Adult Nephrology Unit, Division of Adult Nephrology, Shaare Zedek Medical Center, PO Box 3235, 91031, Jerusalem, Israel.
Intern Emerg Med. 2018 Aug;13(5):717-725. doi: 10.1007/s11739-017-1715-8. Epub 2017 Jul 29.
Neutrophil-to-lymphocyte ratio (NLR) is considered a readily available biomarker of systemic inflammation. An association between elevated NLR and adverse outcomes in a variety of medical and surgical conditions including CKD has been demonstrated in several studies. In this study, we evaluated the accuracy of single Emergency Department (ED) measurement of NLR for early diagnosis of acute kidney injury (AKI). We prospectively studied 294 patients aged 71.6 ± 17. We measured NLR at presentation to the ED. AKI is defined as a new-onset 1.5-fold or more increase in serum creatinine or a 25% decrease in estimated GFR sustained for at least 3 days despite volume resuscitation. The primary outcome is AKI. Secondary outcome is in-hospital mortality. A multivariate model and ROC analysis were performed to evaluate the association and eventual predictive capacity of NLR for the outcomes. 36 patients (12.2%) developed AKI and 26 (9%) died, 8 (22%) of the AKI group and 17 patients (7%) of the non-AKI group. The Mean NLR is significantly higher in AKI compare to non-AKI patients (11.7 ± 15.2 vs 6.45 ± 7.19, p = 0.048). A multivariate model adjusted for age, gender, blood pressure, plasma albumin and hemoglobin levels confirms that the NLR is higher in AKI patients (p = 0.031). Receiver operating characteristics curve reveals an AUC of 0.715 (95% CI 0.63-0.8) sensitivity 0.78, specificity 0.65, and OR 6.423 (CI 2.659-16.026) for a cutoff value of NLR 5.5. The relation between NLR and in-hospital mortality is not statistically significant (p = 0.92). Single ED measurement of NLR might be a useful tool for early diagnosis of AKI. This finding is particularly important in light of the low cost and widespread availability of NLR, especially compared with other biomarkers currently under study in the context of AKI.
中性粒细胞与淋巴细胞比值（NLR）被认为是全身炎症的一种易于获得的生物标志物。几项研究表明，在包括慢性肾脏病（CKD）在内的多种医学和外科疾病中，NLR 升高与不良结局之间存在关联。在这项研究中，我们评估了单次急诊（ED）测量 NLR 对急性肾损伤（AKI）的早期诊断的准确性。我们前瞻性研究了 294 名年龄为 71.6±17.7 岁的患者。我们在 ED 就诊时测量 NLR。AKI 的定义为血清肌酐新出现的 1.5 倍或更多增加，或估计的肾小球滤过率（eGFR）持续下降 25%，持续至少 3 天，尽管进行了容量复苏。主要结局是 AKI。次要结局是院内死亡率。我们进行了多变量模型和 ROC 分析，以评估 NLR 与结局的关联和最终预测能力。36 名患者（12.2%）发生 AKI，26 名患者（9%）死亡，AKI 组 8 名（22%），非 AKI 组 17 名（7%）。AKI 患者的平均 NLR 明显高于非 AKI 患者（11.7±15.2 与 6.45±7.19，p=0.048）。调整年龄、性别、血压、血浆白蛋白和血红蛋白水平的多变量模型证实 AKI 患者的 NLR 更高（p=0.031）。受试者工作特征曲线显示 AUC 为 0.715（95%CI 0.63-0.8），灵敏度为 0.78，特异性为 0.65，截断值为 NLR 5.5 时的 OR 为 6.423（CI 2.659-16.026）。NLR 与院内死亡率之间的关系无统计学意义（p=0.92）。ED 单次测量 NLR 可能是 AKI 早期诊断的有用工具。鉴于 NLR 的成本低且广泛可用，特别是与目前在 AKI 背景下研究的其他生物标志物相比，这一发现尤为重要。
