Fan Guohui, Liu Xin, Xu Feiya, Zhang Xiaomeng, Si Chaozeng, Yin Tingyu, Lyu Yanshuang, Ma Jing, Liu Bing, Yang Weizhong, Jia Cunbo, Wang Dingyi
National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Clinical research and Data management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Department of Nephrology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, China.
Kidney Med. 2025 Jul 3;7(9):101063. doi: 10.1016/j.xkme.2025.101063. eCollection 2025 Sep.
RATIONALE & OBJECTIVE: Lymphopenia may have a potential mechanism on the development of acute kidney injury (AKI) after respiratory virus infection but has never been revealed. We aimed to investigate the relationship between lymphopenia and AKI in patients hospitalized with respiratory virus infections.
STUDY & DESIGN: A single-center and retrospective cohort study.
SETTING & PARTICIPANTS: Data were retrospectively collected from electronic medical records of patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, or other respiratory virus infections from 2016- 2023.
Prolonged lymphopenia (<1.1 × 10/L) was defined as continuous lymphopenia lasting for ≥1 day before AKI diagnosis. Serial measurements of serum creatinine levels and lymphocyte counts before AKI were collected.
AKI developed after infection was identified according to the KDIGO guideline.
Multivariable logistic regression models and Cox proportional regression models were conducted to evaluate associations between lymphopenia or blood count ratios and AKI.
A total of 3,104 patients were analyzed, including 1,945 infected with SARS-CoV-2, 597 with influenza, and 472 with other respiratory virus infections. The AKI incidences were 18.0%, 23.3%, and 16.3%, respectively. Serum creatinine level was significantly negatively correlated with lymphocyte count in SARS-CoV-2 and influenza infections. Multivariable regression showed lymphopenia, especially prolonged lymphopenia, was significantly associated with AKI in all virus groups, especially in influenza. The risk magnitudes of monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio on admission for AKI varied by different viral infections. Lymphopenia or not was not associated with AKI stages or AKI recovery.
The results were limited by the retrospective, single-center setting and the probability of underestimation of the prevalence of both lymphopenia and AKI.
Lymphopenia, especially prolonged lymphopenia, and neutrophil-to-lymphocyte ratio on admission were risk factors for AKI after respiratory virus infection, with the highest risk observed in patients with influenza.
淋巴细胞减少可能是呼吸道病毒感染后急性肾损伤（AKI）发生发展的潜在机制，但尚未得到揭示。我们旨在调查因呼吸道病毒感染住院患者中淋巴细胞减少与AKI之间的关系。
一项单中心回顾性队列研究。
回顾性收集了2016年至2023年因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）、流感或其他呼吸道病毒感染住院患者的电子病历数据。
持续性淋巴细胞减少（<1.1×10⁹/L）定义为在AKI诊断前持续≥1天的淋巴细胞减少。收集AKI发生前血清肌酐水平和淋巴细胞计数的系列测量值。
根据KDIGO指南确定感染后发生的AKI。
采用多变量逻辑回归模型和Cox比例回归模型评估淋巴细胞减少或血细胞计数比值与AKI之间的关联。
共分析了3104例患者，其中1945例感染SARS-CoV-2，597例感染流感，472例感染其他呼吸道病毒。AKI发生率分别为18.0%、23.3%和16.3%。在SARS-CoV-2和流感感染中，血清肌酐水平与淋巴细胞计数显著负相关。多变量回归显示，淋巴细胞减少，尤其是持续性淋巴细胞减少，在所有病毒组中均与AKI显著相关，尤其是在流感组中。入院时单核细胞与淋巴细胞比值、中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值对AKI的风险程度因不同病毒感染而异。淋巴细胞减少与否与AKI分期或AKI恢复无关。
本研究结果受回顾性、单中心研究设计的限制，且淋巴细胞减少和AKI患病率可能被低估。
淋巴细胞减少，尤其是持续性淋巴细胞减少，以及入院时中性粒细胞与淋巴细胞比值是呼吸道病毒感染后发生AKI的危险因素，流感患者的风险最高。
