Inflammation, glucose metabolism, and nutritional markers in relation to all-cause and cardiac mortality among initial hemodialysis patients: a multicenter cohort study.

Objective: To investigate the prognostic value of inflammatory biomarkers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), glucose metabolism (glucose-to-lymphocyte ratio, GLR), and nutritional (albumin, ALB) biomarkers for predicting all-cause and cardiac mortality in patients initiating hemodialysis (HD), and evaluates their incremental value when integrated into traditional risk models. Methods: A retrospective cohort of 795 initial HD patients (2014-2020) was analyzed, with follow-up through 2022. Cox proportional hazards models were used to assess associations between biomarkers and mortality. Predictive performance was evaluated using time-dependent ROC curves, C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Patients were randomly assigned to training ( Results: Elevated NLR, PLR, and GLR were independently associated with increased all-cause and cardiac mortality, whereas lower LMR and ALB were protective (all Conclusion: Incorporating inflammatory, glucose metabolism and nutritional biomarkers into traditional risk models substantially improves long-term mortality risk stratification in initial HD patients, offering a robust, clinically applicable tool to support individualized prognostic assessment and intervention planning.