Objective To investigate the correlation of platelet-to-lymphocyte ratio (PLR) with depression in patients with maintenance hemodialysis (MHD) based on propensity score matching (PSM).

Methods General information such as age, gender and underlying diseases, biochemical indicators, and Beck Depression Inventory (BDI) scores of patients in hemodialysis centers of 20 Grade Ⅲ and Level A hospitals in Guizhou Province from June to August 2023 were collected. Patients were divided into depression group and non-depression group based on the occurrence of depression, and differences in clinical characteristics were compared between the groups. A 1 to 1 propensity score matching was used to obtain patients with similar baseline data (gender, age, education level) in the depression and non-depression groups, and differences in clinical characteristics between the two groups were compared. Participants were divided into Q1, Q2, Q3 and Q4 groups according to the quartiles of PLR, and differences in clinical characteristics among the groups were compared. Logistic regression analysis was used to evaluate the relationship between PLR and depression in MHD patients. Receiver operating characteristic (ROC) curve was used to assess the value of PLR in predicting depression in MHD patients.

Results A total of 2, 081 MHD patients were included in this study, including 1, 286 males (61.8%), with a mean age of (54.3±14.7) years. A total of 368 patients (17.7%) had depression, and 359 pairs were successfully matched after propensity score matching. The depression group had higher rates of diabetes and PLR, but lower serum creatinine and hemoglobin levels (P < 0.05). The risk of depression in the PLR Q4 group was 22.654 times than that of the Q1 group (95%CI, 12.713 to 40.369, P < 0.001). After initially adjusting for age, diabetes, and hypertension, the risk of depression in the PLR Q4 group was 28.272 times than that of the Q1 group (95%CI, 15.390 to 51.937, P < 0.001). After further adjusting for serum creatinine, hemoglobin, albumin, white blood cell count, total cholesterol, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and neutrophil-to-lymphocyte ratio, the risk of depression in the PLR Q4 group was 10.557 times than that of the Q1 group (95%CI, 3.461 to 32.201, P < 0.001). The ROC curve analysis results indicated that the sensitivity of PLR in predicting depression in MHD patients was 78.0%, the specificity was 73.5%, the optimal threshold was 114.14, and the area under the curve was 0.798 (95%CI, 0.765 to 0.832, P < 0.001).

Conclusion PLR is an independent risk factor for depression and has a high predictive value for depression in MHD patients.