Use of hematological indices in severe septic acute kidney injury to predict hospital mortality and need for renal replacement therapy at discharge.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL
SAGE Open Medicine Pub Date : 2025-05-15 eCollection Date: 2025-01-01 DOI:10.1177/20503121251333691
Diana Carolina Vargas Ángel, Camilo Andrés Chaparro, Oscar Mauricio Muñoz, Kateir Contreras-Villamizar, Camilo Alberto González, Daniel Augusto Martín, Laura Viviana Galindo
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Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

使用血液学指标预测严重脓毒性急性肾损伤的住院死亡率和出院时肾脏替代治疗的需要。
目的:最近的研究发现,中性粒细胞/淋巴细胞比率、血小板/淋巴细胞比率和中性粒细胞/淋巴细胞×血小板比率是脓毒症患者有希望的预后指标。本研究旨在评估这些比率在预测脓毒性急性肾损伤患者的死亡率和出院时肾脏替代治疗需求方面的区别能力。方法:基于多中心回顾性队列的脓毒性急性肾损伤需要肾脏支持的成年患者的诊断试验研究。计算三个疾病时刻(入院、诊断急性肾损伤、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不同血液学比值在各疾病时刻的判别能力。结果:共纳入152例患者。住院死亡率为61.8%,出院时需要肾脏替代治疗的幸存者为24.2%。在肾脏替代治疗开始时采取的测量具有预测不良后果的最佳区分能力。对于中性粒细胞/淋巴细胞比值,预测死亡率的曲线下面积为0.596;(95% CI: 0.500-0.692),预测肾脏替代治疗需求为0.592 (95% CI: 0.286-0.898)。在所有提出的情况下,中性粒细胞/淋巴细胞比例和中性粒细胞/淋巴细胞×血小板比例比血小板/淋巴细胞比例表现出优越的性能。所有三个比率都表现出相当差的区分能力。结论:血液学比值在预测脓毒性急性肾损伤病例的不良结局方面具有较差的歧视性。在肾脏替代治疗开始时,中性粒细胞与淋巴细胞的比例是一个潜在的有用的、经济的、易于应用的工具,可用于死亡率和透析依赖的预测模型。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
SAGE Open Medicine
SAGE Open Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.50
自引率
4.30%
发文量
289
审稿时长
12 weeks
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