Comparison of Inflammatory Markers in the Diagnosis of Metabolic Syndrome in Hemodialysis Patients: A Multicenter Observational Study

Figures & data

Table 1 General Characteristics of Participants with and without MetS

Variables	Non-MetS (n= 386)	MetS (n= 474)	P value
Age (years)	60.4±12.9	62.3±12.3	0.029
Sex (%)			<0.001
Male	53.4	46.6
Female	31.5	68.5
BMI (kg/m^2)	20.8±2.4	25.4±3.6	<0.001
Kt/V	1.42±0.33	1.32±0.31	<0.001
Dialysis vintage (months)	48.1(23.9–92.9)	47.0(25.1–95.1)	0.894
Smoking (%)	53.4	49.2	0.320
Drinking (%)	52.6	51.1	0.774
IPAQ (Met/week)	1386(693–3353)	1386(424–3066)	0.376
MIS	4.62±3.0	4.08±2.76	0.006
CCI	3.79±1.62	3.90±1.69	0.341
MetS components (%)
Waist circumference (cm)	79.5±8.0	95.3±8.9	<0.001
Systolic pressure (mmHg)	153.4±25.3	152.5±27.3	0.630
Diastolic pressure (mmHg)	84.8±16.4	81.1±15.0	0.001
Fasting glucose (mmol/L)	7.26±3.35	8.50±4.37	<0.001
Triglycerides (mmol/L)	1.40(0.94–1.90)	2.15(1.42–3.28)	<0.001
HDL cholesterol (mmol/L)	1.07±0.30	0.89±0.24	<0.001
LDL cholesterol (mmol/L)	2.19±0.74	2.39±0.85	<0.001
Laboratory parameters
WBC (×10^3/μL)	6.06±1.76	6.65±1.97	<0.001
Neutrophils (×10^3/μL)	4.13±1.50	4.62±1.58	<0.001
Lymphocytes (×10^3/μL)	1.20±0.57	1.28±0.60	0.123
NLR	4.01±2.13	4.18±2.34	0.420
Monocytes (×10^3/μL)	0.40(0.32–0.51)	0.44(0.31–0.55)	0.065
Eosinophils (×10^3/μL)	0.20(0.11–0.36)	0.20(0.10–0.30)	0.382
Basophils (×10^3/μL)	0.03(0.01–0.05)	0.02(0.00–0.04)	0.394
hs-CRP (mg/L)	1.83(0.81–4.18)	3.42(1.51–7.11)	<0.001
Hemoglobin (g/dL)	112.4±16.8	109.5±16.4	0.015
Albumin (g/L)	39.3±3.3	39.9±3.8	0.010
Creatinine(μmol/L)	954.2±285.5	973.6±289.3	0.358
Uric acid	441.3±86.1	450.7±102.0	0.026
Calcium (mg/dL)	2.25±0.64	2.27±0.27	0.630
Phosphorus (mg/dL)	1.89±0.64	2.00±0.63	0.014
Chronic conditions (%)
Stroke	51.4	55.8	0.264
CHD	52.4	55.7	0.274
Heart failure	18.4	23.0	0.099
Hypertension	45.8	53.0	0.562
Diabetes	47.3	61.9	<0.001
Hyperlipidemia	46.8	64.1	<0.001

Note: Data are presented as mean ± SD or n (%).

Abbreviations: BMI, body mass index; Kt/V, fractional clearance index for urea; MIS, malnutrition inflammation score; IPAQ, International Physical Activity Questionnaire; WC, waist circumference; MetS, metabolic syndrome; WBC, white blood cells; NLR, neutrophil-to-lymphocyte ratio; hs-CRP, high-sensitivity C-reactive protein; CHD, coronary heart disease.

Table 2 Logistic Regression Analyses of the Association of WBC, Neutrophils, and hs-CRP Quartiles with MetS

	Q1	Q2	Q3	Q4	P for Trend
WBC (×10^3/μL, range)	1.50–5.10	5.11–6.20	6.21–7.47	>7.47
Crude	Ref	0.87(0.66–1.41)	1.86(1.27–2.74)	1.80(1.23–2.63)	0.201
Adjusted model	Ref	0.95(0.51–1.76)	1.84(0.95–3.54)	1.43(0.75–2.74)	0.402
Neutrophils (×10^3/μL, range)	0.43–3.28	3.29–4.15	4.16–5.21	>5.21
Crude	Ref	0.86(0.52–1.42)	2.16(1.31–3.56)	2.13(1.29–3.52)	0.168
Adjusted model	Ref	0.58(0.28–1.23)	2.02(0.91–4.47)	1.33(0.61–2.90)	0.546
hs-CRP (mg/L, range)	0.17–1.06	1.07–2.54	2.55–5.95	>5.95
Crude	Ref	1.74(1.17–2.59)	2.43(1.62–3.64)	3.25(2.15–4.92)	0.060
Adjusted model	Ref	1.76(0.86–3.61)	2.49(1.22–5.08)	4.31(2.03–9.14)	0.010

Notes: Data are presented as adjusted OR, with 95% CI in parentheses, unless otherwise stated. Adjusted model is adjusted with age, sex, BMI, Kt/V, Uric acid, dialysis vintage, smoking, drinking, MIS, physical activity level, CCI.

Abbreviations: WBC, white blood cells; hs-CRP, high-sensitivity C-reactive protein; MetS, metabolic syndrome; Q, quartiles.

Table 3 AUC and Cutoff Point of hs-CRP in Identifying Subjects with Metabolic Syndrome

Variable	AUC	Optimal Cutoff Point	Sensitivity	Specificity
hs-CRP	0.638(0.596–0.680)	1.58	74.4%	46.8%

Abbreviations: hs-CRP, high-sensitivity C-reactive protein; AUC, area under curve.

Figure 1 Receiver operating characteristic (ROC) curves of hs-CRP in identifying subjects with metabolic syndrome.

Table 4 Logistic Regression Analyses of the Association of hs-CRP with MetS and Its Components

Variable	Odds Ratio(95% CI)
	Crude	P value	Adjusted Model	P value
hs-CRP
Metabolic syndrome	2.56(1.90–3.46)	<0.001	2.46(1.44–4.18)	0.001
High waist circumference	2.47(1.83–3.34)	<0.001	2.20(1.29–3.77)	0.004
Elevated blood pressure	0.56(0.15–2.03)	0.374	0.93(0.19–4.61)	0.929
Elevated fasting glucose	1.28(0.92–1.80)	0.146	1.24(0.82–1.88)	0.308
Elevated TG	1.89(1.40–2.55)	<0.001	1.55(1.06–2.26)	0.024
Low HDL	1.83(1.32–2.55)	<0.001	1.43(0.94–2.16)	0.094

Notes: Data are presented as adjusted OR, with 95% CI in parentheses, unless otherwise stated. Adjusted model is adjusted with age, sex, BMI, Kt/V, Uric acid, dialysis vintage, smoking, drinking, MIS, physical activity level, CCI.