Department of Urology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, China.
Department of Urology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, China.
Clin Chim Acta. 2019 Mar;490:207-213. doi: 10.1016/j.cca.2018.09.014. Epub 2018 Sep 7.
Inflammation plays a critical role in the development of acute kidney injury (AKI). Neutrophil-lymphocyte ratio (NLR) is a biomarker of systemic inflammation used to predict the prognostic outcome of several diseases. We conducted a retrospective cohort study to investigate if NLR can be used as a biomarker to predict the mortality of AKI.
Records of critically ill patients with AKI were extracted from the Medical Information Mart for Intensive Care Database III version 1.3 (MIMIC-III v1.3). The primary outcome was 30-day mortality and the two secondary outcomes were in hospital and 90-day mortality. We used the Cox proportional hazards models to assess the association between different categories of NLR and outcomes. This analysis included data for 13,678 eligible subjects, with a total of 2,588 30-day, 2,224 in-hospital and 3,545 90-day deaths during the follow-up period. For 30-day mortality, an increased risk of mortality was associated with a higher level of NLR. The HR (95% confidence interval [CI]) of upper tertile (NLR > 12.14) was 1.37 (1.17-1.60) in a multivariate model when compared with that of the lower tertile (NLR < 5.55). In the quintile analysis, we confirmed the upward trend with HR (95% CI) of the fifth quintile (NLR > 17.4) of 1.35 (1.08, 1.69) in a multivariate model compared to the first quintile (NLR < 3.82). A similar tendency was observed for 90-day mortality. In the analysis of in-hospital mortality, the HR of fifth quintile (NLR > 17.4) showed a slight decrease.
Our analysis indicates that a higher level of NLR is associated with increased risk of 30-day and 90-day mortality in AKI patients. The similar upward trend is not detected in analysis of in-hospital mortality.
炎症在急性肾损伤（AKI）的发展中起着关键作用。中性粒细胞与淋巴细胞比值（NLR）是一种全身性炎症的生物标志物，用于预测多种疾病的预后结果。我们进行了一项回顾性队列研究，以调查 NLR 是否可作为预测 AKI 患者死亡率的生物标志物。
从医疗信息集市强化护理数据库 III 版 1.3 版（MIMIC-III v1.3）中提取 AKI 重症患者的记录。主要结局为 30 天死亡率，两个次要结局为住院期间和 90 天死亡率。我们使用 Cox 比例风险模型评估不同 NLR 类别与结局之间的关系。这项分析包括了 13678 名合格受试者的数据，在随访期间共有 2588 例 30 天、2224 例住院和 3545 例 90 天死亡。对于 30 天死亡率，较高的 NLR 水平与更高的死亡率风险相关。在多变量模型中，与 NLR 较低的三分位（NLR<5.55）相比，上三分位（NLR>12.14）的 HR（95%置信区间[CI]）为 1.37（1.17-1.60）。在五分位数分析中，我们在多变量模型中确认了第五五分位数（NLR>17.4）的 HR（95%CI）呈上升趋势，为 1.35（1.08, 1.69），与第一五分位数（NLR<3.82）相比。90 天死亡率的分析也观察到了类似的趋势。在住院期间死亡率的分析中，第五五分位数（NLR>17.4）的 HR 略有下降。
我们的分析表明，较高的 NLR 水平与 AKI 患者 30 天和 90 天死亡率的增加风险相关。在住院期间死亡率的分析中，未检测到类似的上升趋势。
