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Abstract

I n t r o d u c t i o n: A high neutrophil-to-lymphocyte ratio (NLR) has been reported to be a strong biomarker of inflammation.

A i m: We sought to evaluate the impact of NLR on long-term all-cause and cardio-vascular (CV) mortality in hemodialysis (HD) patients.

Ma t e r i a l a n d Me t h o d s: A total of 84 chronic kidney disease (CKD) stage 5 patients with 54 of them on HD, with a median age of 61.5 (51.3–74.8) years were enrolled. The association between NLR and clinical biomarkers was investigated. Multivariable Cox regression analysis was used to find significant predictors of all-cause and CV mortality at follow-up.

R e s u l t s: The median NLR (interquartile range) was 3.0 (2.1–4.1). Patients with NLR ≥3.9 (the highest tertile) had higher five-year all-cause mortality then remaining patients (53.6% vs. 30.4%; p = 0.039). On the contrary, only a trend towards increased CV mortality was observed (25.0% vs. 42.9%; p = 0.10). NLR ≥3.9 was a significant predictor of all-cause mortality at five years [hazard ratio (95%CI): 2.23 (1.10– 4.50); p = 0.025] in Cox regression model adjusted for age, gender, and diabetes status. Similarly, while using NLR as continuous variable a significant association between NLR and all-cause mortality was confirmed even after adjustment for covariates [hazard ratio per 1 unit increase (95%CI): 1.26 (1.06–1.51); p = 0.009] with the area under the receiver operating characteristic (ROC) curve of 0.64. Correlations between NLR and WBC, concentration of fibrinogen, albumin were observed.

C o n c l u s i o n s: Asymptomatic inflammation measured by NLR showed an association with long-term all-cause mortality in stage 5 CKD patients, even while white blood cell count was in the normal range.

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Authors and Affiliations

Karolina Woziwodzka
Artur Dziewierz
Magdalena Pawica
Agnieszka Panek
Marcin Krzanowski
Paulina Gołasa
Paweł Latacz
Magdalena Burkat
Marek Kuźniewski
Katarzyna Krzanowska
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Abstract

The complex course of the COVID-19 and the distant complications of the SARS-CoV-2 infection still remain an unfaded challenge for modern medicine. The care of patients with the sympto-matic course of COVID-19 exceeds the competence of a single specialty, often requiring a multispecialist approach. The CRACoV-HHS (CRAcow in CoVid pandemic — Home, Hospital and Staff) project has been developed by a team of scientists and clinicians with the aim of optimizing medical care at hospital and ambulatory settings and treatment of patients with SARS-CoV-2 infection. The CRACoV project integrates 26 basic and clinical research from multiple medical disciplines, involving different populations infected with SARS-CoV-2 virus and exposed to infection.
Between January 2021 and April 2022 we plan to recruit subjects among patients diagnosed and treated in the University Hospital in Cracow, the largest public hospital in Poland, i.e. 1) patients admitted to the hospital due to COVID-19 [main module: ‘Hospital’]; 2) patients with signs of infection who have been confirmed as having SARS-CoV-2 infection and have been referred to home isolation due to their mild course (module: ‘Home isolation’); 3) patients with symptoms of infection and high exposure to SARS- CoV-2 who have a negative RT-PCR test result. In addition, survey in various professional groups of hospital employees, both medical and non-medical, and final-fifth year medical students (module: ‘Staff’) is planned.
The project carries both scientific and practical dimension and is expected to develop a multidisciplinary model of care of COVID-19 patients as well as recommendations for the management of particular groups of patients including: asymptomatic patient or with mild symptoms of COVID-19; symptomatic patients requiring hospitalization due to more severe clinical course of disease and organ complications; patient requiring surgery; patient with diabetes; patient requiring psychological support; patient with undesirable consequences of pharmacological treatment.
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Bibliography

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2. Sydor W.: COVID-19 a zaburzenia krzepnięcia. Medical Research Reviews. ISBN 978–83–65515–97–1.
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6. Undas A., Podolak-Dawidziak M., Pruszczyk P., Windyga J.: Tromboprofilaktyka i leczenie przeciwkrzepliwe u dorosłych chorych hospitalizowanych z powodu COVID-19. 30 marca 2020. https://nil.org.pl/aktualnosci/5395-tromboprofilaktyka-i-leczenie-przeciwkrzepliwe-u-doroslych- chorych-hospitalizowanych-z-powodu-covid-19.
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Authors and Affiliations

Wojciech Sydor
1 2
Barbara Wizner
3
Magdalena Strach
2
Monika Bociąga-Jasik
4 5
Krzysztof Mydel
6
Agnieszka Olszanecka
7
Marek Sanak
8 5
Maciej Małecki
9 5
Jadwiga Wójkowska-Mach
10
Robert Chrzan
11
Aleksander Garlicki
4 5
Tomasz Gosiewski
12 5
Marcin Krzanowski
13 5
Jarosław Surowiec
14 5
Stefan Bednarz
15 5
Marcin Jędrychowski
16 5
Tomasz Grodzicki
3 5
The CraCoV-HHS Investigators

  1. Center for Innovative Therapies, Clinical Research Coordination Center, University Hospital in Cracow, Poland
  2. Department of Rheumatology and Immunology, Jagiellonian University Medical College, Cracow, Poland
  3. Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
  4. Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, Cracow, Poland
  5. Steering Committee of the CRACoV-HHS
  6. Deputy Director for Coordination and Development, University Hospital in Cracow, Poland
  7. Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Cracow, Poland
  8. 2nd Department of Internal Medicine, Jagiellonian University Medical College, Cracow, Poland
  9. Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Cracow, Poland
  10. Chair of Microbiology, Medical Faculty, Jagiellonian University Medical College, Cracow, Poland
  11. Department of Radiology, Jagiellonian University Medical College, Cracow, Poland
  12. Department of Molecular Medical Microbiology, Chair of Microbiology, Medical Faculty, Jagiellonian University Medical College, Cracow, Poland
  13. Department of Nephrology and Dialysis Unit, Jagiellonian University Medical College; Deputy Medical Director, University Hospital in Cracow, Poland
  14. Head of Quality, Hygiene and Infection Control Section at University Hospital in Cracow, Poland
  15. Head of Primary Care Unit at University Hospital in Cracow, Poland
  16. Director of University Hospital in Cracow, Poland

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