الفهرس 
Hepatocellular carcinoma
Diagnosis and treatment approachOnly 14 pages are availabe for public view
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Abstract
Introduction: Inflammation and malnutrition are important components of CKD that responsible to cardiovascular mortality and morbidity. Neutrophil to lymphocyte ratio (NLR) and Platelet to lymphocyte ratio (PLR) were reported as inflammatory markers in various cardiac and non-cardiac diseases. We aimed to evaluate the value of NLR &PLR as inflammatory markers among CKD patients and its association with nutritional status of the patients.
Methods: A case-control study included 60 non- dialysis CKD adult patients, (staging from 3-5 by using MDRD equation), were recruited from outpatient clinics of internal medicine and nephrology, Ain Shams University hospital, Cairo, Egypt, and 30 healthy volunteers matched to age and sex as control group. Full history and clinical examination were done, dietary intake number of calories and grams for the protein they contain have been calculated and estimated as Kcal/Kg/day and gm/Kg/day respectively. Anthropometric measurements of Height (cm), weight (Kg), BMI, MAC (mid-arm circumference) cm, MAC adequacy%, TSF (Triceps skin fold thickness) mm, TSF %, MAMC (mid-armmuscle circumference) cmg, modified subjective global assessment (m-SGA) was filled up which composed of 7 components giving SGA Grades (A, B &C) modified to BMI, Albumin level and TLC to obtain the total score that classifying nutritional status to normal, moderate and sever. Complete blood count, NLR & PLR were calculated, hs-CRP, serum albumin, blood urea nitrogen (BUN), serum creatinine, sodium (Na), potassium (K), Total Calcium, Phosphorous, intact parathyroid hormone (i PTH), Total cholesterol, triglycerides (TG), serum iron, TIBC, ferritin, transferrin and urine for albumin/creatinine ratio (ACR). Results: The mean6SD of NLR in patients group was 2.8362.76, it was significantly higher compared to healthy subjects (U=509.5, P<0.001). The mean 6SD of PLR in patients was 144.6663.17 higher than the mean of PLR 130.2649.11 in control group but with no statistically significant difference (P>0.05). Both ratios PLR & NLR were positively correlated to high hs-CRP in patients group (rs=0.278,P=0.03& rs=0.358,P=0.001) respectively. The mean of m-SGA was 3.6061.39, 17 (28.3%) of studied patients had moderate malnutrition, 43 (71.7%) had severe malnutrition in comparison to control group (P<0.001). The mean of hs-CRP among CKD patients was 8195.0611946.6 ng/ml significantly higher than mean hs-CRP in Control group 546.76238.5 ng/ml (P<0.01). A significant positive correlation between m-SGA score with ACR, BUN, serum creatinine, phosphorus and significantly negatively correlated to serum albumin, haemoglobin, and calcium (P<0.01) among CKD patients. Significant correlation of NLR with MAMC (cm) (rs=0.232, P=0.027) in patient group. But there was no statistically significant correlation between m-SGA score and NLR, PLR or hs-CRP among patients group. Conclusions: NLR and PLR can be utilized clinically as inflammatory markers in non-dialysis CKD patients with malnutrition.