Wei Wei, Yang Binyu, Zhu Yuyi, Liu Caihong, Huang Yongxiu, Yang Letian, Li Jian, Ren Jinglei, Ma Liang, Zhang Ling, Zhao Yuliang, Fu Ping
Department of Nephrology, Institute of Kidney Diseases, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Clin Exp Med. 2025 Jun 13;25(1):201. doi: 10.1007/s10238-025-01746-4.
The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a potential biomarker for the prediction and risk stratification of acute kidney injury (AKI), but conflicting results were reported by literature. We therefore conducted a pooled analysis to consolidate available evidence regarding the predictive and prognostic value of NLR in AKI patients. A systematic search was performed in the PubMed/Medline, Embase, and Cochrane Central Register of Controlled Trials (Central) databases from inception to March 2025 for cohort studies investigating the association between NLR and AKI. Quality assessment was performed via the Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tool. The predictive and prognostic value of the NLR for AKI was evaluated via pooled estimates of odds ratio (OR), sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NeLR), diagnostic score (DS), diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curves, and the Fagan nomogram. Twenty-nine studies with 102,870 patients were pooled in this meta-analysis. Higher NLR was associated an increased risk of AKI (OR 1.52, 95% CI 1.29-1.79; p < 0.001). The pooled sensitivity and specificity were 0.70 (95% CI 0.65-0.74) and 0.67 (95% CI 0.60-0.74). The combined values of the PLR, NeLR, DS, and DOR were 2.13 (1.74-2.60), 0.45 (0.38-0.52), 1.56 (1.24-1.89), and 4.78 (3.46-6.60), respectively, with a pooled area under the curve (AUC) for the SROC being 0.74 (95% CI 0.70-0.78). Subgroup analysis suggested that the associations remained statistically significant in contrast-associated AKI (p < 0.001) and surgery-associated AKI (p < 0.001), but of boarder line significance in sepsis-associated AKI (p = 0.082). In addition, higher NLR was also found to be related to 1.47-fold increase in mortality among AKI patients (OR 1.47, 95% CI 1.13-1.91, p = 0.004). NLR is not only an effective marker for predicting AKI event, but also a prognostic tool to identify AKI patients with higher risk of death. Future studies are needed to justify its value in different AKI subtypes.
中性粒细胞与淋巴细胞比值（NLR）已被认为是预测急性肾损伤（AKI）及进行风险分层的潜在生物标志物，但文献报道的结果相互矛盾。因此，我们进行了一项汇总分析，以整合关于NLR在AKI患者中的预测和预后价值的现有证据。从数据库建立至2025年3月，我们在PubMed/Medline、Embase和Cochrane对照试验中心注册库（Central）数据库中进行了系统检索，以查找调查NLR与AKI之间关联的队列研究。通过诊断准确性研究质量评估（QUADAS-2）工具进行质量评估。通过比值比（OR）、敏感性、特异性、阳性似然比（PLR）、阴性似然比（NeLR）、诊断评分（DS）、诊断比值比（DOR）、汇总受试者工作特征（SROC）曲线和Fagan列线图的汇总估计值，评估NLR对AKI的预测和预后价值。本荟萃分析纳入了29项研究，共102,870例患者。较高的NLR与AKI风险增加相关（OR 1.52，95% CI 1.29-1.79；p < 0.001）。汇总敏感性和特异性分别为0.70（95% CI 0.65-0.74）和0.67（95% CI 0.60-0.74）。PLR、NeLR、DS和DOR的合并值分别为2.13（1.74-2.60）、0.45（0.38-0.52）、1.56（1.24-1.89）和4.78（3.46-6.60），SROC曲线下的汇总面积（AUC）为0.74（95% CI 0.70-0.78）。亚组分析表明，在对比剂相关性AKI（p < 0.001）和手术相关性AKI（p < 0.001）中这种关联仍具有统计学意义，但在脓毒症相关性AKI中具有临界意义（p = 0.082）。此外，还发现较高的NLR与AKI患者死亡率增加1.47倍相关（OR 1.47，95% CI 1.13-1.91，p = 0.004）。NLR不仅是预测AKI事件的有效标志物，也是识别死亡风险较高的AKI患者的预后工具。未来需要开展研究以证明其在不同AKI亚型中的价值。
