de Hond Titus A P, Ocak Gurbey, Groeneweg Leonie, Oosterheert Jan Jelrik, Haitjema Saskia, Khairoun Meriem, Kaasjager Karin A H
Department of Internal Medicine and Acute Medicine, University Medical Centre Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands.
Department of Internal Medicine, Sint Antonius Hospital, 3435 CM Nieuwegein, The Netherlands.
J Clin Med. 2022 Feb 16;11(4):1017. doi: 10.3390/jcm11041017.
The early recognition of acute kidney injury (AKI) is essential to improve outcomes and prevent complications such as chronic kidney disease, the need for renal-replacement therapy, and an increased length of hospital stay. Increasing evidence shows that inflammation plays an important role in the pathophysiology of AKI and mortality. Several inflammatory hematological ratios can be used to measure systemic inflammation. Therefore, the association between these ratios and outcomes (AKI and mortality) in patients suspected of having an infection at the emergency department was investigated. Data from the SPACE cohort were used. Cox regression was performed to investigate the association between seven hematological ratios and outcomes. A total of 1889 patients were included, of which 160 (8.5%) patients developed AKI and 102 (5.4%) died in <30 days. The Cox proportional-hazards model revealed that the neutrophil-to-lymphocyte ratio (NLR), segmented-neutrophil-to-monocyte ratio (SMR), and neutrophil-lymphocyte-platelet ratio (NLPR) are independently associated with AKI <30 days after emergency-department presentation. Additionally, the NLR, SMR and NLPR were associated with 30-day all-cause mortality. These findings are an important step forward for the early recognition of AKI. The use of these markers might enable emergency-department physicians to recognize and treat AKI in an early phase to potentially prevent complications.
急性肾损伤（AKI）的早期识别对于改善预后以及预防诸如慢性肾病、肾脏替代治疗需求和住院时间延长等并发症至关重要。越来越多的证据表明，炎症在AKI的病理生理学和死亡率中起重要作用。几种炎症血液学指标可用于衡量全身炎症。因此，研究了这些指标与急诊科疑似感染患者的预后（AKI和死亡率）之间的关联。使用了来自SPACE队列的数据。进行Cox回归以研究七种血液学指标与预后之间的关联。共纳入1889例患者，其中160例（8.5%）发生AKI，102例（5.4%）在30天内死亡。Cox比例风险模型显示，中性粒细胞与淋巴细胞比值（NLR）、分叶中性粒细胞与单核细胞比值（SMR）以及中性粒细胞-淋巴细胞-血小板比值（NLPR）与急诊科就诊后30天内的AKI独立相关。此外，NLR、SMR和NLPR与30天全因死亡率相关。这些发现是AKI早期识别的重要进展。使用这些标志物可能使急诊科医生能够在早期识别和治疗AKI，从而有可能预防并发症。
