Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio: can we predict frailty and its related outcomes in dialyzed patients?

Background Frailty is associated with aging, but it is more prominent among the patients on dialysis and characterized by increased vulnerability to stressors, which is associated with adverse outcomes and poor quality of life. The aim of this study is to evaluate the association of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and frailty in hemodialysis patients and the effect on their outcomes. Patients and methods A cross-sectional study was conducted on 80 patients, divided into two groups according to their Till Burg Frailty indicator. Sociodemographic data, laboratory investigations, assessment of dialysis adequacy, anthropometric measures, calculation of NLR and PLR, and Tilburg Frailty Indicator were assessed in all participating patients. Outcomes included hospitalization, physician visits, disability, and mortality were evaluated. Results The Tilburg Frailty Instrument correlates positively with age, duration of dialysis, and inflammatory markers NLR and PLR and negatively with mean arm circumference, hemoglobin, serum phosphorus, and high-density lipoprotein. The linear regression revealed that the frailty would be increased ( B =0.041, 0.015, and 0.010) as the duration of dialysis, PLR, and NLR increased, respectively. Furthermore, the frailty will be raised ( B =−0.48) as the phosphorus serum level declines. The optimal cut-off value of NLR was more than 1.64, and of PLR was more than 96.88 to predict frailty in end-stage renal disease patients. Frequent physician visits and hospitalization were prevalent in frail patients with no effect on disability and mortality of the studied patients. Conclusion The PLR and NLR have a diagnostic value of frailty and are associated with increasing the prevalence of frequent physician visits and hospitalization among frail hemodialysis patients.