Abstract: Objective  To investigate the value of neutrophil/lymphocyte ratio (NLR), Platelet/lymphocyte ratio (PLR) and serum lipoprotein phospholipase A2 (Lp-PLA2) in the diagnosis of protein energy wasting in patients undergoing maintenance hemodialysis (MHD).  Methods   Clinical data of 327 patients with end stage renal disease (ESRD) who received MHD treatment in Taizhou People's Hospital were collected. According to the International Society of Renal Nutrition and metabolism the patients with MHD who developed PEW were divided into PEW and non-PEW groups. The application values of NLR, PLR, and serum Lp-PLA2 in the diagnosis of PEW in MHD patients were compared.  Results  In the PEW group, Body Mass Index (BMI) (Z=-5.358, P＜0.001), albumin (Z=-8.147, P＜0.001), prealbumin (Z=-5.363, P＜0.001), total cholesterol (Z=-2.297, P =0.022), creatinine (Z=-4.168, P＜0.001), uric acid (t=-2.326, P =0.020) levels were significantly lower than those in non-Pew group, age (Z=-2.753, P=0.006), NLR (Z=-5.588, NLR (Z=-5.588, P=0.020), and NLR (Z=-4.168, P＜0.001) were significantly lower than those in non-Pew group, P＜0.001), PLR (Z=-4.672, P＜0.001) and Lp-PLA2 (t=-9.269, P＜0.001) levels were significantly higher than those in non-Pew group. The results of multivariate binary Logistic stepwise regression equation analysis showed that NLR (OR=1.094,95% CI:1.004～1.192,P=0.041), PLR (OR=1.021, 95% CI:1.009～1.033,＜0.001), Lp-PLA2 (OR=1.085, 95% CI:1.056～1.114, P＜0.001) levels were independent risk factors for PEW in hemodialysis patients. NLR (95% CI:0.631～0.756, P＜0.001), PLR (95%CI: 0.597～0.726, P＜0.001), Lp-PLA2 (95% CI:0.735～0.841, P＜0.001), NLR combined PLR (95% CI:0.631～0.756, P＜0.001) 0.650～0.775, P＜0.001), NLR combined with Lp-PLA2 (95% CI: 0.800～0.889, P＜0.001), PLR combined with Lp-PLA2 (95% CI: 0.782～0.875, P＜0.001), NLR combined with PLR and Lp-PLA2 (95% CI: 0.809～0.895, P＜0.001) area under ROC curve were 0.693, 0.662, 0.788, 0.713, 0.844, 0.829, 0.852, respectively. NLR, PLR, Lp-PLA2 all had certain diagnostic value for the occurrence of PEW in MHD patients. The area under ROC curve was 0.852 (95% CI: 0.809～0.895, P＜0.001) when the three combined, indicating the maximum diagnostic efficiency.  Conclusion  NLR, PLR and serum Lp-PLA2 levels can be used as reference indicators for PEW in MHD patients, and strengthening the joint monitoring of NLR, PLR and serum Lp-PLA2 levels can provide intervention evidence for the diagnosis and treatment of PEW.

Key words: Protein energy consumption, Maintenance hemodialysis, Neutrophil/lymphocyte ratio, Platelet/lymphocyte ratio, Lipoprotein phospholipase A2