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A novel predictor in acute kidney injury: Neutrophil to lymphocyte count

Year 2018, Volume: 57 Issue: 1, 8 - 13, 01.03.2018

Devrim Bozkurt Aslı Kılavuz Mehmet Berktaş Fehmi Akçiçek

https://doi.org/10.19161/etd.414355

Abstract

Aim: Acute Kidney injury (AKI) represents a clinical condition reflecting systemic inflammation. Neutrophil-to-lymphocyte ratio (NLR) is novel prognostic marker in various inflammatory conditions. In this retrospective cohort we evaluated two hundred and thirteen AKI patients.

Materials and Methods: The patients’ baseline values on admission, final values at discharge and after discharging during follow-up period in outpatient clinic until six months to one year were recorded. NLR change during follow-up period after hospitalization was also examined.

Results: It has been shown that, final NLR and timely changed NLR during hospital course are significant mortality predictors in AKI patients both in univariate and mutually adjusted multivariate logistic regression analysis. To predict mortality, we showed that, level of 9.90 point for final NLR has 73% sensitivity and 87% specifity as compared to value below in ROC analysis (HR: 7.31, CI 3.36-15.91; p<0.001).

Conclusion: NLR may be a novel screening tool on patiens' mortality for AKI patients during their hospital course.

Keywords

Keywords: Acute renal failure mortality

References

  • Hoste EA, Clermont G, Kersten A. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care 2006;10(3): R73.
  • Vallés PG, Lorenzo AG, Bocanegra V. Acute kidney injury: What part do toll-like receptors play? Int J Nephrol Renovasc Dis 2014;19(7):241-5.
  • Powell TC, Powell SL, Allen BK. Association of inflammatory and endothelial cell activation biomarkers with acute kidney injury after sepsis. Springerplus 2014;28(3):207.
  • Wang X, Zhang G, Jiang X. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: A meta-analysis of observational studies. Atherosclerosis 2014;234(1):206-13.
  • Ouellet G, Malhotra R, Penne EL. Neutrophil-lymphocyte ratio as a novel predictor of survival in chronic hemodialysis patients. Clin Nephrol 2016;85(4):191-8.
  • Bhat TM, Afari ME, Garcia LA. Neutrophil lymphocyte ratio in peripheral vascular disease: A review. Expert Rev Cardiovasc Ther 2016;14(7):871-5.
  • Dilektasli E, Inaba K, Haltmeier T. The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients. J Trauma Acute Care Surg 2016;81(5):882-8.
  • KDIGO AKI Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int 2012;Suppl 2:1-138.
  • Levey AS, Bosch JP, Lewis JB. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Int Med 1999;130(6):461-70.
  • Gammelager H, Christiansen CF, Johansen MB. Five-year risk of end stage renal disease among intensive care patients surviving dialysis- requiring acute kidney injury: A nationwide cohort study. Crit Care 2013;17(4):R145.
  • Levy MM, Fink MP, Marshall JC. 2001 CCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31(4):1250-6.
  • Lameire NH, Bagga A, Cruz D. Acute kidney injury: An increasing global concern. Lancet 2013;13(9887):170-9.
  • Cruz DN, Ronco C. Acute kidney injury in the intensive care unit: Current trends in incidence and outcome. Crit Care 2007;11(4):149.
  • Chronopoulos A, Rosner MH, Cruz DN. Acute kidney injury in elderly intensive care patients: A review. Intensive Care Med 2010;36(9):1454-64.
  • Bellomo R, Wan L, Langenberg C. Septic acute kidney injury: New concepts. Nephron Exp Nephrol 2008;109(4):e95-e100.
  • Bagshaw SM, Uchino S, Bellomo R. Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2(3):431-9.
  • Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102(1):5-14.
  • Kinsey GR, Li L, Okusa MD. Inflammation in acute kidney injury. Nephron Exp Nephrol 2008;109(4):e102-7.
  • Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal 2014;28(1):27-31.
  • Sawant AC, Adhikari P, Narra SR. Neutrophil to lymphocyte ratio predicts short and long term mortality following revascularization therapy for ST elevation myocardial infarction. Cardiol J 2014;21(5):500-8.
  • Demirkol S, Balta S, Unlu M. Neutrophils/lymphocytes ratio in patients with cardiac syndrome X and its association with carotid intima-media thickness. Clin Appl Thromb Hemost 2014;20(3):250-5.
  • Park BJ, Shim JY, Lee HR. Relationship of neutrophil-lymphocyte ratio with arterial stiffness and coronary calcium score. Clin Chim Acta 2011;412(11-12):925-9.
  • Arbel Y, Finkelstein A, Halkin A. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patient undergoing angiography. Atherosclerosis 2012;225(2):456-60.
  • Park JJ, Jang HJ, Oh IY. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013;111(5):636-42.
  • Papa A, Emdin M, Passino C. Predictive value of elevated neutrophil lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395(1-2):27-31.
  • Uthamalingam S, Patvardhan EA, Subramanian S. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107(3):433-8.
  • An X, Mao HP, Wei X. Elevated neutrophil to lymphocyte ratio predicts overall and cardiovascular mortality in maintenance peritoneal dialysis patients. Int Urol Nephrol 2012;44(5):1521-8.
  • Kato A, Tsuji T, Sakao Y. A Comparison of systemic inflammation-based prognostic scores in patients on regular hemodialysis. Nephron Extra 2013;3(1):91-100.
  • Hudzik B, Szkodziński J, Lekston A. Mean platelet volume-to-lymphocyte ratio: A novel marker of poor short- and long-term prognosis in patients with diabetes mellitus and acute myocardial infarction. J Diabetes Complications 2016;30(6):1097-102.
  • Liu X, Shen Y, Wang H. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: A prospective observational study. Mediators Inflamm 2016;24:8191254.

