V-shaped relationship between platelet-to-lymphocyte ratio and mortality in patients with cardio-cerebrovascular disease: An observational study

This study aimed to elucidate the association between platelet-to-lymphocyte ratio (PLR) and long-term mortality risk in patients with cardio-cerebrovascular diseases (CVD), providing insights for early intervention strategies. Nonlinear associations between the PLR and all-cause mortality were examined using spline smoothing plots analysis. The inflection point of PLR’s effect on all-cause mortality was determined using threshold saturation and log-likelihood ratio tests. Subgroup analyses were performed to assess result stability. A competing risk model was employed to investigate the relationship between PLR and cardiovascular mortality. A total of 5024 adult patients with hypertension were included in this study. The average follow-up duration was 78 months. Spline smoothing plots analysis revealed a V-shaped relationship between PLR and all-cause mortality, with an inflection point at 64.48. When PLR was <64.48, the risk of all-cause mortality declined gradually (HR = 0.979, 95% CI: 0.968–0.990, P = .0003) with increasing PLR. Conversely, when PLR was ≥64.48, the risk of all-cause mortality gradually increased (HR = 1.002, 95% CI: 1.001–1.003, P < .0001) with increasing PLR. The competing risk model indicated a comparable association between PLR and cardiovascular mortality in patients with CVD. This study establishes a V-shaped PLR-mortality relationship in CVD patients with an inflection point at 64.48. This highlights the potential of PLR as a clinically actionable biomarker for precision risk management, offering a basis for early intervention strategies.