The prognostic value of elevated neutrophil-lymphocyte ratio for cardiac surgery-associated acute kidney injury: A systematic review and meta-analysis

Serologic parameters in young patients with retinal vein occlusion treated with anti-vascular endothelial growth factor

AIM

To assess the relationship between serological parameters and the prognosis of young patients with retinal vein occlusion (RVO) after intravitreal conbercept injection (IVC).

METHODS

This study enrolled 100 young patients (≤50 years old) diagnosed with RVO-related macular edema (RVO-ME) who had been undergoing IVC at the 474 Hospital in Xinjiang between January 2022 and October 2023. Patients were categorized into two groups: 70 eyes in the effective group and 30 eyes in the ineffective group. The effective group comprised patients exhibiting a visual acuity improvement of ≥2 lines at the last follow-up, with resolved ME and central macular thickness (CMT) <300 µm. Conversely, the ineffective group included patients with visual acuity improvement of <1 line, persistent ME, and CMT ≥300 µm at the last follow-up. Serological parameters, including white blood cell count, neutrophil count, lymphocyte count, monocyte count, and mean platelet volume were assessed before treatment. The correlation between best-corrected visual acuity (BCVA) and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and systemic immune response index (SIRI) was analyzed. Additionally, the association between these serological parameters and the efficacy of IVC was explored.

RESULTS

Three months after treatment, the effective group demonstrated a significant improvement in BCVA from 0.82±0.20 to 0.36±0.10, with a concurrent decrease in CMT from 661.28±163.90 to 200.61±82.45 µm (P<0.001). Conversely, the ineffective group exhibited minimal changes in BCVA (0.86±0.25 to 0.82±0.14) and CMT (669.84±164.95 to 492.13±138.67 µm, P<0.001). The differences in BCVA and CMT between the two groups were statistically significant (P<0.001). According to subgroup analysis, in patients with central RVO (CRVO), BCVA improved from 0.82±0.23 to 0.49±0.12 in the effective group and from 0.80±0.18 to 0.76±0.22 in the ineffective group (P<0.001). The CMT changes followed a similar pattern. In patients with branch RVO (BRVO), comparable trends in BCVA and CMT changes were observed between the effective and ineffective groups (P<0.001). Additionally, the effective group exhibited higher PLR and SII values than the ineffective group (P<0.05). Further CRVO and BRVO subgroups analysis exhibited consistent PLR and SII value trends.

CONCLUSION

Compared to other inflammatory factors, elevated PLR and SII levels before treatment are better predictors of outcomes in young RVO-ME patients undergoing IVC treatment.

Machine Learning Model for Predicting Risk Factors of Prolonged Length of Hospital Stay in Patients with Aortic Dissection: a Retrospective Clinical Study

The length of hospital stay (LOS) is crucial for assessing medical service quality. This study aimed to develop machine learning models for predicting risk factors of prolonged LOS in patients with aortic dissection (AD). The data of 516 AD patients were obtained from the hospital's medical system, with 111 patients in the prolonged LOS (> 30 days) group based on three quarters of the LOS in the entire cohort. Given the screened variables and prediction models, the XGBoost model demonstrated superior predictive performance in identifying prolonged LOS, due to the highest area under the receiver operating characteristic curve, sensitivity, and F1-score in both subsets. The SHapley Additive exPlanation analysis indicated that high density lipoprotein cholesterol, alanine transaminase, systolic blood pressure, percentage of lymphocyte, and operation time were the top five risk factors associated with prolonged LOS. These findings have a guiding value for the clinical management of patients with AD.

Complete Blood Cell Count-Based Ratios Identify Total Joint Arthroplasty Patients Likely to Benefit from Perioperative Dexamethasone

BACKGROUND

Complete blood cell count-based ratios (CBRs), including the neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), are inflammatory markers associated with postoperative morbidity. Given the link between the surgical stress response and complications after total joint arthroplasty (TJA), this study aimed to evaluate whether higher preoperative CBR values predict greater postoperative benefits associated with dexamethasone utilization.

