Predictive value of monocyte-to-high-density lipoprotein ratio for all-cause mortality in maintenance hemodialysis patients

Objective  To explore the predictive value of monocyte-to-high-density lipoprotein (HDL) ratio (MHR) for all-cause mortality in maintenance hemodialysis (MHD) patients.

Methods  From November 2014 to November 2020, 100 MHD patients admitted into Blood Purification Center were recruited. At the end of the study, 24 patients died and 76 survived. The inter-group differences of general profiles, laboratory parameters, MHR, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP)-to-albumin ratio (CAR) were compared. The influencing factors of death were analyzed by Logistics regression. Based upon the level of median MHR, they were divided into two groups of high MHR (n=50) and low MHR (n=50). Survival analysis was conducted by the Kaplan-Meier method. Receiver operating characteristic (ROC) curve was plotted for assessing the predictive values of the relevant parameters for all-cause death.

Results  Patients were older in death group than those in survival group 77.00(71.25, 85.75) years vs 64.00(52.25, 73.75) years, P<0.05. The proportion of patients with diabetes (54.17% vs 28.95%) and levels of NLR 5.059(2.959, 5.961) vs 3.582(2.746, 4.468), MLR 0.391(0.300, 0.493) vs 0.317(0.227, 0.411), CRP 5.475(2.368, 7.350) mg/L vs 2.410(1.025, 5.475) mg/L, CAR 0.142(0.062, 0.208) mg/g vs 0.061(0.027, 0.144) mg/g and MHR 0.457(0.340, 0.598) vs 0.328(0.241, 0.454) were higher in death group than those in survival group (P<0.05). The level of HDL was lower in death group than that in survival group 0.840(0.725, 1.018) mmol/L vs 1.010(0.813, 1.280) mmol/L, P<0.05. Logistic regression analysis indicated that age and MHR were risk factors for all-cause mortality. Overall survival rate was lower in high MHR group than that in low MHR group (χ²=6.657, P<0.05). ROC curve implied that MHR, CAR, NLR, MLR and their combinations had predictive values for MHD patients. Area under curve (AUC) was 0.694, 0.691, 0.650, 0.647 and 0.740 respectively (P<0.05）.

Conclusions  MHR has clinical predictive value for all-cause mortality in MHD patients.