Yan Yang-Tian, Liu Rui, Liu Jian, Zhang Wen-Juan, Wang Shuang, Tang Tian-Ying, Lei Yu-Qiong, Zhu Xiao-Yu, Liu Ke-Xuan, Zheng Quan-Jing, Liu Hua-Min
Department of Anesthesiology, Guangdong Provincial Key Laboratory of Precision Anesthesia and Perioperative Organ Protection, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Department of Anesthesiology, the second Hospital of Lanzhou University, Lanzhou, Gansu, People's Republic of China.
J Inflamm Res. 2025 May 9;18:6091-6102. doi: 10.2147/JIR.S512306. eCollection 2025.
Acute kidney injury (AKI) is a frequent complication following joint arthroplasty. This study investigated the association between novel inflammation indices and postoperative AKI.
This retrospective cohort study included 1434 patients who underwent hip or knee arthroplasty, with 1225 patients comprising the complete case analysis dataset. The primary analysis was performed using the complete case analysis dataset, while sensitivity analyses were conducted in both the imputed dataset and the dataset excluding patients with abnormal preoperative creatinine. Inflammation indices, including the Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), Aggregate Index of Systemic Inflammation (AISI), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), were derived from neutrophil, lymphocyte, monocyte, and platelet counts. Multivariate logistic regression and receiver-operating characteristic curve (ROC) analyses were performed to assess predictive performance. The area under the ROC (AUC) was compared using DeLong test.
Among 1225 patients in the complete case analysis dataset, 116 (9.47%) developed AKI (Stage I: 59, Stage II: 55, Stage III: 2). Elevated SIRI and MLR were independently associated with increased AKI risk [adjusted OR (95% CI) for Quartile 4 vs Quartile 1: 1.961 (1.070-3.595) and 1.902 (1.043-3.468), respectively]. AISI showed marginal significance [adjusted trend OR (95% CI): 1.192 (0.995-1.428)]. The predictive performance of the basic model (AUC = 0.565) significantly improved after incorporating SIRI, AISI, and MLR (ΔAUC: +0.066, +0.065, +0.070, respectively; all DeLong < 0.05). Monocyte count alone also enhanced prediction (ΔAUC: +0.065, DeLong < 0.05). Sensitivity analyses confirmed robustness.
SIRI, MLR, AISI, and monocyte count may serve as predictive indicators for AKI following joint arthroplasty. Further randomized trials are needed to establish causality.
急性肾损伤（AKI）是关节置换术后常见的并发症。本研究调查了新型炎症指标与术后AKI之间的关联。
这项回顾性队列研究纳入了1434例行髋关节或膝关节置换术的患者，其中1225例患者组成了完整病例分析数据集。主要分析使用完整病例分析数据集进行，同时在插补数据集和排除术前肌酐异常患者的数据集上进行敏感性分析。炎症指标，包括全身免疫炎症指数（SII）、全身炎症反应指数（SIRI）、全身炎症聚集指数（AISI）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和单核细胞与淋巴细胞比值（MLR），均来自中性粒细胞、淋巴细胞、单核细胞和血小板计数。进行多因素逻辑回归和受试者工作特征曲线（ROC）分析以评估预测性能。使用DeLong检验比较ROC曲线下面积（AUC）。
在完整病例分析数据集中的1225例患者中，116例（9.47%）发生了AKI（I期：59例，II期：55例，III期：2例）。SIRI和MLR升高与AKI风险增加独立相关[四分位数4与四分位数1的调整后比值比（95%CI）分别为：1.961（1.070 - 3.595）和1.902（1.043 - 3.468）]。AISI显示出边际显著性[调整后的趋势比值比（95%CI）：1.192（0.995 - 1.428）]。纳入SIRI、AISI和MLR后，基本模型的预测性能（AUC = 0.565）显著改善（ΔAUC分别为：+0.066、+0.065、+0.070；所有DeLong检验 < 0.05）。单独的单核细胞计数也增强了预测能力（ΔAUC：+0.065，DeLong检验 < 0.05）。敏感性分析证实了结果的稳健性。
SIRI、MLR、AISI和单核细胞计数可能作为关节置换术后AKI的预测指标。需要进一步的随机试验来确定因果关系。
