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Hematologic predictors of in-hospital mortality in chronic hemodialysis patients with catheter-related bloodstream infections

evidence-based-medicine
hematology
infectious-diseases
nephrology

Abstract

Background: Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in patients undergoing chronic hemodialysis. Identifying reliable prognostic markers is essential for early risk stratification and clinical decision-making.

Materials and Methods: This retrospective study included 147 patients with end-stage renal disease receiving chronic hemodialysis via central venous catheter who were hospitalized with confirmed CRBSIs between 2020 and 2024. Demographic, clinical, and laboratory data were collected on admission and the third day of hospitalization. Inflammatory markers such as white blood cell count (WBC), neutrophil count, mean platelet volume (MPV), and derived indices including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were evaluated in relation to in-hospital mortality.

Results: Thirteen patients (8.8%) died during hospitalization. Age, WBC, neutrophil count, and MPV were significantly higher in the mortality group (p<0.01). While NLR and PLR on admission were not significantly different, third-day PLR values were significantly lower in non-survivors (p=0.033), showing moderate predictive performance (AUC = 0.679). Point biserial correlation and ROC analysis supported the prognostic utility of WBC, neutrophils, and PLR.

Conclusion: Age, WBC, neutrophils, MPV, and third-day PLR are potential prognostic markers for in-hospital mortality in hemodialysis patients with CRBSIs. Dynamic monitoring of these hematologic indices may support early clinical decision-making.

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