Abstract: Objective   Explore the predictive value of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) combined with C-reactive protein (CRP) for cardiovascular disease (CVD) in maintenance hemodialysis (MHD) patients.  Method  Selecting patients diagnosed with uremia and undergoing MHD in nephrology department of Civil Aviation General Hospital from August 2018 to June 2023, patients were divided into survival group and cardiovascular death group based on the occurrence of cardiovascular death events. Demographic data including age, gender, body mass index (BMI), dialysis age and laboratory data (blood routine, biochemical routine) were collected. Independent risk factors were identified by using on logistic regression analysis, and receiver operator characteristic (ROC) curves were used for predictive performance analysis.  Result  A total of 267 patients were included, including 228 of survival group and 39 of cardiovascular death group.1. There were no statistically significant difference in general data such as age  (t= -1.835, P=0.068), gender (χ2=3.515, P=0.061), BMI (t=1.971, P=0.051), and dialysis age (t=-1.092, P=0.062) between the two groups. 2. MPV [11.30(10.4, 12.6)] fL, NLR [6.75(4.8, 12.7)], and CRP [15.80(5.8, 64.5)]mg/L in cardiovascular death event group were significantly higher than survival group (Z/t values were     -7.456, -5.340, -5.416, respectively, all P＜0.001). While albumin (ALB), creatinine (Cr), calcium (Ca), phosphorus (P), and hemoglobin (Hb) were significantly lower than survival group (Z/t values were 5.968, 5.168, 4.375,    -3.552, -2.052, and P were ＜0.001, ＜0.001, ＜0.001, 0.040, 0.039, respectively). 3. Elevated levels of MPV (OR=7.182, 95% CI：2.974 ～17.348, P＜0.001)、NLR (OR=1.203, 95% CI：1.015 ～1.427, P=0.033)、CRP (OR=1.127, 95% CI：1.098 ～1.258, P=0.042) and decreased levels of Hb (OR=1.062, 95% CI：1.007～1.319, P=0.027)、Ca (OR=0.006, 95% CI：0.000～0.184,P=0.003) were independent risk factors for cardiovascular death in MHD patients. 4. ROC curve analysis indicated MPV (AUC= 0.881, 95% CI：0.821～0.940, P＜0.001), NLR (AUC= 0.764, 95% CI：0.668～0.860, P＜0.001), CRP (AUC= 0.778, 95% CI：0.677～0.878, P＜0.001), and their combined factors (including MPV, NLR, and CRP) have predictive value for cardiovascular death events in MHD patients, and the area under the curve (AUC) of combined factors was higher than the single indicator (AUC=0.931, 95% CI: 0.882～0.980, P＜0.001).  Conclusion  Elevated MPV, NLR, CRP, and decreased Hb and Ca were independent risk factors for cardiovascular death in MHD patients. MPV, NLR, CRP, and their combined factors have a predictive value for cardiovascular death events in MHD patients, and the predictive value of their combined factors has greater clinical guidance significance.

Key words: Hemodialysis, Cardiovascular death events, Mean platelet volume, Neutrophil/lymphocyte ratio, C-reactive protein