Neutrophil-to-lymphocyte ratio is a marker for acute kidney injury progression and mortality in critically ill populations: a population-based, multi-institutional study View Full Text


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Article Info

DATE

2021-10-08

AUTHORS

Jia-Jin Chen, George Kuo, Pei-Chun Fan, Tao-Han Lee, Chieh-Li Yen, Cheng-Chia Lee, Ya-Chung Tian, Chih-Hsiang Chang

ABSTRACT

BackgroundsNeutrophil-to-lymphocyte ratio (NLR), a surrogate marker of systemic response to physiological stress, is used for prognosis prediction in many diseases. However, the usefulness of this marker for predicting acute kidney injury (AKI) progression is unclear.MethodsThis retrospective study was based on the Chang Gung Research Database. Patients admitted to the intensive care unit with a diagnosis of stage 1 or 2 AKI were identified. The primary outcome was a composite of progression to stage 3 AKI, requirement of renal replacement therapy, or 14-day in-hospital mortality. The association between NLR and the primary outcome was examined using a logistic regression model and multivariable analysis. The nonlinearity and cutoff points of this relationship were determined using a restricted cubic spline model.ResultsA total of 10,441 patients were enrolled. NLR level at the time of stage 1–2 AKI diagnosis was a marker of adverse outcomes. After adjustment for confounders, NLR was independently associated with the composite outcome of AKI progression, renal replacement therapy, or mortality. The restricted cubic spline model revealed a J-shaped curve, with the lowest odds ratio for an NLR between 7 and 38. Subgroup analysis revealed linear and J-shaped relationships between NLR and the primary outcome in patients admitted to the intensive care unit for medical reasons and for cardiovascular surgery, respectively.ConclusionsNLR is an independent marker of AKI progression and in-hospital mortality. Because it is readily available in daily practice, it might be used for risk stratification in the AKI population.Graphic abstract More... »

PAGES

911-920

References to SciGraph publications

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  • 2019-03-15. Neutrophil-to-lymphocyte ratio and incident end-stage renal disease in Chinese patients with chronic kidney disease: results from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) in JOURNAL OF TRANSLATIONAL MEDICINE
  • 2016-03-15. Creatinine-based definitions: from baseline creatinine to serum creatinine adjustment in intensive care in CRITICAL CARE
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    http://scigraph.springernature.com/pub.10.1007/s40620-021-01162-3

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    DIMENSIONS

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    28 schema:description BackgroundsNeutrophil-to-lymphocyte ratio (NLR), a surrogate marker of systemic response to physiological stress, is used for prognosis prediction in many diseases. However, the usefulness of this marker for predicting acute kidney injury (AKI) progression is unclear.MethodsThis retrospective study was based on the Chang Gung Research Database. Patients admitted to the intensive care unit with a diagnosis of stage 1 or 2 AKI were identified. The primary outcome was a composite of progression to stage 3 AKI, requirement of renal replacement therapy, or 14-day in-hospital mortality. The association between NLR and the primary outcome was examined using a logistic regression model and multivariable analysis. The nonlinearity and cutoff points of this relationship were determined using a restricted cubic spline model.ResultsA total of 10,441 patients were enrolled. NLR level at the time of stage 1–2 AKI diagnosis was a marker of adverse outcomes. After adjustment for confounders, NLR was independently associated with the composite outcome of AKI progression, renal replacement therapy, or mortality. The restricted cubic spline model revealed a J-shaped curve, with the lowest odds ratio for an NLR between 7 and 38. Subgroup analysis revealed linear and J-shaped relationships between NLR and the primary outcome in patients admitted to the intensive care unit for medical reasons and for cardiovascular surgery, respectively.ConclusionsNLR is an independent marker of AKI progression and in-hospital mortality. Because it is readily available in daily practice, it might be used for risk stratification in the AKI population.Graphic abstract
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    35 schema:keywords AKI
    36 AKI diagnosis
    37 AKI population
    38 AKI progression
    39 Abstract Neutrophils
    40 Chang Gung Research Database
    41 ConclusionsNLR
    42 MethodsThis retrospective study
    43 NLR
    44 NLR levels
    45 Research Database
    46 ResultsA total
    47 acute kidney injury progression
    48 adjustment
    49 adverse outcomes
    50 analysis
    51 association
    52 cardiovascular surgery
    53 care unit
    54 composite of progression
    55 composite outcome
    56 composites
    57 confounders
    58 cubic spline models
    59 curves
    60 cutoff point
    61 daily practice
    62 database
    63 diagnosis
    64 disease
    65 hospital mortality
    66 ill population
    67 independent marker
    68 injury progression
    69 intensive care unit
    70 kidney injury progression
    71 levels
    72 linear
    73 logistic regression models
    74 lower odds ratio
    75 lymphocyte ratio
    76 markers
    77 medical reasons
    78 model
    79 mortality
    80 multi-institutional study
    81 multivariable analysis
    82 neutrophils
    83 nonlinearity
    84 odds ratio
    85 outcomes
    86 patients
    87 physiological stress
    88 point
    89 population
    90 practice
    91 prediction
    92 primary outcome
    93 prognosis prediction
    94 progression
    95 ratio
    96 reasons
    97 regression models
    98 relationship
    99 renal replacement therapy
    100 replacement therapy
    101 requirements
    102 response
    103 retrospective study
    104 risk stratification
    105 spline model
    106 stage 1
    107 stratification
    108 stress
    109 study
    110 subgroup analysis
    111 surgery
    112 surrogate marker
    113 systemic response
    114 therapy
    115 time
    116 total
    117 units
    118 usefulness
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