中性粒细胞/淋巴细胞比值及血小板比值对脓毒症相关性急性肾损伤患者死亡率的预测价值
Neutrophil, lymphocyte and platelet ratio as a predictor of mortality in septic-acute kidney injury patients.
机构信息
Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
出版信息
Nefrologia (Engl Ed). 2020 Jul-Aug;40(4):461-468. doi: 10.1016/j.nefro.2019.11.006. Epub 2020 Jan 13.
BACKGROUND
AKI is frequent in critically ill patients, in whom the leading cause of AKI is sepsis. The role of intrarenal and systemic inflammation appears to be significant in the pathophysiology of septic-AKI. The neutrophils to lymphocytes and platelets (N/LP) ratio is an indirect marker of inflammation. The aim of this study was to evaluate the prognostic ability of N/LP ratio at admission in septic-AKI patients admitted to an intensive care unit (ICU).
METHODS
This is a retrospective analysis of 399 septic-AKI patients admitted to the Division of Intensive Medicine of the Centro Hospitalar Universitário Lisboa Norte between January 2008 and December 2014. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. N/LP ratio was calculated as: (Neutrophil count×100)/(Lymphocyte count×Platelet count).
RESULTS
Fifty-two percent of patients were KDIGO stage 3, 25.8% KDIGO stage 2 and 22.3% KDIGO stage 1. A higher N/LP ratio was an independent predictor of increased risk of in-hospital mortality in septic-AKI patients regardless of KDIGO stage (31.59±126.8 vs 13.66±22.64, p=0.028; unadjusted OR 1.01 (95% CI 1.00-1.02), p=0.027; adjusted OR 1.01 (95% CI 1.00-1.02), p=0.015). The AUC for mortality prediction in septic-AKI was of 0.565 (95% CI (0.515-0.615), p=0.034).
CONCLUSIONS
The N/LP ratio at ICU admission was independently associated with in-hospital mortality in septic-AKI patients.
背景
急性肾损伤（AKI）在危重症患者中较为常见，其主要病因是脓毒症。肾内和全身炎症在脓毒症相关性 AKI 的病理生理学中似乎起着重要作用。中性粒细胞与淋巴细胞及血小板比值（N/LP 比值）是炎症的间接标志物。本研究旨在评估脓毒症相关性 AKI 患者入住重症监护病房（ICU）时 N/LP 比值对预后的预测能力。
方法
这是对 2008 年 1 月至 2014 年 12 月期间入住里斯本北方大学中心医院重症医学科的 399 例脓毒症相关性 AKI 患者的回顾性分析。采用肾脏病预后质量倡议（KDIGO）分类来定义 AKI。N/LP 比值计算方法为：（中性粒细胞计数×100）/（淋巴细胞计数×血小板计数）。
结果
52%的患者为 KDIGO 第 3 期，25.8%为 KDIGO 第 2 期，22.3%为 KDIGO 第 1 期。无论 KDIGO 分期如何，较高的 N/LP 比值均是脓毒症相关性 AKI 患者住院死亡风险增加的独立预测因素（31.59±126.8 比 13.66±22.64，p=0.028；未校正 OR 1.01（95%CI 1.00-1.02），p=0.027；校正 OR 1.01（95%CI 1.00-1.02），p=0.015）。脓毒症相关性 AKI 患者死亡预测的 AUC 为 0.565（95%CI（0.515-0.615），p=0.034）。
结论
入住 ICU 时的 N/LP 比值与脓毒症相关性 AKI 患者的住院死亡率独立相关。
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