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Kidney Week

Abstract: SA-PO109

Mortality Associated with the Neutrophil-Lymphocyte Ratio in Septic AKI Requiring Continuous Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Song, Jeongin, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Lee, Jinwoo, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Yun, Donghwan, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Seong Geun, Inje University Sanggye Paik Hospital, Nowon-gu, Seoul, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Oh, Kook-Hwan, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Han, Seung Seok, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
Background

Sepsis is an important cause of acute kidney injury in intensive care unit patients, accounting for 15–20% of renal replacement therapy prescriptions. The neutrophil-lymphocyte ratio, a marker of systemic inflammation and immune response, was previously associated with the mortality rate in multiple conditions. Herein, we aimed to examine how the neutrophil-lymphocyte ratio relates to the mortality rate in septic acute kidney injury patients requiring continuous renal replacement therapy.

Methods

Neutrophil-lymphocyte ratios of 6 and 18 were used for dividing neutrophil-lymphocyte ratios into three groups and, thus, were set higher than those in previous studies accounting for steroid use in sepsis. Cox proportional hazard models were used to calculate hazard ratios of mortality outcomes before and after matching their propensity scores.

Results

A total of 798 septic acute kidney injury patients requiring continuous renal replacement therapy were classified into three neutrophil-lymphocyte ratio groups: low (< 6), medium (6 ≤ x < 18), and high (≥ 18) (277, 115, and 406, respectively). The in-hospital mortality rates per group were 83.4%, 74.8%, and 70.4%, respectively (Table 1, P < 0.001). Per the univariable Cox survival analysis after propensity score matching, a high neutrophil-lymphocyte ratio was related to approximately 24% reduced mortality. The survival benefit of the high neutrophil-lymphocyte ratio group compared with the other two groups remained consistent across all subgroups, showing any P for interactions > 0.05.

Conclusion

A high neutrophil-lymphocyte ratio is associated with better clinical outcomes, such as low mortality, in septic acute kidney injury patients undergoing continuous renal replacement therapy.

Mortality outcomes according to the NLR results
 Total (n = 798)NLR < 6 (n = 277)6 ≤ NLR < 18 (n = 115)18 ≤ NLR (n = 406)P
On CRRT mortality (%)61.470.460.955.4<0.001
ICU mortality (%)66.874.765.261.80.002
In hospital mortality (%)75.683.474.870.40.001

NLR, neutrophil/lymphocyte ratio; ICU, intensive care unit; CRRT, continuous renal replacement therapy