What does this research mean for the field?

The Advanced Lung Cancer Inflammation Index (ALI) is significantly and inversely associated with the presence of carotid plaque in non-dialysis patients with chronic kidney disease stages 3-5. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 23, 2026BMC Cardiovascular Disorders0 citationsOpen Access

The association between the advanced lung cancer inflammation index and carotid plaque in non-dialysis CKD stage 3–5 patients: a cross-sectional study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Non-dialysis chronic kidney disease (CKD) stage 3-5 (n=204). Intervention: Advanced Lung Cancer Inflammation Index (ALI) vs. Lower ALI levels. Primary outcome: Presence of carotid plaque (OR 0.29, 95% CI 0.13-0.66, p=0.003).

LWLi Wang JWJialin Wang JJJun Ji

Key Result

Logarithm-transformed Advanced Lung Cancer Inflammation Index (ALI) was significantly and inversely associated with the presence of carotid plaque (OR 0.29) in non-dialysis patients with chronic kidney disease stages 3-5.

Key Points

To explore the relationship between the Advanced Lung Cancer Inflammation Index and carotid plaque in non-dialysis CKD stage 3–5 patients.
Conducted a cross-sectional study with 204 non-dialysis CKD stage 3–5 patients.
Evaluated carotid plaque using ultrasound and assessed the Advanced Lung Cancer Inflammation Index (ALI).
Applied multivariable logistic regression and restricted cubic spline analyses for statistical evaluation.
Found an inverse association between ALI and carotid plaque (OR: 0.29, P = 0.003).
Patients in the highest ALI quartile had a significantly lower risk of carotid plaques (OR: 0.17, P = 0.005).
RCS analysis did not identify a significant non-linear relationship between ALI and carotid plaque (P for non-linearity = 0.828).

Study Design

Type

Cross-Sectional (n=204)

Multicenter

Structured PICO

Is the Advanced Lung Cancer Inflammation Index (ALI) associated with the presence of carotid plaque in non-dialysis CKD stage 3-5 patients?

Population

204 non-dialysis chronic kidney disease (CKD) stage 3-5 patients admitted between April and July 2019. Key exclusions: renal replacement therapy, history of kidney transplantation, severe cardiovascular disease (MI within 6 months or NYHA III/IV heart failure).

Intervention

Advanced Lung Cancer Inflammation Index (ALI) evaluated as a predictor

Outcome

Presence of carotid plaque assessed using ultrasoundsurrogate

The Advanced Lung Cancer Inflammation Index (ALI) is inversely associated with the presence of carotid plaque in non-dialysis CKD stage 3-5 patients, suggesting it may serve as a simple marker for subclinical atherosclerosis.

Main Result

Effect estimate: OR 0.29 (95% CI 0.13-0.66)

p-value: p=0.003

Limitations

Cross-sectional design precludes causal inference or predictive claims
Single center with a modest sample size limits generalizability and statistical power
Assessed carotid atherosclerosis using a binary plaque measure rather than quantitative indices such as plaque area or burden
Inter-observer variability of ultrasound measurements was not formally assessed due to the retrospective design
ALI does not capture other relevant dimensions of cardiovascular risk such as endothelial function, oxidative stress, or vascular calcification

Abstract

Atherosclerosis and arterial plaque are common and severe complications in patients with chronic kidney disease (CKD), particularly in advanced stages (CKD 3–5). Identifying reliable predictors for cardiovascular risk in this population is crucial. The Advanced Lung Cancer Inflammation Index (ALI), a marker that integrates body mass index (BMI), albumin, and the neutrophil-to-lymphocyte ratio (NLR), has shown promise as a predictor of inflammation and nutritional status. However, its association with carotid plaque in non-dialysis CKD patients remains unexplored. This retrospective cross-sectional study included 204 non-dialysis CKD stage 3–5 patients admitted between April and July 2019. ALI was calculated as BMI × albumin/NLR, and carotid plaque was assessed using ultrasound. Multivariable logistic regression models were employed to evaluate the association between logarithm-transformed ALI (LnALI) and carotid plaque, adjusting for relevant covariates. Restricted cubic spline (RCS) analyses were conducted to assess the potential non-linear relationship between ALI and carotid plaque formation. Patients with carotid plaques were older (67 57–74 vs. 51 40–61 years, P < 0.001) and had a higher prevalence of diabetes mellitus (51.2% vs. 19.2%, P < 0.001) and cardiovascular disease (35.7% vs. 12.5%, P < 0.001). LnALI was inversely associated with carotid plaque (OR: 0.29, 95% CI: 0.13–0.66, P = 0.003). Patients in the highest ALI quartile had a significantly lower risk of carotid plaques compared to those in the lowest quartile (OR: 0.17, 95% CI: 0.05–0.58, P = 0.005). RCS analysis did not detect a significant non-linear association between LnALI and carotid plaque. (P for non-linearity = 0.828). ALI was significantly and inversely associated with carotid plaque in non-dialysis CKD stage 3–5 patients. As an index integrating inflammatory and nutritional components, ALI may reflect the overall cardiometabolic status of this population. Prospective studies are needed to determine its value for cardiovascular risk stratification in clinical practice.

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