Objective To construct a comprehensive inflammatory response score (CIRS) based on the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), and to develop a dynamic nomogram for predicting the risk of left ventricular dysfunction (LVSD) in patients with chronic renal failure (CRF).

Methods A total of 196 CRF patients were selected. The correlation between NLR, PLR, and MLR and left ventricular ejection fraction (LVEF) was analyzed using the Pearson test. The area under the curve (AUC) of NLR, PLR, and MLR was calculated based on the receiver operating characteristic (ROC) curve, and the CIRS was constructed according to the optimal cutoff values. Multivariate logistic regression analysis was used to identify independent risk factors for LVSD in CRF patients and to construct a nomogram. Calibration curves, decision curves, and clinical impact curves were used to evaluate the predictive performance and clinical net benefit of the nomogram. DynNom and other software were used to develop a dynamic nomogram for predicting the risk of LVSD in CRF patients.

Results Among the 196 patients, the incidence of LVSD in CRF patients was 25.0% (49/196). Patients with LVSD had higher body mass index (BMI), phosphate, fibrinogen (Fib), alanine aminotransferase (ALT), and blood urea nitrogen levels, and lower systolic blood pressure (SBP), hemoglobin (Hb), albumin (Alb), and calcium (Ca) levels compared to patients without LVSD (P ＜ 0.05 to P ＜ 0.01). NLR, PLR, and MLR were significantly negatively correlated with LVEF (P ＜ 0.01). The AUCs of NLR, PLR, and MLR for diagnosing LVSD in CRF patients were 0.828 (0.767 to 0.878), 0.795 (0.732 to 0.849), and 0.821 (0.760 to 0.872), respectively, with optimal cutoff values of ＞4.31, ＞179.66, and ＞0.22, respectively. CIRS was constructed based on the optimal cutoff values of NLR, PLR, and MLR, and its AUC for diagnosing LVSD in CRF patients was 0.902 (0.852 to 0.940). Multivariate logistic regression analysis revealed that Hb, Alb, Ca, phosphate, Fib, and CIRS were independent risk factors for LVSD in CRF patients (P ＜ 0.05). Calibration curve analysis indicated good fit of the nomogram; decision curve analysis showed that when the threshold probability was ＞0.015, the clinical net benefit of the nomogram in predicting LVSD in CRF patients was ＞0; clinical impact curve analysis demonstrated that the nomogram's predicted high-risk individuals closely matched the actual high-risk individuals.

Conclusion The CIRS constructed based on NLR, PLR, and MLR, combined with Hb, Alb, Ca, P, and CIRS to develop a dynamic nomogram, can accurately predict the risk of LVSD in CRF patients.