM. This association can help prevent deaths in the older population and encourage proper utilization of the elderly resources. Additionally, age was a significant potential confounder for ACM in patients who are receiving PD. Thus, caution should be taken when predicting mortality in the elderly population.