METHODS

The Premier Healthcare Database was queried for adult patients who underwent primary, elective total hip or knee arthroplasty (THA or TKA). Multivariable logistic regression models using dexamethasone exposure and CBRs as independent variables assessed primary end points of 90-day postoperative complications and length of stay (LOS) of ≥3 days. The probability difference between the dexamethasone and non-dexamethasone groups for each primary end point was determined across all values of each CBR. Probability differences were compared across CBR quartiles.

RESULTS

A total of 32,849 primary, elective TJAs (12,788 THAs [38.93%], 20,061 TKAs [61.07%]) performed between 2016 and 2021 were identified, and 22,282 (67.83%) of the patients received perioperative dexamethasone. Among patients with an NLR value of >1.00, those receiving dexamethasone had a lower probability of postoperative complications (all p < 0.05). Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients in the highest NLR quartile (≥4.67) compared with the lowest quartile (NLR <1.84) (p = 0.002). Among patients with an MLR value of ≥0.36, those receiving dexamethasone had significantly lower odds of postoperative complications. Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients with an MLR of ≥0.33 (the 2 highest quartiles) compared with an MLR of <0.24 (the lowest quartile) (p = 0.039).

CONCLUSIONS

Higher NLR and MLR values were associated with greater marginal benefit from perioperative dexamethasone treatment, establishing a modifiable link between adverse outcomes and perioperative inflammation in TJA.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

High neutrophil-to-lymphocyte ratio as a cost-effective marker of acute kidney injury and in-hospital mortality after cardiac surgery: a case-control study

BACKGROUND

Inflammation is one of the important pathophysiological characteristics of acute kidney injury (AKI) after cardiac surgery. The aim was to explore the relationship between preoperative neutrophil-to-lymphocyte ratio (NLR), a simple and cost-effective maker of inflammatory response, and AKI after cardiac surgery. Furthermore, whether the NLR affected in-hospital mortality was also investigated.

METHODS

The electronic medical records of patients from January 1, 2006 to December 31, 2018 undergoing cardiac surgery were utilized. The interest outcome was AKI, defined as the criteria of Kidney Disease Improving Global Outcomes (KDIGO), and other outcomes were severe AKI (KDIGO stage ≥2) and in-hospital mortality. Logistic regression was utilized to assess the association of preoperative NLR with outcomes while adjust for potential confounders.

RESULTS

Totally, 23,638 patients were included. The incidence of AKI was 27.6%. The NLR was significantly greater in patients with AKI compared to those without. As the nonlinear relationship between NLR and AKI indicated by restricted cubic spline, NLR was analyzed as a categorical variable with the cutoff value of five. Multivariate analysis demonstrated that NLR > 5 was significantly associated with an increased risk of AKI, with an odds ratio of 5.046 (95% confidence interval, 4.589 to 5.548), when compared to patients with NLR ≤ 5. Furthermore, high NLR was also an independent risk factor for severe AKI and in-hospital mortality.

CONCLUSIONS

A higher preoperative NLR was increased the risk of AKI, severe AKI, and in-hospital mortality after cardiac surgery, which may be helpful for stratifying patients to develop individualized treatment.

Association between inflammatory biomarkers and postoperative acute kidney injury after cardiac surgery in patients with preoperative renal dysfunction: a retrospective pilot analysis

BACKGROUND

Acute kidney injury (AKI) represents a significant post-cardiac surgery complication, particularly prevalent among individuals with pre-existing renal dysfunction. Chronic kidney disease (CKD) is frequently accompanied by persistent, low-grade inflammation, which is known to exacerbate systemic stress responses during surgical procedures. This study hypothesizes that these inflammatory responses might influence the incidence and severity of postoperative acute kidney injury (AKI), potentially serving as a protective mechanism by preconditioning the kidney to stress.

