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Half of the patients with severe sepsis presented with acute kidney injury. Sepsis associated acute kidney injury (SA-AKI) is one of the life-threatening conditions and their mortality rate is very high. Nearly twenty five percent of them required renal replacement therapy.
This study aimed to show the comparison of initial hematological parameters between non-survivors and survivors at day 28 in sepsis patients presented with acute kidney injury on admission. It was a retrospective observational cohort study. Data were collected from medical records of patients admitted to medical ICU during 2020 September to 2022 April. Total 116 patients presented with AKI on admission according to the KDIGO criteria were included. The hematological parameters such as Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR) and Neutrophil to Lymphocyte to Platelet Ratio (NLPR) were compared between two groups.
Among 116 patients presented with SA-AKI, 51 patients (44.0%) expired within 28 days. Although the initial NLR and PLR were not significantly different, NLPR was significantly different between non-survivors and survivors at day 28 (p = 0.017).
Table (1) Baseline characteristics of patients with SA-AKI (n = 116)
Parameters
Non-survivors
Survivors
p value
Number of patients (%)
51 (44.0 %)
65 (56.0 %)
Stages of AKI, n (%)
Stage I
27 (52.9 %)
38 (58.5 %)
0.249*
Stage II
9 (17.6 %)
16 (24.6 %)
Stage III
15 (29.4 %)
11 (16.9 %)
Age (years), mean ± SD
57.53 ± 14.21
55.88 ± 15.27
0.552†
Female, n (%)
20 (39.2 %)
30 (46.2 %)
0.454*
BMI (kg/m^2), mean ± SD
21.68 ± 3.59
22.97 ± 3.99
0.075†
Systolic BP (mmHg) mean ± SD
104.51 ± 25.50
98.23 ± 24.17
0.178†
Co-morbid diseases, n (%)
Hypertension
23 (45.1 %)
37 (56.9 %)
0.206*
COAD
4 (7.8 %)
6 (9.2 %)
1.000**
Diabetes Mellitus
13 (25.5 %)
26 (40.0%)
0.101*
Stroke
9 (13.8 %)
0.040*
Sources of infection, n (%)
Pneumonia
37 (72.5 %)
34 (52.3 %)
0.026*
Urinary tract infection
0 (0 %)
13 (20.0 %)
<0.001*
Gastrointestinal infection
12 (23.5 %)
14 (21.5 %)
0.799*
Skin and soft tissue infection
7 (13.7 %)
10 (15.4 %)
0.082*
Others
1 (1.5 %)
1.000*
* Pearson’s chi-square test **Fisher’s exact test †Independent t-test
Table (2) Laboratory parameters of patients with SA-AKI (n = 116)
Parameters, Median (IQR)
Creatinine (mg/dL)
1.99 (2.10)
1.76 (1.33)
0.552‡
Total WBC (10^9/L)
15.6 (10.20)
15.12 (8.83)
0.427‡
ANC (10^9/L)
13.5 (9.20)
12.26 (8.11)
0.188‡
ALC (10^9/L)
1.30 (0.90)
1.23 (1.07)
0.947‡
Platelets (10^9/L)
237.00 (226.00)
320.00 (189.00)
0.107‡
NLR
10.38 (8.06)
9.17 (8.85)
0.103‡
PLR
172.50 (251.62)
228.75 (235.04)
0.254‡
NLPR
4.48 (6.64)
3.62 (4.04)
0.017‡
‡Mann-Whitney U test
ANC absolute neutrophil count, ALC absolute lymphocyte count, NLR neutrophil to lymphocyte ratio, PLR platelet to lymphocyte ratio, NLPR neutrophil to lymphocyte to platelet ratio
Neutrophil to Lymphocyte to Platelet Ratio may predict 28 days mortality in patients with sepsis associated acute kidney injury.
