{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:54:16Z","timestamp":1776315256814,"version":"3.50.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The neutrophil-to-lymphocyte ratio (NLR) is a biomarker of systemic inflammation and has been associated with adverse outcomes in dialysis patients. Its role in predicting the future risk of peritoneal dialysis-associated peritonitis (PDAP) before clinical onset remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between pre-peritonitis NLR levels and the risk of developing PDAP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, matched (1:1) case\u2013control study involving patients on peritoneal dialysis at a single center between January 2010 and October 2024. Cases were patients who developed a first episode of PDAP (diagnosed per ISPD guidelines). Controls were matched to cases on sex and age (\u00b13\u202fyears). The exposure was NLR measured from routine blood tests during a 3-month period preceding the peritonitis event for cases, or a corresponding pre-index period for controls. Logistic regression analysis was used to assess the association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 178 patients (89 cases and 89 matched controls) were included in the analysis. In conditional logistic regression models accounting for the matched design, a higher NLR was independently associated with an increased risk of PDAP. When analyzed as a continuous variable (per 1-unit increase in ln(NLR)), the fully adjusted odds ratio (OR) was 2.25 (95% confidence interval [CI]: 1.26\u20134.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.006). When NLR was categorized into tertiles, patients in the highest tertile (NLR\u202f\u2265\u202f1.24) demonstrated a consistent positive association with peritonitis risk compared to those in the lowest tertile (NLR\u202f&amp;lt;\u202f0.52), with a fully adjusted OR of 11.00 (95% CI: 3.06\u201339.52,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001; P for trend &amp;lt; 0.001). Restricted cubic spline analysis revealed a significant linear dose\u2013response relationship (P for non-linearity\u202f=\u202f0.511). An elevated NLR (\u2265 median) also showed moderate discriminative ability for predicting PDAP, with an area under the curve (AUC) of 0.78 (95% CI: 0.71\u20130.85).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A higher NLR measured during a clinically stable period prior to infection is associated with an increased risk of subsequent PDAP. If validated in prospective studies, NLR may serve as a simple and readily available biomarker for risk stratification in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1787005","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:20:44Z","timestamp":1776313244000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Neutrophil-to-lymphocyte ratio as a harbinger of peritonitis in peritoneal dialysis: a case\u2013control study"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenhui","family":"Lei","sequence":"first","affiliation":[{"name":"Nephrology and Urology Center, Fifth Affiliated Hospital of Wenzhou Medical University","place":["Lishui, Zhejiang, China"]},{"name":"Department of Rheumatology and Immunology, The Fifth Affiliated Hospital of Wenzhou Medical University","place":["Lishui, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai-ping","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Ganzhou Cancer Hospital","place":["Ganzhou, Jiangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoli","family":"Sun","sequence":"additional","affiliation":[{"name":"Nephrology and Urology Center, Fifth Affiliated Hospital of Wenzhou Medical University","place":["Lishui, Zhejiang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Xin","sequence":"additional","affiliation":[{"name":"Department of Medicine, The First Hospital of Quanzhou Affiliated to Fujian Medical University","place":["Quanzhou, Fujian, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"641","DOI":"10.2215\/CJN.0000000000000280","article-title":"Peritoneal dialysis-related infections","volume":"19","author":"Cho","year":"2024","journal-title":"Clin J Am Soc Nephrol: CJASN"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.34067\/KID.0000842022","article-title":"The clinical utility of the neutrophil-to-lymphocyte ratio as a discriminatory test among bacterial, mycobacterium tuberculosis, and nontuberculous mycobacterium peritoneal dialysis-related peritonitis","volume":"3","author":"Fung","year":"2022","journal-title":"Kidney360"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2259996","DOI":"10.1080\/0886022X.2023.2259996","article-title":"Progress in the application of the neutrophil-to-lymphocyte ratio in dialysis-related complications","volume":"45","author":"Yang","year":"2023","journal-title":"Ren Fail"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"699502","DOI":"10.3389\/fmed.2021.699502","article-title":"Neutrophil-to-lymphocyte ratio and treatment failure in peritoneal Dialysis-associated peritonitis","volume":"8","author":"He","year":"2021","journal-title":"Front Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1093\/oxfordjournals.aje.a115101","article-title":"The impact of confounder selection criteria on effect estimation","volume":"129","author":"Mickey","year":"1989","journal-title":"Am J Epidemiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1177\/00033197241238512","article-title":"Prognostic role of neutrophil to lymphocyte ratio in contrast-induced nephropathy: a systematic review and