Vargas Ángel Diana Carolina, Chaparro Camilo Andrés, Muñoz Oscar Mauricio, Contreras-Villamizar Kateir, González Camilo Alberto, Martín Daniel Augusto, Galindo Laura Viviana
Nephrology Department, San Ignacio University Hospital, Bogotá, Colombia.
Internal Medicine Department, Hospital Universitario San Ignacio, Bogotá, Colombia.
SAGE Open Med. 2025 May 15;13:20503121251333691. doi: 10.1177/20503121251333691. eCollection 2025.
Recent studies have identified the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and neutrophil/lymphocyte × platelet ratio as promising prognostic markers in patients with sepsis. This study aims to evaluate the discriminatory ability of these ratios to predict mortality and requirement for renal replacement therapy at discharge, in patients with septic acute kidney injury.
Diagnostic test study based on a multicenter retrospective cohort of adult patients with septic acute kidney injury requiring renal support. Hematologic ratios were calculated for three disease moments (admission, diagnosis of acute kidney injury, initiation of renal replacement therapy). Receiver operating characteristic curves were used to analyze the discriminative ability of the different hematological ratios at each disease moment.
A total of 152 patients were included. In-hospital mortality occurred in 61.8%, and 24.2% of survivors required renal replacement therapy at discharge. Measurements taken at the initiation of renal replacement therapy had the best discriminatory ability to predict adverse outcomes. For neutrophil/lymphocyte ratio the area under the curve to predict mortality was 0.596; (95% CI: 0.500-0.692), and to predict the requirement of renal replacement therapy 0.592 (95% CI: 0.286-0.898). In all proposed scenarios, the neutrophil/lymphocyte ratio and neutrophil/lymphocyte × platelet ratio demonstrated superior performance in comparison to the platelet/lymphocyte ratio. All three ratios exhibited comparable poor discriminatory ability.
Hematological ratios have poor discriminatory capacity for predicting adverse outcomes in cases of septic acute kidney injury. The neutrophil-to-lymphocyte ratio taken at the initiation of renal replacement therapy is a potentially useful, economical, and easily applicable tool to be included in predictive models of mortality and dialysis dependence.
近期研究已确定中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值以及中性粒细胞/淋巴细胞×血小板比值是脓毒症患者有前景的预后标志物。本研究旨在评估这些比值对脓毒性急性肾损伤患者出院时死亡率及肾脏替代治疗需求的鉴别能力。
基于多中心回顾性队列研究，纳入需要肾脏支持的成年脓毒性急性肾损伤患者进行诊断试验研究。计算三个疾病时间点（入院、急性肾损伤诊断、开始肾脏替代治疗）的血液学比值。采用受试者工作特征曲线分析各疾病时间点不同血液学比值的鉴别能力。
共纳入152例患者。院内死亡率为61.8%，24.2%的幸存者出院时需要肾脏替代治疗。开始肾脏替代治疗时的测量值对预测不良结局具有最佳鉴别能力。中性粒细胞/淋巴细胞比值预测死亡率的曲线下面积为0.596；（95%可信区间：0.500 - 0.692），预测肾脏替代治疗需求的曲线下面积为0.592（95%可信区间：0.286 - 0.898）。在所有设定情况下，中性粒细胞/淋巴细胞比值和中性粒细胞/淋巴细胞×血小板比值与血小板/淋巴细胞比值相比表现更优。所有三个比值的鉴别能力均较差。
血液学比值对预测脓毒性急性肾损伤患者的不良结局鉴别能力较差。在开始肾脏替代治疗时测定的中性粒细胞与淋巴细胞比值是一种潜在有用、经济且易于应用的工具，可纳入死亡率和透析依赖预测模型。
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