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In the context of sepsis, Acute Kidney Injury (AKI) is a life-threatening condition associated with a significant mortality rate. While the KDIGO criteria are widely recognized for diagnosing AKI, there is an urgent need for more sophisticated risk assessment tools. Recently, Neutrophil-Lymphocyte ratio (N/L), platelet-lymphocyte ratio (P/L) and Neutrophil/(Lymphocyte x Platelet) (N/LP) ratios have emerged as promising inflammatory markers with the potential to enhance risk stratification.
The study was conducted on a cohort of adult individuals aged 18 years or older of both genders who were hospitalized at the Colsanitas Bogotá healthcare network or the Hospital Universitario San Ignacio between January 2016 and August 2021. These patients had a diagnosis of septic AKI as per KDIGO criteria and required renal support. Exclusion criteria encompassed individuals with incomplete data, hospital stays shorter than 48 hours, pregnant individuals, those with obstructive uropathy, recipients of kidney transplants, individuals with rapidly progressive glomerulonephritis or nephritic syndrome, patients with end-stage renal disease, as well as those with severe COVID-19-associated AKI necessitating dialysis after documented superinfection. These inclusion and exclusion criteria were pivotal for the retrospective analysis of N/L, P/L and N/LP ratios as predictive markers for in-hospital mortality in septic AKI patients.
418 patients were included with a diagnosis of AKI, of which 176 were diagnosed with COVID-19, and 242 with sepsis of another origin. 66.2% were male (n=277), the baseline eGFR was 75 mL/min/1.73m2 with a median SOFA score of 10 (IQR 3). The median values for N/L, P/L, and N/LP were 9.92 (IQR 13.2), 222.92 (IQR 235), and 4.58 (IQR 7.23), respectively. None of the three indices were associated with mortality risk in the bivariate analysis (p > 0.25). The ROC analysis for N/L, P/L, and N/LP showed an AUC of 0.53, 0.60, and 0.54, respectively. This AUC was lower compared to creatinine 0.65 and SOFA score 0.63. The combined use of the three indices resulted in an AUC of 0.54, with sensitivity and specificity of 50% and 53%, respectively.
Blood cell indices are a straightforward approach commonly employed to predict worse outcomes. Nonetheless, when utilized as a tool to predict mortality in AKI, they exhibit limited efficacy. Whether considered individually or in combination, cellular indices do not demonstrate superior predictive performance in comparison to traditional markers such as serum creatinine and/or SOFA score.