Prognostic Value of Inflammatory Indices and the Advanced Lung Cancer Inflammation Index (ALI) for Survival Outcomes in Hemodialysis Patients

Abstract

Background and Objectives: Chronic systemic inflammation and malnutrition drive adverse outcomes in maintenance hemodialysis (HD) patients. This study investigated the prognostic utility of four accessible inflammatory indices—systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), atherogenic index of plasma (AIP), and advanced lung cancer inflammation index (ALI)—in predicting survival. Materials and Methods: This retrospective cohort study evaluated electronic health records of 222 incident HD patients in Turkey (2014–2021), followed through December 2024. Baseline biomarkers were calculated prior to HD initiation. Survival outcomes were assessed using Kaplan–Meier curves, and independent predictors of all-cause mortality were determined via multivariable Cox proportional hazards regression models. Results: During a median follow-up of 24.9 months, 106 patients (47.7%) died. Non-survivors presented with significantly higher median SII, NLR, and AIP, and markedly lower ALI than survivors (all p < 0.001). Multivariable analysis revealed that elevated SII (HR: 1.035, 95% CI: 1.020–1.050; p < 0.001) and NLR (HR: 1.081, 95% CI: 1.042–1.122; p < 0.001) were risk factors for mortality. In contrast, higher ALI demonstrated a significant protective effect on survival (HR: 0.975, 95% CI: 0.953–0.998; p = 0.036). Kaplan–Meier analyses confirmed superior overall survival in patients with lower SII, NLR, AIP, and higher ALI. Conclusions: SII, NLR, AIP, and ALI are practical, cost-effective biomarkers for mortality risk stratification in HD patients. ALI, integrating both nutritional and inflammatory dimensions, demonstrates particularly robust prognostic value for predicting survival.