AUTHOR=Hou Shi-mei , Gao Yu-ting , Wu Meng-huan , Ren Yu-xin , Zheng Jing , Wang Yao , Cao Jing-yuan , Wang Xiao-xu , Yang Yan , Wang Bin , Yang Min , Li Min 

TITLE=Inflammation, glucose metabolism, and nutritional markers in relation to all-cause and cardiac mortality among initial hemodialysis patients: a multicenter cohort study

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2025.1660267

DOI=10.3389/fnut.2025.1660267

ISSN=2296-861X

ABSTRACT=ObjectiveTo investigate the prognostic value of inflammatory biomarkers including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), glucose metabolism (glucose-to-lymphocyte ratio, GLR), and nutritional (albumin, ALB) biomarkers for predicting all-cause and cardiac mortality in patients initiating hemodialysis (HD), and evaluates their incremental value when integrated into traditional risk models.MethodsA retrospective cohort of 795 initial HD patients (2014–2020) was analyzed, with follow-up through 2022. Cox proportional hazards models were used to assess associations between biomarkers and mortality. Predictive performance was evaluated using time-dependent ROC curves, C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Patients were randomly assigned to training (n = 557) and validation (n = 238) sets, and a survival nomogram was developed based on a full-risk model incorporating both traditional and biomarker variables.ResultsElevated NLR, PLR, and GLR were independently associated with increased all-cause and cardiac mortality, whereas lower LMR and ALB were protective (all p < 0.05). NLR exhibited the highest predictive accuracy across 1-, 3-, and 5-year intervals, followed by GLR and PLR. The full-risk model significantly outperformed the baseline model, with AUCs up to 0.980 and 0.966 for all-cause mortality and 0.947 and 0.978 for cardiac mortality in training and validation sets, respectively (all p < 0.001). Improvements in C-index, NRI, and IDI supported its enhanced predictive utility.ConclusionIncorporating inflammatory, glucose metabolism and nutritional biomarkers into traditional risk models substantially improves long-term mortality risk stratification in initial HD patients, offering a robust, clinically applicable tool to support individualized prognostic assessment and intervention planning.