The importance of hematological parameters in predicting catheter infections in uremic patients

The Importance of Hematological Parameters in Predicting Catheter Infections in Uremic Patients Background and Aim: The uremia caused by chronic kidney disease (CKD) is a major cause of mortality and morbidity. Catheters used in uremic patients result in nosocomial infection. Hematological parameters such as mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLO), platelet to lymphocyte ratio (TLO), red cell distribution width (RDW) and hematocrit,which are known to be associated with the severity, differential diagnosis, prognosis and mortality of numerous diseases, can be useful in the prediction of catheter infections.In this study, we aimed to investigatethe value of hematological markers including MPV, NLO, TLO, RDW and hematocrit in predicting catheter infections in patients with CKD. Material and Methods: The retrospective study included 42 patients withCKDwho were diagnosed with catheter infection (Group 1) and 45 patients who were followed up due to CKD and did not have any infection (Group 2) between 2013 and 2017. Statistical comparisons were performedbetween the groups based on the laboratory parameters. Results: Group 1 comprised 12 (28.6%) male and 30 (71.4%) female patients with a mean age of 55.4±18.0 years. In the same group, mean hospital stay was 22.7±12.6 days, 92.9% of the patients were receiving hemodialysis, 54.8% of the patients had a temporary catheter and 45.2% had a permanent-port system catheter, 40.5% of the patients had subclavian, 38.1% had jugular, and 21.4% had femoral catheters,and mean duration of catheterization was 10.9±12.1 days. White blood cell count (p<0.001), neutrophil count (p<0.001), NLO (p<0.001), TLO (p=0.002), RDW (p<0.001), alanine aminotransferase (p<0.001), and aspartate aminotransferase (p<0.001) were significantly higher in Group 1compared to Group 2, whereas lymphocyte count (p<0.001) and hematocrit (p<0.001), albumin (p<0.001), and creatinine levels (p<0.001) were significantly lower in Group 1 compared to Group 2.The risk of infection was increased by an average of 46.1 times in the presence of an NLO level of >5 and ≤5 and was increased by 5.42 timesin the presence of a hematocrit level of ≤33% compared to >33% between Group 1 and Group 2. Asignificant positive correlation was found between sedimentation and MPV in Group 1 (r=0.327, p=0.037). Discussion and Conclusion: Although the hematological parameters such as elevated NLO, TLO and RDW levels and low hematocrit levels were found to be significant in the prediction of catheter infection in uremic patients, only an NLO level of >5 and a hematocrit level of ≤33% were found to significantly increase the risk of catheter infection. Accordingly, we believe that NLO and hematocrit levels should be followed upclosely in patients with CKD for the prediction of infection during catheterization.