Akut böbrek hasarlanmasında yeni bir gösterge: Nötrofil-lenfosit oranı

Year 2018, Volume: 57 Issue: 1, 8 - 13, 01.03.2018

Devrim Bozkurt Aslı Kılavuz Mehmet Berktaş Fehmi Akçiçek

https://doi.org/10.19161/etd.414355

Abstract

Amaç: Akut böbrek hasarlanması (ABH), sistemik inflamasyonu yansıtan bir klinik durumdur. Nötrofil-lenfosit oranı (NLO), değişik inflamatuar durumlarda bilinen yeni prognostik göstergedir. Bu retrospektif kohort çalışmasında iki yüz on üç akut böbrek hasarlanmalı hasta incelendi.

Gereç ve Yöntem: Hastaların başvuru anı, çıkış anı ve taburculuk sonrası poliklinik takiplerinde var olan altı ay bir yıllık değerleri kaydedildi. Bu takip periyodunda hastaların NLO değişimleri incelendi.

Bulgular: Tek değişkenli ve çoklu değişkenli regresyon analizlerinde, hem taburculuk anı NLO değeri hem de zamansal NLO değişimi, akut böbrek hasarlanmalı hastalarda bağımsız mortalite öngörücüsü olarak saptandı. Yapılan ROC analizinde, mortalite ön görücülüğünde, NLO üst sınır için 9.90 değeri, %87 özgüllük ve %73 duyarlılıkta saptandı (HR: 7.31, CI 3.36-15.91; p<0.001).

Sonuç: Akut böbrek hasarlanmalı hastalarda, NLO, hastane yatış sürecinde mortalite için yeni bir takip parametresi olabilir.


