Peripheral blood myeloid-to-lymphoid ratio: a novel indicator for assessing renal and cardiovascular risks in chronic kidney disease patients-a multicenter longitudinal investigation.

backgroundThe myeloid-to-lymphoid ratio (MLR) has been associated with adverse outcomes in various clinical settings; however, its prognostic significance in chronic kidney disease (CKD) remains to be elucidated.

methodsWe conducted a comprehensive analysis utilizing data from the Research in Evaluation and Treatment aimed at Renal Disease (RETARD) cohort and the National Health and Nutrition Examination Survey (NHANES) database. The primary objective was to determine whether baseline peripheral blood MLR could predict the occurrence of end-stage kidney disease (ESKD), cardiovascular events (CVD), and overall mortality in CKD patients. MLR values were calculated, and optimal thresholds for predicting ESKD and CVD were established using rank statistics. To thoroughly assess the predictive capacity of MLR, we employed restricted cubic splines, weighted Cox regression, stratified analyses, and time-dependent receiver-operating characteristic (ROC) curves.

resultsA total of 1704 CKD patients were included in the study, with an average age of 47 years and 48.90% being female. Compared to healthy controls, CKD patients exhibited a significantly higher MLR (p < 0.001). MLR was positively correlated with serum creatinine, blood urea nitrogen, and cystatin-C levels, while it was negatively correlated with the estimated glomerular filtration rate. Over a median follow-up period of 4.86 years, 356 ESKD events and 272 CVD events were recorded. Kaplan-Meier analysis demonstrated that a higher MLR was associated with an increased risk of both ESKD and CVD. After multivariate adjustment, a high MLR was linked to a 1.3-fold increased risk for ESKD (hazard ratio [HR] = 1.317, 95% confidence interval [CI] 1.040-1.660, p = 0.020) and CVD events (HR = 1.349, 95% CI 1.050-1.740, p = 0.021). In addition, the predictive value of MLR for overall mortality and cardiovascular-specific mortality was validated in the NHANES database (p = 0.001). Receiver operating characteristic (ROC) curve analysis indicated that incorporating MLR with clinical parameters significantly enhanced the prediction of ESKD events (area under the curve [AUC] = 0.927, 95% CI 0.911-0.943) and CVD events (AUC = 0.814, 95% CI 0.781-0.846).

conclusionsBaseline peripheral blood MLR serves as a significant predictor of ESKD, CVD, and overall mortality in CKD patients, highlighting its potential as a valuable biomarker for risk stratification.