Lan Duong Thi Ngoc, Coradduzza Donatella, Van An Le, Paliogiannis Panagiotis, Chessa Carla, Zinellu Angelo, Mangoni Arduino A, Carru Ciriaco
Department of General Internal Medicine and Endocrinology, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Indian J Clin Biochem. 2025 Apr;40(2):307-315. doi: 10.1007/s12291-024-01184-1. Epub 2024 Feb 13.
Chronic kidney disease (CKD) is a complex health condition characterized by the gradual loss of renal function, often leading to end-stage renal disease (ESRD). It results from a combination of medical, environmental, and genetic factors. Predicting the rate of renal function decline and effectively managing the progression to ESRD is challenging in clinical practice. CKD assessment involves various indicators, including estimated glomerular filtration rate (eGFR), albuminuria levels, serum creatinine, and others. This study aimed to explore the predictive potential of specific blood cell indexes in forecasting further renal function decline and the transition from CKD stage 3-4 to ESRD. We assessed the following blood cell indexes in 377 CKD stage 3-4 patients: absolute neutrophil count (ANC), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), derived NLR (dNLR), mean platelet volume (MPV), aggregate index of systemic inflammation (AISI), and systemic inflammation index (SII). ANC, MPV, NLR, PLR, dNLR, and SII were found to independently predict a rapid decline in eGFR. Notably, NLR and dNLR demonstrated the highest sensitivity and specificity with cut-off values of 3.36 and 2.45, respectively (NLR: 88.6 and 81.7%; dNLR: 85.2 and 75.8%). The corresponding area under the ROC curve values were 0.877 (95% CI 0.837-0.918, < 0.001) for NLR and 0.849 (95% CI 0.805-0.892, < 0.001) for dNLR. However, none of the blood cell indexes independently predicted the transition to ESRD. The NLR and the dNLR exhibited the highest predictive capacity towards a rapid decline in renal function in CKD. No blood cell index, however, independently predicted the transition into ERSD.
慢性肾脏病（CKD）是一种复杂的健康状况，其特征是肾功能逐渐丧失，常导致终末期肾病（ESRD）。它是由医学、环境和遗传因素共同作用导致的。在临床实践中，预测肾功能下降的速度并有效管理向ESRD的进展具有挑战性。CKD评估涉及多种指标，包括估计肾小球滤过率（eGFR）、蛋白尿水平、血清肌酐等。本研究旨在探讨特定血细胞指标在预测肾功能进一步下降以及从CKD 3-4期向ESRD转变方面的预测潜力。我们评估了377例CKD 3-4期患者的以下血细胞指标：绝对中性粒细胞计数（ANC）、中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、衍生NLR（dNLR）、平均血小板体积（MPV）、全身炎症聚集指数（AISI）和全身炎症指数（SII）。发现ANC、MPV、NLR、PLR、dNLR和SII可独立预测eGFR的快速下降。值得注意的是，NLR和dNLR表现出最高的敏感性和特异性，截断值分别为3.36和2.45（NLR：88.6%和81.7%；dNLR：85.2%和75.8%）。NLR的ROC曲线下面积值为0.877（95%CI 0.837-0.918，P<0.001），dNLR为0.849（95%CI 0.805-0.892，P<0.001）。然而，没有一个血细胞指标能独立预测向ESRD的转变。NLR和dNLR对CKD患者肾功能快速下降的预测能力最强。然而，没有血细胞指标能独立预测向ESRD的转变。
