Dynamics in perioperative neutrophil-to-lymphocyte*platelet ratio as a predictor of early acute kidney injury following cardiovascular surgery

Yang Li; Zhouping Zou; Yunlu Zhang; Bowen Zhu; Yichun Ning; Bo Shen; Chunsheng Wang; Zhe Luo; Jiarui Xu; Xiaoqiang Ding

doi:10.1080/0886022X.2021.1937220

Dynamics in perioperative neutrophil-to-lymphocyte*platelet ratio as a predictor of early acute kidney injury following cardiovascular surgery

Ren Fail. 2021 Dec;43(1):1012-1019. doi: 10.1080/0886022X.2021.1937220.

Authors

Yang Li^{1

2

3}, Zhouping Zou^{1

2

3}, Yunlu Zhang^{1

2

3}, Bowen Zhu^{1

2

3}, Yichun Ning^{1

2

3}, Bo Shen^{1

2

3}, Chunsheng Wang⁴, Zhe Luo⁵, Jiarui Xu^{1

2

3}, Xiaoqiang Ding^{1

2

3}

Affiliations

¹ Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
² Shanghai Medical Center of Kidney, Shanghai, China.
³ Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.
⁴ Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
⁵ Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.

Abstract

Background: In this study, we applied a composite index of neutrophil-lymphocyte * platelet ratio (NLPR), and explore the significance of the dynamics of perioperative NLPR in predicting cardiac surgery-associated acute kidney injury (CSA-AKI).

Methods: During July 1^st and December 31^th 2019, participants were prospectively derived from the 'Zhongshan Cardiovascular Surgery Cohort'. NLPR was determined using neutrophil counts, lymphocyte and platelet count at the two-time points. Dose-response relationship analyses were applied to delineate the non-linear odds ratio (OR) of CSA-AKI in different NLPR levels. Then NLPRs were integrated into the generalized estimating equation (GEE) to predict the risk of AKI.

Results: Of 2449 patients receiving cardiovascular surgery, 838 (34.2%) cases developed CSA-AKI with stage 1 (n = 658, 26.9%), stage 2-3 (n = 180, 7.3%). Compared with non-AKI patients, both preoperative and postoperative NLPR were higher in AKI patients (1.1[0.8, 1.8] vs. 0.9[0.7,1.4], p < 0.001; 12.4[7.5, 20.0] vs. 10.1[6.4,16.7], p < 0.001). Such an effect was a 'J'-shaped relationship: CSA-AKI's risk was relatively flat until 1.0 of preoperative NLPR and increased rapidly afterward, with an odds ratio of 1.13 (1.06-1.19) per 1 unit. Similarly, patients whose postoperative NLPR value >11.0 were more likely to develop AKI with an OR of 1.02. Integrating the dynamic NLPRs into the GEE model, we found that the AUC was 0.806(95% CI 0.793-0.819), which was significantly higher than the AUC without NLPR (0.799, p < 0.001).

Conclusion: Dynamics of perioperative NPLR is a promising marker for predicting acute kidney injury. It will facilitate AKI risk management and allow clinicians to intervene early so as to reverse renal damage.

Keywords: Acute kidney injury; cardiovascular surgery; lymphocyte; neutrophils; platelet; predictor.

MeSH terms

Acute Kidney Injury / blood*
Acute Kidney Injury / diagnosis
Acute Kidney Injury / etiology
Adult
Aged
Biomarkers / blood
Blood Platelets / metabolism*
Cardiac Surgical Procedures / adverse effects*
Female
Humans
Leukocyte Count / methods
Lymphocytes / metabolism*
Male
Middle Aged
Neutrophils / metabolism*
Platelet Count / methods
Postoperative Complications / blood*
Postoperative Complications / diagnosis
Postoperative Complications / etiology
Prospective Studies
Risk Factors

Substances

Biomarkers

Grants and funding

The study was financially supported by Shanghai Key Laboratory of Kidney and Blood Purification [no. 14DZ2260200], the National Natural Science Foundation of China [no. 81901939], Zhongshan hospital WITMED Clinical Research Project [no. 2020ZHZS15], and Shanghai Municipal Hospital Frontier Technology Project [no. SHDC12018127].