Keywords

Anahtar Sözcükler: Akut böbrek yetmezliği mortalite

References

  • Hoste EA, Clermont G, Kersten A. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: A cohort analysis. Crit Care 2006;10(3): R73.
  • Vallés PG, Lorenzo AG, Bocanegra V. Acute kidney injury: What part do toll-like receptors play? Int J Nephrol Renovasc Dis 2014;19(7):241-5.
  • Powell TC, Powell SL, Allen BK. Association of inflammatory and endothelial cell activation biomarkers with acute kidney injury after sepsis. Springerplus 2014;28(3):207.
  • Wang X, Zhang G, Jiang X. Neutrophil to lymphocyte ratio in relation to risk of all-cause mortality and cardiovascular events among patients undergoing angiography or cardiac revascularization: A meta-analysis of observational studies. Atherosclerosis 2014;234(1):206-13.
  • Ouellet G, Malhotra R, Penne EL. Neutrophil-lymphocyte ratio as a novel predictor of survival in chronic hemodialysis patients. Clin Nephrol 2016;85(4):191-8.
  • Bhat TM, Afari ME, Garcia LA. Neutrophil lymphocyte ratio in peripheral vascular disease: A review. Expert Rev Cardiovasc Ther 2016;14(7):871-5.
  • Dilektasli E, Inaba K, Haltmeier T. The prognostic value of neutrophil-to-lymphocyte ratio on mortality in critically ill trauma patients. J Trauma Acute Care Surg 2016;81(5):882-8.
  • KDIGO AKI Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int 2012;Suppl 2:1-138.
  • Levey AS, Bosch JP, Lewis JB. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Int Med 1999;130(6):461-70.
  • Gammelager H, Christiansen CF, Johansen MB. Five-year risk of end stage renal disease among intensive care patients surviving dialysis- requiring acute kidney injury: A nationwide cohort study. Crit Care 2013;17(4):R145.
  • Levy MM, Fink MP, Marshall JC. 2001 CCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31(4):1250-6.
  • Lameire NH, Bagga A, Cruz D. Acute kidney injury: An increasing global concern. Lancet 2013;13(9887):170-9.
  • Cruz DN, Ronco C. Acute kidney injury in the intensive care unit: Current trends in incidence and outcome. Crit Care 2007;11(4):149.
  • Chronopoulos A, Rosner MH, Cruz DN. Acute kidney injury in elderly intensive care patients: A review. Intensive Care Med 2010;36(9):1454-64.
  • Bellomo R, Wan L, Langenberg C. Septic acute kidney injury: New concepts. Nephron Exp Nephrol 2008;109(4):e95-e100.
  • Bagshaw SM, Uchino S, Bellomo R. Septic acute kidney injury in critically ill patients: Clinical characteristics and outcomes. Clin J Am Soc Nephrol 2007;2(3):431-9.
  • Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001;102(1):5-14.
  • Kinsey GR, Li L, Okusa MD. Inflammation in acute kidney injury. Nephron Exp Nephrol 2008;109(4):e102-7.
  • Celikbilek A, Ismailogullari S, Zararsiz G. Neutrophil to lymphocyte ratio predicts poor prognosis in ischemic cerebrovascular disease. J Clin Lab Anal 2014;28(1):27-31.
  • Sawant AC, Adhikari P, Narra SR. Neutrophil to lymphocyte ratio predicts short and long term mortality following revascularization therapy for ST elevation myocardial infarction. Cardiol J 2014;21(5):500-8.
  • Demirkol S, Balta S, Unlu M. Neutrophils/lymphocytes ratio in patients with cardiac syndrome X and its association with carotid intima-media thickness. Clin Appl Thromb Hemost 2014;20(3):250-5.
  • Park BJ, Shim JY, Lee HR. Relationship of neutrophil-lymphocyte ratio with arterial stiffness and coronary calcium score. Clin Chim Acta 2011;412(11-12):925-9.
  • Arbel Y, Finkelstein A, Halkin A. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patient undergoing angiography. Atherosclerosis 2012;225(2):456-60.
  • Park JJ, Jang HJ, Oh IY. Prognostic value of neutrophil to lymphocyte ratio in patients presenting with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 2013;111(5):636-42.
  • Papa A, Emdin M, Passino C. Predictive value of elevated neutrophil lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta 2008;395(1-2):27-31.
  • Uthamalingam S, Patvardhan EA, Subramanian S. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107(3):433-8.
  • An X, Mao HP, Wei X. Elevated neutrophil to lymphocyte ratio predicts overall and cardiovascular mortality in maintenance peritoneal dialysis patients. Int Urol Nephrol 2012;44(5):1521-8.
  • Kato A, Tsuji T, Sakao Y. A Comparison of systemic inflammation-based prognostic scores in patients on regular hemodialysis. Nephron Extra 2013;3(1):91-100.
  • Hudzik B, Szkodziński J, Lekston A. Mean platelet volume-to-lymphocyte ratio: A novel marker of poor short- and long-term prognosis in patients with diabetes mellitus and acute myocardial infarction. J Diabetes Complications 2016;30(6):1097-102.
  • Liu X, Shen Y, Wang H. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: A prospective observational study. Mediators Inflamm 2016;24:8191254.
There are 30 citations in total.

Details

Primary Language English
Journal Section Research Articles
Authors

Devrim Bozkurt 0000-0003-4557-3390

Aslı Kılavuz 0000-0002-0474-9911

Mehmet Berktaş 0000-0003-0604-9449

Fehmi Akçiçek 0000-0003-2583-4709

Publication Date March 1, 2018
Submission Date August 21, 2016
Published in Issue Year 2018Volume: 57 Issue: 1

Cite

Vancouver Bozkurt D, Kılavuz A, Berktaş M, Akçiçek F. A novel predictor in acute kidney injury: Neutrophil to lymphocyte count. EJM. 2018;57(1):8-13.
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