Meta-analysis","volume":"76","author":"He","year":"2025","journal-title":"Angiology"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1205687","DOI":"10.3389\/fimmu.2023.1205687","article-title":"Associations of complete blood cell count-derived inflammatory biomarkers with asthma and mortality in adults: a population-based study","volume":"14","author":"Ke","year":"2023","journal-title":"Front Immunol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"111575","DOI":"10.1016\/j.diabres.2024.111575","article-title":"Association between inflammatory biomarkers and mortality in individuals with type 2 diabetes: NHANES 2005-2018","volume":"209","author":"Zhang","year":"2024","journal-title":"Diabetes Res Clin Pract"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1007\/s11255-019-02250-x","article-title":"The relationship between vitamin D and inflammatory markers in maintenance hemodialysis patients","volume":"51","author":"Kara","year":"2019","journal-title":"Int Urol Nephrol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"9327136","DOI":"10.1155\/2017\/9327136","article-title":"High neutrophil-to-lymphocyte ratio predicts cardiovascular mortality in chronic hemodialysis patients","volume":"2017","author":"Li","year":"2017","journal-title":"Mediat Inflamm"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.jocn.2023.01.005","article-title":"Commentary: \"inflammation and the role of infection: complications and treatment options following neurotrauma\"","volume":"113","author":"Willman","year":"2023","journal-title":"J Clin Neurosci"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1046\/j.1523-1755.2002.00470.x","article-title":"Intercurrent clinical events are predictive of plasma C-reactive protein levels in hemodialysis patients","volume":"62","author":"van Tellingen","year":"2002","journal-title":"Kidney Int"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1159\/000519644","article-title":"Neutrophil-to-lymphocyte ratio and erythropoietin resistance among maintenance hemodialysis patients","volume":"51","author":"Zhang","year":"2022","journal-title":"Blood Purif"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"6271","DOI":"10.2147\/JIR.S437256","article-title":"Neutrophil percentage-to-albumin ratio and risk of mortality in patients on peritoneal Dialysis","volume":"16","author":"Yu","year":"2023","journal-title":"J Inflamm Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"9958081","DOI":"10.1155\/2021\/9958081","article-title":"High neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are associated with poor survival in patients with hemodialysis","volume":"2021","author":"Zhang","year":"2021","journal-title":"Biomed Res Int"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1007\/s10157-020-01894-9","article-title":"The relationship between neutrophil-to-lymphocyte ratio and the first occurrence of pneumonia in peritoneal dialysis patients","volume":"24","author":"Zhang","year":"2020","journal-title":"Clin Exp Nephrol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"4634736","DOI":"10.1155\/2020\/4634736","article-title":"Neutrophil to lymphocyte ratio predicts adverse cardiovascular outcome in peritoneal dialysis patients younger than 60 years old","volume":"2020","author":"Zeng","year":"2020","journal-title":"Mediat Inflamm"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1177\/08968608231166870","article-title":"Corrigendum to 2022 ISPD peritonitis guidelines: 2022 update on prevention and treatment","volume":"43","author":"Li","year":"2023","journal-title":"Peritoneal Dialysis Int"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1053\/j.ajkd.2019.09.016","article-title":"Peritoneal dialysis-related infection rates and outcomes: results from the peritoneal Dialysis outcomes and practice patterns study (PDOPPS)","volume":"76","author":"Perl","year":"2020","journal-title":"Am J Kidney Diseases"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"3848","DOI":"10.1111\/jocn.17600","article-title":"Risk factors for peritoneal Dialysis-associated peritonitis due to home-based operation management: a retrospective cohort study","volume":"34","author":"Pan","year":"2025","journal-title":"J Clin Nurs"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1193754","DOI":"10.3389\/fmed.2023.1193754","article-title":"Construction and validation of a predictive model for the risk of peritoneal dialysis-associated peritonitis after peritoneal dialysis catheterization","volume":"10","author":"Dai","year":"2023","journal-title":"Front Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1186\/s12882-025-04165-5","article-title":"A nomogram for predicting the risk of peritoneal dialysis-associated peritonitis in patients with end-stage renal disease undergoing peritoneal dialysis: model development and validation study","volume":"26","author":"Wang","year":"2025","journal-title":"BMC Nephrol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1186\/s12879-024-09334-9","article-title":"Pathogenic spectrum and risk factors of peritoneal dialysis-associated peritonitis: a single-center retrospective study","volume":"24","author":"You","year":"2024","journal-title":"BMC Infect Dis"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1787005\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:20:45Z","timestamp":1776313245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1787005\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":24,"alternative-id":["10.3389\/fmed.2026.1787005"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1787005","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]},"article-number":"1787005"}}