Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery

doi:10.4240/wjgs.v12.i7.326

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Jul 27, 2020; 12(7): 326-335
Published online Jul 27, 2020. doi: 10.4240/wjgs.v12.i7.326

Table 1 Risk factors of acute kidney injury occurrence by univariate and multivariate analyses

Parameters	Univariate analysis		Multivariate analysis
Parameters	HR (95%CI)	P value	HR (95%CI)	P value
Age ( < 65 yr/≥ 65 yr)	1.010 (0.996-1.024)	0.146	-	-
Sex (male/femal)	1.761 (1.008-3.075)	0.047	0.684 (0.325-1.438)	0.316
Smoking (yes/no)	0.599 (0.351-1.021)	0.060	-	-
Drinking (yes/no)	0.547 (0.306-0.977)	0.042	0.916 (0.401-2.097)	0.836
MAP (mmHg)	1.001 (0.988-1.014)	0.923
Hypertension (yes/no)	1.218 (0.668-2.223)	0.519	-	-
Diabetes mellitus (yes/no)	0.828 (0.393-1.744)	0.619	-	-
Cirrhosis (yes/no)	0.563 (0.239-1.324)	0.188	-	-
Ischemic heart disease (yes/no)	0.387 (0.166-0.901)	0.028	1.111 (0.385-3.212)	0.845
Stroke (yes/no)	2.500 (0.834-7.493)	0.102	-	-
Malignant diseases (yes/no)	0.949 (0.514-1.751)	0.867	-	-
SOFA score at ICU admission	1.092 (1.030-1.157)	0.003	1.010 (0.937-1.088)	0.801
APACHE II at ICU admission	1.038 (1.005-1.073)	0.023	1.006 (0.954-1.060)	0.836
PLT (10⁹/L)	0.999 (0.997-1.002)	0.487	-	-
WBC (10⁹/L)	1.026 (0.999-1.055)	0.062	-	-
TB	1.001 (0.999-1.003)	0.216
Creatinine	1.005 (1.003-1.007)	< 0.001	1.000 (0.998-1.002)	0.989
K	1.676 (1.190-2.362)	0.003	0.918 (0.594-1.416)	0.698
Na	1.012 (0.979-1.046)	0.473	-	-
INR	1.269 (0.980-1.641)	0.070	-	-
PaO₂/FiO₂	0.994 (0.883-1.119)	0.920	-	-
Arterial lactate¹	0.936 (0.876-1.000)	0.051
Procalcitonin²	1.003 (0.096-1.011)	0.348	-	-
Blood transfusion (yes/no)	0.898 (0.555-1.452)	0.660	-	-
NLR	1.052 (1.026-1.078)	< 0.001	1.290 (1.212-1.373)	< 0.001

¹High neutrophil to lymphocyte ratio (NLR) group (n = 167), Low NLR group (n = 89).

²High NLR group (n = 154), Low NLR group (n = 79). HR: Hazard ratio; MAP: Mean arterial pressure; SOFA score: Sequential organ failure assessment score; APACH II: Acute physiology and chronic health evaluation; PLT: Platelet count; WBC: White blood cell count; TB: Total bilirubin; INR: International normalized ratio; PaO₂/FiO₂: Oxygen partial pressure/oxygen concentration; NLR: Neutrophil to lymphocyte ratio.

Table 2 Patient demographics and clinical features of the high and low NLR groups

