ASSOCIATION OF NEUTROPHIL-LYMPHOCYTE RATIO AND ACUTE KIDNEY INJURY IN SEPTIC PATIENTS IN THE ICU

Abstract

SESSION TITLE: Advances in Critical Care Practice SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Acute Kidney injury (AKI) is a common complication among patients with sepsis and conveys increased morbidity and mortality. Neutrophil-lymphocyte ratio (NLR) is a marker of inflammation and has been described to reflect severity of the infectious processes. We investigated the association between admission NLR and the development of AKI in septic patients admitted to the Intensive Care Unit (ICU). METHODS: Patients directly admitted to the ICU from the Emergency Department with a diagnosis of severe sepsis and septic shock between 2012-2014 at a large tertiary care center were included. Baseline demographics and laboratory values were collected retrospectively. The first absolute neutrophil and lymphocyte count of the hospital admission was used to calculate the NLR. Patients were classified into groups based on the degree of NLR elevation. The severe NLR group was defined as NLR greater than 18. The primary outcome was the development of AKI during ICU stay. Multivariate logistic regression was performed to determine predictors of AKI. RESULTS: A total of 125 patients were included in the study. There was a predominance of males (62%) and African Americans (53%). Mean (± SD) age was 54 ± 13 years and overall hospital mortality was 45%. 85 patients (68%) developed AKI during ICU stay. The median NLR in the AKI group was significantly higher than the non-AKI group: 14.14 (IQR 7.30-30.13) vs 8.64 (IQR 3.76-16.8) , p=0.012. The severe NLR group had a median NLR of 32.6 (IQR 24.5-45.7) and included a total of 46 patients (37%). In the univariate analysis, the severe NLR group was significantly associated with longer ICU stay (4 days in the severe NLR group vs 2 days in the non-severe NLR group, p=0.038) and development of AKI (p=0.023). On multivariate analysis, development of AKI was independently associated with severe NLR [adjusted Odds Ratio (OR)= 2.75, 95% Confidence Interval [CI] (1.03-7.39); p=0.044], creatinine level at admission (OR= 1.74, 95% CI 1.13-2.68, p=0.012) and Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR= 1.10, 95% CI 1.03-1.16, p=0.002). Chloride levels at 24 hours from admission was insignificant predictor of AKI in the model (OR= 1.05, 95% CI 0.97-1.13, p=0.229). CONCLUSIONS: Severe elevation of NLR was significantly associated with longer ICU stay and was independently associated with development of AKI in patients with severe sepsis and septic shock even after adjustment for SOFA scores. NLR is a simple laboratory parameter that can be easily obtained to predict kidney dysfunction in septic patients. CLINICAL IMPLICATIONS: AKI in the ICU is independently associated with adverse outcomes. Predictors of AKI may be helpful for early detection of patients at risk of kidney dysfunction and guide management for prevention of the same. DISCLOSURES: No relevant relationships by Afsana Asharaf, source=Web Response No relevant relationships by Rabab Nasim, source=Web Response No relevant relationships by Avantika Nathani, source=Web Response No relevant relationships by Prince Ntiamoah, source=Web Response No relevant relationships by VICTOR PRADO, source=Web Response No relevant relationships by Christian Trujillo, source=Web Response No relevant relationships by Connor Wakefield, source=Web Response