Neutrophils to Lymphocytes Rato is an Easy Non Expensive Marker of Infammaton in Hemodialysis Patents Abdelbassit Shaarawy 1 , Aber Halim Baki 1 , Nahla Mohamed Teama 1* , Rania M Abdel Halim 2 , Noha Alaa Eldin Fahim 2 and Reem Ahmed Sultan 1 1 Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Egypt 2 Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Egypt * Corresponding author: Nahla Mohamed Teama, Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Egypt, Tel: 01090447009; E-mail: nahlateama25@gmail.com Received date: November 23, 2018; Accepted date: December 11, 2018; Published date: December 14, 2018 Citaton: Shaarawy A, Baki AH, Teama NM, Halim RMA, Fahim NAE, et al. (2018) Neutrophils to Lymphocytes Rato is an Easy Non Expensive Marker of Infammaton in Hemodialysis Patents. J Clin Exp Nephrol Vol.3 No.4: 19. DOI: 10.21767/2472-5056.100070 Copyright: ©2018 Shaarawy A, et al. This is an open-access artcle distributed under the terms of the Creatve Commons Atributon License, which permits unrestricted use, distributon, and reproducton in any medium, provided the original author and source are credited. Abstract Background: Patents with end stage renal disease (ESRD) have elevated levels of infammatory mediators including C- reactve protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6). Neutrophil to lymphocyte rato was introduced as a novel inexpensive indicator that refects the severity and extension of systemic infammaton and atherosclerosis, and predicts adverse clinical outcomes in cardiac and non-cardiac disorders including ESRD. The aim of this study is to evaluate the frequency of subclinical infammaton using neutrophil to lymphocyte rato (NLR) and its relaton to other biochemical parameters in ESRD patents on maintenance haemodialysis (HD) in comparison to high-sensitvity C-reactve protein (hsCRP). Methods: A cross sectonal observatonal study including 100 clinically stable ESRD patents on regular haemodialysis (mean age 48.25 ± 13.67, 57% were males), NLR was calculated from complete blood count and hsCRP was recorded for all patents where 8.2 mg/L indicated infammaton. Results: NLR was positvely correlated to hsCRP, using ROC curve (AUC=0.647) and the best cut of point to detect subclinical infammaton in HD patents was calculated with NLR greater than or equal 1.54, with sensitvity 68.25% and specifcity 54%. By using univariate and multple variate analysis in our work to test for independent predictors of hsCRP levels as an indicator for infammaton, it was found that NLR can be used as an independent predictor of hsCRP as an infammatory marker, with statstcally signifcant correlaton (p=0.015). Spearman coefcient (rs=0.220) shows statstcally signifcant (p=0.028) positve correlaton between NLR and hsCRP. Conclusion: NLR is an easy, simple and non-expensive method that can be used as a marker of infammaton in HD patents when compared to hsCRP. Keywords: hsCRP; Infammaton in HD; Neutrophil-to- lymphocyte rato Introducton End stage renal disease (ESRD) patents on regular hemodialysis (HD) have higher rates of mortality and morbidity compared to general populaton. The total life expectancy of a patent with ESRD is only one-fourth to one-ffh that of the general populaton [1]. Cardiovascular diseases (CVD) are considered to be the commonest cause of mortality, followed by infectons and septcemia as the second most common [2]. Both cardiovascular and infectous causes of death are associated with a state of chronic infammaton. Chronic infammaton, a key factor in the pathogenesis of atherosclerosis, is increased in ESRD patents compared to normal populaton. It is predicted that early and specifc detecton of infammaton might improve the quality of life of those patents and decrease rate of mortality and morbidity [3]. Patents with ESRD have elevated serum levels of infammatory mediators including C-reactve protein (CRP), interleukin (IL)-6 and tumor necrosis factor-α (TNF-α), as it has been shown that they play a central role in the vicious circle of malnutriton, infammaton, and atherosclerosis and increase risk for cardiovascular events and overall mortality in ESRD patents [4]. Leukocytes are considered the classic infammatory markers, due to their central role in the development of atherosclerosis and its complicatons by mediatng several biochemical pathways [4]. It was found that increased neutrophil count was strongly associated with malnutriton and infammaton, and that decreased lymphocyte count had a weaker associaton. Increased neutrophils and decreased lymphocytes were also an independent predictor of mortality in HD patents [3]. Research Article iMedPub Journals http://www.imedpub.com/ DOI: 10.21767/2472-5056.100070 Journal of Clinical & Experimental Nephrology ISSN 2472-5056 Vol.3 No.4:19 2018 © Under License of Creative Commons Attribution 3.0 License | This article is available from: http://clinical-experimental-nephrology.imedpub.com/ 1