Variables	Overall (n = 282)	High-NLR group (n = 181)	Low-NLR group (n = 101)	P value
Age (yr)	60.48 ± 17.74	62.62 ± 17.44	58.42 ± 18.17	0.146
Sex (male/female)	180/102	114/67	66/35	0.695
Operative site				0.330
Gastrointestinal surgery, n (%)	214 (75.89)	134 (74.03)	80 (79.21)
Hepatobiliary surgery, n (%)	68 (24.11)	47 (25.97)	21 (20.79)
Characteritics of surgery				0.398
Emergency surgery	55 (19.5)	38 (21.0)	17 (16.8)
Non-emergency surgery	227 (80.5)	143 (79.0)	84 (83.2)
Lab values at ICU admission
PLT (10⁹/L)	144.17 ± 112.61	146.84 ± 114.94	139.40 ± 108.70	0.596
WBC (10⁹/L)	12.67 ± 9.34	14.85 ± 10.25	8.77 ± 5.65	< 0.001
ALT (U/L)	169.28 ± 356.37	194.10 ± 413.23	126.53 ± 259.71	0.140
AST (U/L)	258.83 ± 683.02	310.81 ± 822.44	169.28 ± 308.64	0.098
TB (μmol/L)	87.42 ± 132.18	90.95 ± 126.59	81.14 ± 142.01	0.554
Albumin (g/L)	28.63 ± 6.42	28.14 ±5.90	29.49 ± 7.20	0.091
Creatinine (μmol/L)	131.44 ± 135.27	138.84 ± 122.81	118.20 ± 154.87	0.225
K (mmol/L)	3.95 ± 0.76	4.03 ± 0.77	3.82 ± 0.73	0.034
Na (mmol/L)	137.55 ± 7.72	137.68 ± 7.54	137.32 ± 8.05	0.708
Neutrophil (10⁹/L)	10.68 ± 7.57	13.10 ± 7.91	6.34 ± 4.32	< 0.001
Lymphocyte (10⁹/L)	1.04 ± 1.04	0.78 ± 0.50	1.49 ± 1.50	< 0.001
PaO₂/FiO₂	3.24 ± 2.08	3.30 ± 1.75	3.14 ± 2.63	0.576
Arterial lactate (mmol/L)¹	3.43 ± 4.13	2.91 ± 3.29	4.40 ± 5.23	0.006
Procalcitonin (ng/mL)²	15.85 ± 35.73	17.11 ± 39.68	13.37 ± 26.29	0.453
SOFA score at ICU admission	7.74 ± 5.01	7.63 ± 4.11	7.93 ± 6.34	0.806
APACHE II at ICU admission	16.04 ± 7.78	15.95 ± 7.49	16.19 ± 8.31	0.630
Coexisting conditions
Smoking (yes/no)	91/191	60/121	31/70	0.672
Drinking (yes/no)	65/217	43/138	22/79	0.706
Hypertension (yes/no)	71/211	44/137	27/74	0.653
Diabetes mellitus (yes/no)	36/246	27/154	9/92	0.147
Ischemic heart disease (yes/no)	24/258	16/165	8/93	0.791
Stroke (yes/no)	26/256	15/166	11/90	0.469
Malignant diseases (yes/no)	62/220	43/138	19/82	0.336
ICU care
Ventilation (yes/no)	169/113	103/78	66/35	0.166
Dialysis (yes/no)	72/210	54/127	18/83	0.027
Steroids (yes/no)	81/201	52/129	29/72	0.998
CPR (yes/no)	58/224	35/146	23/78	0.494
Vasopressor (yes/no)	131/151	84/97	47/54	0.984
Transfusion	173/109	112/69	61/40	0.806

High neutrophil to lymphocyte ratio (NLR) group: NLR ≥ 8.380, Low NLR group: NLR < 8.380.

¹High NLR group (n = 167), Low NLR group (n = 89).

²High NLR group (n = 154), Low NLR group (n = 79). WBC: White blood cell count; PLT: Platelet count; ALT: Alanine aminotransferase; AST: Alanine aminotransferase; PaO₂/FiO₂: Oxygen partial pressure/oxygen concentration; APACHE II: Acute physiology and chronic health evaluation; SOFA score: Sequential organ failure assessment score; CPR: Cardio-pulmonary resuscitation; NLR: Neutrophil-to-lymphocyte ratio.

Table 3 Clinical outcomes of the high and low NLR groups

Variables	Overall (n = 282)	High-NLR group (n = 181)	Low-NLR group (n = 101)	P value
Renal
AKI, n (%)	84 (29.79)	69 (38.12)	15 (14.85)	< 0.001
Severe AKI	28 (9.92)	26 (14.36)	2 (1.98)	0.001
Sepsis, n (%)	45 (15.96)	32 (17.68)	11 (10.89)	0.083
Length of ICU stay (d)	11.36 ± 13.37	11.36 ± 12.58	11.38 ± 14.74	0.990
ICU re-admission, n (%)	40 (14.18)	24 (13.25)	16 (15.84)	0.551
ICU mortality, n (%)	41 (14.54)	24 (13.25)	17 (16.83)	0.415
28-d overall mortality (%)¹	80 (28.4)	55 (30.4)	25 (24.8)	0.314

High neutrophil to lymphocyte ratio (NLR) group: NLR ≥ 8.380, Low NLR group: NLR < 8.380; Severe AKI: AKI of stage 2 and stage 3.

¹28-d overall mortality included ICU mortality and 28-d mortality after leaving ICU. AKI: Acute kidney injury; ICU: Intensive care unit.

Citation: 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
URL: https://www.wjgnet.com/1948-9366/full/v12/i7/326.htm
DOI: https://dx.doi.org/10.4240/wjgs.v12.i7.326