Abstract
OBJECTIVE: This study aimed to re-evaluate the prognostic value of inflammation and nutrition-related indices in a large multicenter cohort of hemodialysis patients from 138 dialysis centers in Beijing. METHODS: This retrospective cohort study included 6,679 hemodialysis patients. Indices were calculated from routine laboratory parameters. Survival analyses included Kaplan-Meier curves and multivariate Cox models. C-index, receiver operating characteristic curves and decision curve analysis were used to evaluate the predictive ability of the different indicators. RESULTS: All indicators (including Prognostic Nutritional Index [PNI], Lymphocyte-to-CRP Ratio [LCR], CRP-to-Albumin Ratio [CAR], Systemic Immune-Inflammation Index [SII], Platelet-to-Lymphocyte Ratio [PLR], and Neutrophil-to-Lymphocyte Ratio [NLR]) except for PLR were identified as independent predictors of OS (overall survival). Among these indicators, the PNI consistently demonstrated superior discriminatory ability in predicting outcomes among hemodialysis patients. Multivariate Cox regression analysis showed that the risk of mortality in hemodialysis decreased with an increase in PNI (adjusted HR 0.78, 95% CI: 0.75-0.82, P < 0.01). The optimal cut-off value for PNI was determined to be 42.3. CONCLUSIONS: PNI has demonstrated better reliability as a prognostic indicator for hemodialysis patients compared with LCR, CAR, SII, PLR and NLR. The efficient assessment of PNI effectively identifies high-risk individuals and highlights its significance as a valuable prognostic tool in clinical settings.