The 2nd Department of Intensive Care Unit, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Immunol. 2022 Jul 12;13:925494. doi: 10.3389/fimmu.2022.925494. eCollection 2022.
Acute kidney injury (AKI) is a frequent consequence of sepsis and has been linked to poor prognosis. In critically ill patients, the ratio of neutrophils to lymphocytes and platelets (N/LP) has been confirmed as an inflammation-related marker connected with the development of renal dysfunction. However, the effect of the N/LP ratio on the initiation and development of AKI in patients with sepsis remained unclear. The purpose of this study was to determine if the N/LP ratio on intensive care unit (ICU) admission was associated with the occurrence of sepsis-associated AKI (S-AKI) and severe AKI.
Adult septic patients from the Medical Information Mart for Intensive Care-IV database were screened and classified into three categories (low, middle, or high) based on their N/LP ratio quartiles. The Cox proportional hazard and competing risk models were used to determine the risk of S-AKI in various N/LP groups, whilst the logistic regression model and restricted cubic splines (RCS) analysis were employed to investigate the link between N/LP ratios and the occurrence of severe AKI. Finally, we did a doubly robust estimation, a subgroup analysis, and a sensitivity analysis to determine the findings' robustness.
We categorized 485, 968, and 485 septic patients into three groups based on their N/LP ratios: low, intermediate, and high. According the Cox proportional hazard model, the hazard rate (95% CI) for those in the middle and high N/LP groups on the incidence of S-AKI were 1.30(1.07, 1.58) and 1.27(1.02, 1.59), respectively, as compared to those in the low N/LP group. And the Fine-Gray proportional subdistribution hazards model indicated that mortality was not a substantial competing risk for S-AKI. Additionally, multivariate logistic regression revealed that the risk of severe AKI increased 1.83 fold in the high group compared to the low group. The RCS result also suggested that the probability of severe AKI rose significantly when N/LP > 9.5. The consistency of these findings was confirmed using doubly robust estimation. However, subgroup and sensitivity analyses revealed that the association between N/LP and the incidence of S-AKI, severe AKI varied considerably between different populations and diagnostic criteria.
A raised initial N/LP level may induce the development of S-AKI and severe AKI within 7 days after ICU admission in septic patients. These influences were enhanced in elder, male, septic shock, and those with poor health condition. Furthermore, high NLP was more strongly connected to the risk of S-AKI and severe AKI in sepsis patients on the urine output-based AKI criteria than on the serum creatinine-based criteria.
急性肾损伤（AKI）是脓毒症的常见后果，并与不良预后相关。在危重病患者中，中性粒细胞与淋巴细胞和血小板的比值（N/LP）已被证实为与肾功能障碍发展相关的炎症相关标志物。然而，N/LP 比值对脓毒症患者 AKI 的发生和发展的影响仍不清楚。本研究旨在确定 ICU 入院时的 N/LP 比值是否与脓毒症相关 AKI（S-AKI）和严重 AKI 的发生有关。
从 Medical Information Mart for Intensive Care-IV 数据库筛选成年脓毒症患者，并根据 N/LP 比值四分位数将其分为三组（低、中、高）。采用 Cox 比例风险和竞争风险模型确定不同 N/LP 组中 S-AKI 的风险，采用 logistic 回归模型和受限立方样条（RCS）分析研究 N/LP 比值与严重 AKI 发生的关系。最后，我们进行了双重稳健估计、亚组分析和敏感性分析，以确定结果的稳健性。
我们根据 N/LP 比值将 485、968 和 485 名脓毒症患者分为三组：低、中、高。根据 Cox 比例风险模型，中、高 N/LP 组发生 S-AKI 的风险率（95%CI）分别为 1.30（1.07，1.58）和 1.27（1.02，1.59），与低 N/LP 组相比。而 Fine-Gray 比例亚分布风险模型表明，死亡率不是 S-AKI 的主要竞争风险。此外，多变量 logistic 回归显示，与低 N/LP 组相比，高 N/LP 组发生严重 AKI 的风险增加了 1.83 倍。RCS 结果还表明，当 N/LP > 9.5 时，严重 AKI 的发生概率显著升高。双重稳健估计也证实了这些发现的一致性。然而，亚组和敏感性分析表明，N/LP 与 S-AKI、严重 AKI 发生率之间的关联在不同人群和诊断标准之间存在很大差异。
脓毒症患者 ICU 入院时初始 N/LP 水平升高可能导致 S-AKI 和严重 AKI 在 7 天内发生。这种影响在年龄较大、男性、脓毒性休克和健康状况较差的患者中更为明显。此外，与基于血清肌酐的 AKI 标准相比，基于尿输出的 AKI 标准下，高 NLP 与脓毒症患者 S-AKI 和严重 AKI 的风险相关性更强。
