Neutrophil-to-Lymphocyte Ratio and Systemic Immune-Inflammation Index as Strong Predictors of Stroke in ESRD: A Retrospective Analysis of Blood Cellular Indices

Background: In End-Stage Renal Disease (ESRD), uremic toxin buildup triggers chronic inflammation, immune dysfunction, and oxidative stress, collectively increasing thromboembolic risk. Blood cellular indices—such as the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and platelet-to-lymphocyte ratio (PLR)—have emerged as key biomarkers of systemic inflammation and endothelial dysfunction, correlating with elevated risks of stroke, pulmonary embolism (PE), myocardial infarction (MI), and deep vein thrombosis (DVT). This study evaluates the predictive power of NLR, SII, and PLR for thromboembolic events in patients with ESRD. Methods: Blood samples were collected from 112 ESRD patients at Loyola University Medical Center. Blood cellular indices were derived from these samples, and incidences of thromboembolic events—including stroke, PE, MI, and DVT—were recorded via retrospective chart review. Logistic regression analyses assessed the predictive power of NLR, SII, and PLR. Results: Logistic regression analysis showed a statistically significant positive association between NLR and stroke (p = 0.0264), with no significant associations for PE (p = 0.0927) or DVT (p = 0.8400). Similarly, higher SII was significantly associated with increased odds of stroke (p = 0.0129), while associations with PE and DVT were not significant. Conclusion: In this ESRD cohort, we assessed NLR, SII, and PLR for predicting thromboembolic events, and compared their relative strengths. Both NLR and SII emerged as significant independent predictors of stroke. These findings highlight the role of blood cellular indices in enhancing risk stratification for thromboembolic events in patients with ESRD, thereby reducing morbidity and mortality. Future research with larger cohorts is needed to validate these findings and better define the role of blood cellular indices in risk stratification.