Abstract
BackgroundInflammation plays an important role in the initiation and progression of acute kidney injury (AKI). However, evidence regarding the prognostic effect of the platelet-to-lymphocyte ratio (PLR), a novel systemic inflammation marker, among patients with AKI is scarce. In this study, we investigated the value of the PLR in predicting the outcomes of critically ill patients with AKI.MethodsPatient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3. PLR cutoff values were determined using smooth curve fitting or quintiles and were used to categorize the subjects into groups. The clinical outcomes were 30-day and 90-day mortality in the intensive care unit (ICU). Cox proportional hazards models were used to evaluate the association between the PLR and survival.ResultsA total of 10,859 ICU patients with AKI were enrolled. A total of 2277 thirty-day and 3112 ninety-day deaths occurred. A U-shaped relationship was observed between the PLR and both 90-day and 30-day mortality, with the lowest risk being at values ranging from 90 to 311. The adjusted HR (95% CI) values for 90-day mortality given risk values < 90 and > 311 were 1.25 (1.12–1.39) and 1.19 (1.08–1.31), respectively. Similar trends were observed for 30-day mortality or when quintiles were used to group patients according to the PLR. Statistically significant interactions were found between the PLR and both age and heart rate. Younger patients (aged < 65 years) and those with more rapid heart rates (≥89.4 beats per minute) tended to have poorer prognoses only when the PLR was < 90, whereas older patients (aged ≥ 65 years) and those with slower heart rates (<89.4 beats per minute) had higher risk only when the PLR was > 311 (P < 0.001 for age and P < 0.001 for heart rate).ConclusionsThe preoperative PLR was associated in a U-shaped pattern with survival among patients with AKI. The PLR appears to be a novel, independent prognostic marker of outcomes in critically ill patients with AKI.
Highlights
Inflammation plays an important role in the initiation and progression of acute kidney injury (AKI)
Subject characteristics Patient records from 14,354 subjects who underwent intensive care unit (ICU) treatment at Beth Israel Deaconess Medical Center were initially extracted from the MIMIC-III database
6881 (63.4%) patients were recruited from the medical ICU, and 3978 (36.6%) patients were recruited from the surgical ICU
Summary
Inflammation plays an important role in the initiation and progression of acute kidney injury (AKI). Evidence regarding the prognostic effect of the platelet-to-lymphocyte ratio (PLR), a novel systemic inflammation marker, among patients with AKI is scarce. In the presence of AKI, patient mortality increases to as high as 60–70%, especially within 1 year after ICU admission [4,5,6]. Systemic inflammation is an integral part of disease progression in critical illness and is commonly associated with sepsis, leading to an increased risk of mortality [7, 8]. Inflammation plays an important role in the initiation and progression of AKI [9,10,11], and morphological and/or functional changes in vascular endothelial cells and/or in the tubular epithelium are observed in patients with AKI. To the best of our knowledge, no epidemiological study to date has explored the prognostic effect of the PLR in patients with AKI
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