Bravo-Santibáñez Edgar, Hernández-González Martha Alicia, López-Briones Sergio, Contreras-Chávez Marisol
Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Unidad de Cuidados Intensivos. León, Guanajuato, México.
Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Departamento de Enseñanza. León, Guanajuato, México.
Rev Med Inst Mex Seguro Soc. 2023 May 2;61(3):342-347.
Acute kidney injury (AKI) is frequent in sepsis (25 to 51%), with high mortality (40 to 80%) and long-term complications. Despite its importance we do not have accessible markers in intensive care. In other entities (post-surgical and COVID-19) the neutrophil/lymphocyte and platelet (N/LP) ratio has been associated with acute kidney injury; however, this relationship has not been studied in a pathology with a severe inflammatory response such as sepsis.
To demonstrate the association between N/LP with AKI secondary to sepsis in intensive care.
Ambispective cohort study in patients over 18 years who were admitted to intensive care with a diagnosis of sepsis. The N/LP ratio was calculated from admission up to the seventh day and up to the diagnosis of AKI and outcome. Statistical analysis was performed with chi squared test, Cramer's V and multivariate logistic regression.
Out of the 239 patients studied, the incidence of AKI developed in 70%. 80.9% of patients with N/LP ratio > 3 had AKI (p < 0.0001, Cramer's V 0.458, OR 3.05, 95% CI 1.602-5.8) and increased renal replacement therapy (21.1 vs. 11.1%, p = 0.043).
N/LP ratio > 3 has a moderate association with AKI secondary to sepsis in the intensive care unit.
急性肾损伤（AKI）在脓毒症中很常见（25%至51%），死亡率高（40%至80%）且存在长期并发症。尽管其很重要，但在重症监护中我们没有可获取的标志物。在其他病症（术后和新冠病毒病）中，中性粒细胞/淋巴细胞与血小板（N/LP）比值与急性肾损伤有关；然而，在脓毒症这种具有严重炎症反应的病症中，这种关系尚未得到研究。
证明重症监护中脓毒症继发的AKI与N/LP之间的关联。
对18岁以上因脓毒症诊断入住重症监护的患者进行双向队列研究。从入院至第七天以及直至AKI诊断和预后计算N/LP比值。采用卡方检验、克莱默V系数和多因素逻辑回归进行统计分析。
在研究的239例患者中，AKI发病率为70%。N/LP比值>3的患者中80.9%发生了AKI（p<0.0001，克莱默V系数0.458，比值比3.05，95%置信区间1.602 - 5.8），且肾脏替代治疗增加（21.1%对11.1%，p = 0.043）。
N/LP比值>3与重症监护病房中脓毒症继发的AKI存在中度关联。
