Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, 325000, China.
Crit Care. 2017 Sep 8;21(1):238. doi: 10.1186/s13054-017-1821-z.
Inflammation plays an important role in the initiation and progression of acute kidney injury (AKI). However, evidence regarding the prognostic effect of the platelet-to-lymphocyte ratio (PLR), a novel systemic inflammation marker, among patients with AKI is scarce. In this study, we investigated the value of the PLR in predicting the outcomes of critically ill patients with AKI.
Patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3. PLR cutoff values were determined using smooth curve fitting or quintiles and were used to categorize the subjects into groups. The clinical outcomes were 30-day and 90-day mortality in the intensive care unit (ICU). Cox proportional hazards models were used to evaluate the association between the PLR and survival.
A total of 10,859 ICU patients with AKI were enrolled. A total of 2277 thirty-day and 3112 ninety-day deaths occurred. A U-shaped relationship was observed between the PLR and both 90-day and 30-day mortality, with the lowest risk being at values ranging from 90 to 311. The adjusted HR (95% CI) values for 90-day mortality given risk values < 90 and > 311 were 1.25 (1.12-1.39) and 1.19 (1.08-1.31), respectively. Similar trends were observed for 30-day mortality or when quintiles were used to group patients according to the PLR. Statistically significant interactions were found between the PLR and both age and heart rate. Younger patients (aged < 65 years) and those with more rapid heart rates (≥89.4 beats per minute) tended to have poorer prognoses only when the PLR was < 90, whereas older patients (aged ≥ 65 years) and those with slower heart rates (<89.4 beats per minute) had higher risk only when the PLR was > 311 (P < 0.001 for age and P < 0.001 for heart rate).
The preoperative PLR was associated in a U-shaped pattern with survival among patients with AKI. The PLR appears to be a novel, independent prognostic marker of outcomes in critically ill patients with AKI.
炎症在急性肾损伤（AKI）的发生和进展中起着重要作用。然而，关于血小板与淋巴细胞比值（PLR）这一新型全身炎症标志物在 AKI 患者中的预后作用的证据仍然有限。在这项研究中，我们研究了 PLR 在预测 AKI 危重症患者结局中的价值。
从 Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 中提取患者数据。使用平滑曲线拟合或五分位数确定 PLR 截断值，并将受试者分为不同组。临床结局为 ICU 内 30 天和 90 天死亡率。Cox 比例风险模型用于评估 PLR 与生存之间的关系。
共纳入 10859 例 AKI ICU 患者。共有 2277 例 30 天和 3112 例 90 天死亡。PLR 与 90 天和 30 天死亡率之间呈 U 型关系，风险值在 90-311 之间时风险最低。风险值<90 和>311 时，90 天死亡率的调整 HR（95%CI）值分别为 1.25（1.12-1.39）和 1.19（1.08-1.31）。当使用五分位数将患者按 PLR 分组时，也观察到 30 天死亡率或趋势相似。还发现 PLR 与年龄和心率之间存在显著的交互作用。仅当 PLR<90 时，年轻患者（<65 岁）和心率较快（≥89.4 次/分钟）的患者预后较差，而年龄较大的患者（≥65 岁）和心率较慢（<89.4 次/分钟）的患者仅当 PLR>311 时风险较高（P<0.001 与年龄相关，P<0.001 与心率相关）。
术前 PLR 与 AKI 患者的生存呈 U 型相关。PLR 似乎是 AKI 危重症患者预后的一种新的独立预后标志物。