METHODS

This retrospective study enrolled patients with preoperative renal dysfunction (eGFR between 15 and 60 ml/min/1.73 m²) who underwent cardiac surgery between January 2020 and December 2022. Preoperative inflammatory biomarkers were evaluated. The primary outcome was the incidence of postoperative AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariate regression models and sensitivity analyses were conducted to ascertain the relationship between inflammatory biomarkers and AKI. Restricted cubic spines (RCS) was conducted to explore nonlinear associations between inflammatory biomarkers and AKI.

RESULTS

AKI occurred in 53.4% (392/734) of patients, accompanied by significant mortality and length of hospital stay increases in cases of AKI (P < 0.005). After full adjustment of confounders, neutrophil percentage-to-albumin ratio (OR = 0.28), systemic inflammation response index (OR = 0.70), systemic immune inflammation index (OR = 0.69), neutrophil-to-lymphocyte ratio (OR = 0.70), monocyte/high-density lipoprotein cholesterol ratio (OR = 0.53), neutrophil/high-density lipoprotein cholesterol ratio (OR = 0.43) demonstrated an inverse association with AKI. Sensitivity analyses revealed that patients in the highest quartile of these biomarkers exhibited a significantly lower prevalence of AKI compared to those in the lowest quartile (p for trend < 0.05). The RCS analysis suggested an "Inverted U-shaped" association of both LnNPAR and LnSIRI with AKI.

CONCLUSIONS

This study identified an inverse association between preoperative inflammatory biomarkers and postoperative AKI in patients with preoperative renal dysfunction. The findings implied that preoperative inflammation may play a protective role against postoperative AKI in this patient population undergoing cardiac surgery.

The Role of Monocyte Distribution Width in the Early Prediction of Sepsis in Patients Undergoing Cardiovascular Surgery: A Cross-Sectional Study

Background and Objectives: This is the first study to examine the role of monocyte distribution width (MDW) in predicting sepsis after cardiovascular surgery. Methods: This study included 43 consecutive patients who had undergone cardiovascular surgery between July 2021 and July 2022. All patients were examined at the following three time points (TPs): preoperative period (TP1), postoperative at 24 h (TP2), and discharge (TP3). SOFA score, leukocyte count, neutrophil-to-lymphocyte ratio (NLR), MDW, C-reactive protein (CRP), and procalcitonin (PCT) levels were tested at each TPs. The Sepsis-3 criteria were used to diagnose patients with sepsis. Results: The mean values of all variables (leukocyte count, NLR, MDW, CRP, and PCT levels) were significantly higher at TP2 and TP3 than at TP1 (p < 0.05). All these values were significantly higher at TP2 than at TP3 (p < 0.05). Patients with sepsis had significantly higher mean values for leukocyte count, NLR, MDW, CRP, and PCT levels than those without sepsis (p < 0.05). There was a significant correlation between MDW and inflammatory markers (CRP, PCT, and NLR) during the three time periods (p < 0.05). According to the ROC analysis, the optimal MDW cutoff value with the highest sensitivity and specificity for predicting sepsis in the postoperative period was 20.5. Conclusions: Our findings indicate that elevated MDW levels may be a valuable predictor of sepsis in patients following cardiovascular surgery.

Prognostic value of systemic inflammatory response index for acute kidney injury and the prognosis of pediatric patients in critical care units

BACKGROUND

We proposed a link between the first systemic inflammatory response index (SIRI) and acute kidney injury (AKI), as well as the prognosis of pediatric patients in intensive care units (PICU).

METHODS

This study comprised 5114 children from the pediatric-specific intensive care (PIC) database. SIRI was estimated as a neutrophil monocyte lymphocyte ratio. All patients were arbitrarily allocated to the training set (n = 3593) and the validation cohort (n = 1521) and divided into two groups depending on their SIRI levels. The diagnostic value of SIRI for pediatric ICU patients was subsequently determined using LASSO regression models.

RESULTS

After controlling for additional confounding variables in the training set, the higher SIRI value (≥ 0.59) had a greater risk of AKI (adjusted odds ratio, OR, 3.95, 95% confidence interval, 95%CI, 2.91-5.36, P<0.001) and in-hospital mortality (hazard ratio, HR, 5.01, 95%CI 2.09-12.03, P<0.001). Similar findings were discovered in the validation set. Furthermore, the suggested nomogram derived from SIRI and other clinical metrics showed outstanding calibration capability as well as therapeutic usefulness in both groups.

