Abstract: Objective To investigate the relationship of neutrophil to lymphocyte ratio (NLR) with adverse outcomes in the elderly patients undergoing maintenance hemodialysis (MHD). Methods A total of 140 elderly patients who received MHD treatment at Blood Purification Center of Deyang People's Hospital from January 2017 to December 2021 were retrospectively enrolled in this study. According to whether the patients died during the follow-up period, they were divided into the death group and the survival group. The clinical data and laboratory indicators of the patients before MHD were compared between the two groups. Cox proportional risk regression model was used to analyze the risk factors affecting the survival time of elderly patients undergoing MHD, and receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of the risk factors for prognosis of the patients. Results Compared with the survival group, the death group had shorter dialysis time, lower levels of hemoglobin and lymphocytes, and higher levels of NLR, platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR) and hypersensitive C-reactive protein (P<0.05). After adjusting multiple confounding factors, multivariate COX regression analysis showed that NLR, diabetes and low level of hemoglobin were independent risk factors affecting the survival time of elderly patients undergoing MHD. ROC curve results showed that 7.66 was the best cutoff point of NLR in predicting the poor prognosis of the patients (P<0.01), with a sensitivity of 60%, a specificity of 91%, and an area under the ROC curve of 0.756 (P<0.01). Conclusions NLR is an independent risk factor that affects the survival time of the elderly MHD patients, and could effectively predict the risk of adverse prognosis in the patients.

Key words: maintenance hemodialysis, neutrophil to lymphocyte ratio, aged, prognosis