Synergistic impact of monocyte-to-lymphocyte ratio and estimated glomerular filtration rate on long-term survival in ami patients with chronic kidney disease
W Zhang, H T Ruan, J T Tao, X Z Lu, H Z Huang, S Y Tang, Ziyao Yuan, J Liu, Y LiuAbstract
Background
Both systemic inflammation and renal impairment are critical prognostic determinants in patients with acute myocardial infarction (AMI). However, the combined and interactive effects of the monocyte-to-lymphocyte ratio (MLR) and estimated glomerular filtration rate (eGFR) on long-term outcomes in AMI patients complicated with chronic kidney disease (CKD) remain unexplored.
Methods
This retrospective cohort study included 4,155 AMI patients with CKD from the Chinese multicenter registry cohort Cardiorenal ImprovemeNt II (CIN-II) registry. Baseline eGFR was calculated using the CKD-EPI creatinine equation. Patients were stratified into four groups based on the medians of MLR and eGFR. The primary outcome was cardiovascular (CV) mortality, and the secondary was all-cause mortality. Survival analysis was performed using Kaplan-Meier curves, multivariable Cox proportional hazards models, and Restricted Cubic Splines (RCS). Additive interactions were evaluated using the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S).
Results
Over a median follow-up of 1,675.5 days, 606 CV deaths and 1,125 all-cause deaths occurred. Kaplan-Meier analysis revealed that the high MLR/low eGFR group experienced the highest cumulative mortality risk (P < 0.0001). RCS demonstrated a continuous linear positive association between MLR and mortality risk. After adjusting for confounders, compared to the reference group (low MLR/high eGFR), the high MLR/low eGFR group exhibited significantly increased risks of CV mortality (HR 2.753, 95% CI 2.082–3.639) and all-cause mortality (HR 1.888, 95% CI 1.567–2.275). Crucially, a significant synergistic additive interaction was observed for CV mortality (RERI: 0.834, AP: 0.310, S: 1.970) and all-cause mortality (RERI: 0.376, AP: 0.202, S: 1.769). This synergistic prognostic value remained highly robust across predefined subgroups, including age, gender, diabetes, hypertension, and PCI status.
Conclusion
Elevated MLR and reduced eGFR exert a profound synergistic effect, dramatically amplifying the long-term risk of CV and all-cause mortality in AMI patients with CKD. Integrating these accessible inflammatory and renal biomarkers provides crucial value for risk stratification in cardiorenal syndrome.central illustration