Bi JB, Zhang J, Ren YF, Du ZQ, Wu Z, Lv Y, Wu RQ. Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery. World J Gastrointest Surg 2020; 12(7): 326-335 [PMID: 32821341 DOI: 10.4240/wjgs.v12.i7.326]
Corresponding Author of This Article
Rong-Qian Wu, MD, PhD, Professor, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 76, West Yanta Road, Xi’an 710061, Shaanxi Province, China. rwu001@mail.xjtu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2020; 12(7): 326-335 Published online Jul 27, 2020. doi: 10.4240/wjgs.v12.i7.326
Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery
Jian-Bin Bi, Jia Zhang, Yi-Fan Ren, Zhao-Qing Du, Zheng Wu, Yi Lv, Rong-Qian Wu
Jian-Bin Bi, Jia Zhang, Yi-Fan Ren, Zhao-Qing Du, Zheng Wu, Yi Lv, Rong-Qian Wu, National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Jian-Bin Bi, Jia Zhang, Yi-Fan Ren, Zhao-Qing Du, Zheng Wu, Yi Lv, Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Bi JB and Wu RQ were involved in the design of the research; Wu Z and Lv Y provided guidance on clinical issues; Bi JB, Zhang J, Ren YF and Du ZQ collected the data; Bi JB analyzed the data; Bi JB wrote the manuscript; Wu RQ supervised the whole research; all authors have read and agreed with the final manuscript.
Supported bythe National Natural Science Foundation of China, No. 81770491.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Xi'an Jiaotong University (Permit number: XJTU1AF2015LSL-057).
Informed consent statement: The need for patients’ informed written consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rong-Qian Wu, MD, PhD, Professor, National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 76, West Yanta Road, Xi’an 710061, Shaanxi Province, China. rwu001@mail.xjtu.edu.cn
Received: December 30, 2019 Peer-review started: December 30, 2019 First decision: April 12, 2020 Revised: May 10, 2020 Accepted: May 15, 2020 Article in press: May 15, 2020 Published online: July 27, 2020 Processing time: 204 Days and 17.8 Hours
Abstract
BACKGROUND
Postoperative acute kidney injury (AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio (NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit (ICU) remains unknown.
AIM
To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.
METHODS
A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.
RESULTS
Postoperative AKI occurred in 84 patients (29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis (P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380 (AKI: 38.12% vs 14.85%, P < 0.001; severe AKI: 14.36% vs 1.98%, P = 0.001).
CONCLUSION
NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.
Core tip: This was a retrospective study to clarify the relationship between neutrophil-to-lymphocyte ratio (NLR) and the occurrence of acute kidney injury (AKI) in patients with gastrointestinal and hepatobiliary surgery in the surgical intensive care unit (ICU). We found that patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI. NLR at admission is a predictor of AKI in patients with gastrointestinal and hepatobiliary surgery in ICU. We recommend that NLR should be included in the routine assessment of AKI occurrence.