CONCLUSIONS

SIRI is a reliable and useful factor for AKI and fatality in pediatric ICU patients, and the proposed nomogram based on SIRI yields an appropriate prediction value for critically sick pediatric patients.

Neutrophil Percentage as a Potential Biomarker of Acute Kidney Injury Risk and Short-Term Prognosis in Patients with Acute Myocardial Infarction in the Elderly

Objective

This study aimed to explore the association of preoperative neutrophil percentage (NEUT%) with the risk of acute kidney injury (AKI) in patients with acute myocardial infarction (AMI) having undergone coronary interventional therapy.

Methods

A single-center, retrospective and observational study was conducted. From December 2012 to June 2021, patients with AMI were enrolled and divided into AKI group and non-AKI group. The NEUT% in the two groups was compared. The association between NEUT% with the risk of post-AMI AKI was analyzed by univariate and multivariable logistic regression. Kaplan-Meier survival curve was drawn to evaluate the prognostic ability of NEUT% for short-term all-cause death following AMI.

Results

A total of 3001 consecutive patients were enrolled with an average age of 64.38 years. AKI occurred in 327 (10.9%) patients. The NEUT% was higher in the AKI group than in the non-AKI group ([76.65±11.43]% versus [73.22±11.83]%, P<0.001). NEUT% was also identified as an independent risk factor for AKI in AMI patients after adjustment (OR=1.021, 95% CI: 1.010-1.033, P < 0.001). Compared with those at the lowest quartile of NEUT%, the patients at quartiles 2-4 had a higher risk of AKI (P for trend = 0.003). The odds of AKI increased by 29.0% as NEUT% increased by 1 standard deviation (OR=1.290, 95% CI: 1.087-1.531, P = 0.004). After a median of 35 days follow-up, 93 patients died. Patients with a higher NEUT% presented a higher risk of all-cause death after AMI (Log rank: χ2 =24.753, P<0.001).

Conclusion

In AMI patients, the peripheral blood NEUT% was positively associated with the odds of AKI and short-term all-cause mortality. NEUT% may provide physicians with more information about disease development and prognosis.

Association of preoperative neutrophil-lymphocyte ratio with acute kidney injury in patients with non-cardiac surgery: difference among surgical types

PURPOSE

To examine the relationship between Neutrophil-Lymphocyte Ratio (NLR) and Acute Kidney Injury (AKI) in patients undergoing noncardiac surgery, and subgroup analysis was performed for different types of non-cardiac surgery.

METHODS

The present retrospective cohort study included 10,159 adult patients who underwent major noncardiac surgery at Nanfang Hospital, Southern Medical University, between 2008 and 2018. Postoperative AKI was defined as an increase in serum creatinine level of at least 0.3 mg/dl within 48 h, or 1.5 times higher than baseline within 7 days postoperatively according to the Kidney Disease Improving Global Outcome. The correlation between preoperative NLR and postoperative AKI was determined by stepwise multivariate logistic regression analysis, and the predictive value of NLR was evaluated by the receiver operating characteristics curve (ROC) analysis.

RESULTS

Four hundred and eighty-five (4.77%) patients developed AKI postoperatively. Preoperative NLR was independently associated with postoperative AKI in all patients undergoing non-cardiac surgery (Odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.06). The optimal cut-off value of NLR was 2.12 according ROC analysis. The OR and 95% CI of AKI for NLR > 2.12 was 1.48 (1.21-1.81) compared with NLR ≤ 2.12. In addition, the positive association was mainly shown in patients undergone digestive system surgery with a cut-off value of 2.12 but not in neurological and musculoskeletal system surgeries.

CONCLUSION

The present study confirmed the association of preoperative NLR with postoperative AKI in digestive system surgical patients. A NLR value of 2.12 may be a useful cut-off to evaluate the risk of AKI.