Dicu-Andreescu Ioana, Garneata Liliana, Ciurea Otilia-Andreea, Dicu-Andreescu Irinel-Gabriel, Ungureanu Elena-Alexandra, Vlad Denis-Valentin, Visan Antonia-Constantina, Ungureanu Victor-Gabriel, Vlad Violeta-Valentina, Vasioiu Patrick-Christian, Ciutacu Elis-Mihaela, Neicu Mihaela, Penescu Mircea, Verzan Constantin, Capusa Cristina
Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Nephrology Department, "Dr. Carol Davila" Teaching Hospital of Nephrology, Bucharest, Romania.
Maedica (Bucur). 2024 Sep;19(3):511-518. doi: 10.26574/maedica.2024.19.3.511.
The importance of hematological parameters has started to be explored with increased interest in many fields lately, with different studies finding an association between those parameters and inflammatory status, atherosclerosis, comorbidities, malnutrition, neoplasia and even a faster progression of chronic kidney disease (CKD). On the other hand, CKD itself presents as an inflammatory condition, in which a lot of pathways are modified and the response to an infectious agent could be less than expected. Regarding the latter aspect, in this study we aim to explore the differences between the hematologic response during a lower versus upper urinary tract infection in patients with CKD.
We analyzed 70 patients with chronic kidney disease and either cystitis or pyelonephritis considering the hematologic parameters, the classical inflammatory ones as well as the etiology of CKD.
Neutrophils, neutrophils/lymphocytes ratio (NLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and fibrinogen were higher in patients with pyelonephritis (PNA), while albumin was significantly lower. In a binary logistic regression model that explained 80.2% of the variability of PNA diagnosis and correctly predicted it in 92.9% of cases, NLR, CRP and fibrinogen were the independent predictors.
Hematologic parameters can serve not only as an indicator of the inflammatory status, but also as a laboratory biomarker for PNA in patients with CKD.
近年来，随着许多领域对血液学参数的兴趣不断增加，其重要性开始得到探索，不同研究发现这些参数与炎症状态、动脉粥样硬化、合并症、营养不良、肿瘤形成，甚至慢性肾脏病（CKD）的更快进展之间存在关联。另一方面，CKD本身表现为一种炎症状态，其中许多途径发生改变，对感染因子的反应可能低于预期。关于后一个方面，在本研究中，我们旨在探讨CKD患者下尿路感染与上尿路感染期间血液学反应的差异。
我们分析了70例患有慢性肾脏病且患有膀胱炎或肾盂肾炎的患者，考虑了血液学参数、经典炎症参数以及CKD的病因。
肾盂肾炎（PNA）患者的中性粒细胞、中性粒细胞/淋巴细胞比值（NLR）、红细胞沉降率（ESR）、C反应蛋白（CRP）和纤维蛋白原较高，而白蛋白显著较低。在一个二元逻辑回归模型中，该模型解释了PNA诊断变异性的80.2%，并在92.9%的病例中正确预测了PNA，NLR、CRP和纤维蛋白原是独立预测因子。
血液学参数不仅可作为炎症状态的指标，还可作为CKD患者PNA的实验室生物标志物。
