Original data.

Objective
Malnutrition, accompanied by an inflammatory profile, is a risk factor for poor prognosis in hemodialysis patients. The purpose of this study was to investigate the predictive value of NLR combined with GNRI for all-cause and cardiovascular mortality in hemodialysis patients.
Methods
A total of 240 maintenance hemodialysis (MHD) patients in hemodialysis centers were enrolled in this retrospective study. The influencing factors of all-cause death in hemodialysis patients were analyzed by COX regression. The cut-off values of GNRI and NLR for predicting mortality in enrolled MHD patients were 89.01 and 4, respectively. Based on these cut-off values, the patients were divided into four groups: G1: high GNRI (≥ 89.01) + high NLR (≥ 4) group; G2: high GNRI (≥ 89.01) + low NLR (<4) group, G3: low GNRI (< 89.01) + high NLR (≥4) group; G4: low GNRI (< 89.01) + low NLR (<4).
Results
During the follow-up period (average: 58 months), the all-cause mortality was 20.83%(50/240) and the cardiovascular mortality was 12.08%(29/240). Both NLR and GNRI were independent risk factors for the prognosis of MHD patients (P<0.05). Survival analysis showed that patients with low GNRI had a lower survival rate than those with high GNRI, whereas patients with high NLR had a lower survival rate than those with low NLR. Kaplan-Meier curve for all-cause mortality revealed that compared to G1, G2, and G4, G3 had the lowest survival rate, while G2 had the highest survival rate among all groups (P < 0.05). Kaplan-Meier curve for cardiovascular mortality showed that G3 had lower survival than G1, G2, and G4 (P < 0.001).
Conclusions
Our study demonstrates that bothGNRI and NLR are associated with all-cause mortality and cardiovascular mortality in MHD patients. Combining these two factorsmay contribute to a prognostic evaluation for MHD patients.

研究目的：营养不良伴随炎症状态是血液透析患者预后不良的危险因素。本研究旨在探讨中性粒细胞与淋巴细胞比值（Neutrophil-to-Lymphocyte Ratio, NLR）联合老年营养风险指数（Geriatric Nutritional Risk Index, GNRI）对血液透析患者全因死亡及心血管死亡的预测价值。
研究方法：本项回顾性研究共纳入血液透析中心的240例维持性血液透析（maintenance hemodialysis, MHD）患者。采用COX回归分析血液透析患者全因死亡的影响因素。本研究纳入的MHD患者中，用于预测死亡的GNRI与NLR截断值分别为89.01和4。基于上述截断值，将患者分为四组：G1组：高GNRI（≥89.01）+高NLR（≥4）组；G2组：高GNRI（≥89.01）+低NLR（<4）组；G3组：低GNRI（<89.01）+高NLR（≥4）组；G4组：低GNRI（<89.01）+低NLR（<4）组。
研究结果：随访期间（平均时长58个月），全因死亡率为20.83%（50/240），心血管死亡率为12.08%（29/240）。NLR与GNRI均为MHD患者预后的独立危险因素（P<0.05）。生存分析结果显示，GNRI水平较低的患者生存率低于GNRI水平较高的患者，而NLR水平较高的患者生存率低于NLR水平较低的患者。全因死亡的Kaplan-Meier曲线分析显示，与G1、G2及G4组相比，G3组生存率最低，而G2组为所有组别中生存率最高者（P<0.05）。心血管死亡的Kaplan-Meier曲线分析显示，G3组生存率低于G1、G2及G4组（P<0.001）。
研究结论：本研究证实，MHD患者的GNRI与NLR均与全因死亡及心血管死亡相关。联合应用这两项指标可为MHD患者的预后评估提供参考依据。