The role of the neutrophil-to-lymphocyte ratio in predicting acute kidney injury in patients with acute pancreatitis

Yıl 2019, Cilt: 18 Sayı: 1, 16 - 22, 29.04.2019

Zeynep Bıyık

https://doi.org/10.17941/agd.548747

Öz

Background and Aims: Neutrophil-to-lymphocyte ratio is an
inflammatory marker that has been demonstrated to predict the development of
acute kidney injury in various diseases. We investigated the role of the
neutrophil-to-lymphocyte ratio in predicting acute kidney injury in patients
with acute pancreatitis. Materials and
Method: A total of 186 patients diagnosed with acute pancreatitis in Selcuk
University School of Medicine [A1] between
September 2016 and September 2018 were included in this retrospective study.
The diagnosis and severity of acute pancreatitis were defined according to the
revised Atlanta classification, while the KDIGO criteria were used for the
diagnosis and staging of acute kidney injury. We also collected details pertaining
to laboratory values and prognostic scoring systems of the patients obtained at
their first visit to the emergency service. Results: Of the 186 patients, more than half were females (59.7%),
and the average age of the patients was 59.3±17.3 years. Acute kidney injury was
detected in 26.3% of the patients, who were found to be older and more
hypertensive than patients without acute kidney injury (p=0.001 for both). The
duration of hospitalization and the duration of intensive care unit stay of
patients with acute kidney injury were significantly longer (p=0.001 for both).
White blood cell and neutrophil counts were significantly higher in the acute
kidney injury group, whereas the lymphocyte count was significantly lower (p
<0.001 for all three). The neutrophil-to-lymphocyte ratio and C-reactive
protein levels measured during patient admission were significantly higher in
the acute kidney injury group (p <0.001 for both). Hematocrit, thrombocyte,
and red cell distribution width values were similar in both groups (p >0.05).
The multivariate regression analysis showed that age (OR: 0.964, 95% [A2] CI:
0.925-1.004, p=0.008), neutrophil-to-lymphocyte ratio (OR: 1.096, 95% CI:
1.028-1.170, p=0.005), and BISAP score (OR: 6.582, 95% CI: 2.810-15.414, p <0.001)
were independent predictors of acute kidney injury for determining the factors
that could independently predict the development of acute kidney injury in
patients with acute pancreatitis. The receiver operating characteristic curve
revealed an area under curve of 0.813 (95% CI: 0.742–0.883), a sensitivity of
73.4%, and a specificity of 81.4% for a cut-off neutrophil-to-lymphocyte ratio value
of 11.2. Conclusions: Baseline neutrophil-to-lymphocyte
ratio evaluated during patient admission may be a useful predictor of acute
kidney injury in patients with acute pancreatitis.

Anahtar Kelimeler

Acute pancreatitis, acute kidney injury

Akut pankreatitli hastalarda akut böbrek hasarını öngörmedeki nötrofil lenfosit oranının rolü

Öz

Giriş ve Amaç: Bir
inflamasyon belirteci olan nötrofil lenfosit oranının çeşitli hastalıklarda akut
böbrek hasarı gelişimini predikte ettiği gösterilmiştir. Biz de akut
pankreatitte akut böbrek hasarını predikte etmede nötrofil lenfosit oranının
rolünü araştırmayı amaçladık. Gereç ve
Yöntem: Bu retrospektif çalışmaya Eylül 2016 ve Eylül 2018 yılları arasında
Selçuk Üniversitesi Tıp Fakültesi’nde akut pankreatit tanısı ile takip edilen
186 hasta dahil edildi. Akut pankreatit tanısı ve şiddetinin belirlenmesinde
Atlanta sınıflaması kullanıldı. Hastaların acile ilk başvuru sırasındaki
laboratuvar değerleri ve prognostik skorlama sistemleri kullanıldı. Akut böbrek
hasarı tanısı ve evrelemesi için KDIGO kriterleri kullanıldı.  Bulgular:
Çalışmaya alınan 186 hastanın yaş ortalaması 59.3±17.3 olup %59.7’si
kadındı. Hastaların %26.3’ünde akut böbrek hasarı gelişmişti. Akut böbrek
hasarı gelişen hastalar akut böbrek hasarı gelişmeyen hastalarla karşılaştırıldığında
daha ileri yaşta oldukları ve hipertansiyon sıklığının daha fazla olduğu görüldü
(her ikisi için  p <0.001). Akut
böbrek hasarı gelişen hastaların yatış süreleri ve yoğun bakım yatış süreleri
anlamlı olarak uzun bulundu (her ikisi için p=0.001). Akut böbrek hasarı grubunda
beyaz küre ve nötrofil sayıları anlamlı olarak yüksek bulunurken lenfosit
sayısı anlamlı olarak düşük bulundu (her üçü için de p <0.001). Hastaneye
kabulde bakılan nötrofil lenfosit oranı ve C-reaktif protein de akut böbrek
hasarı grubunda anlamlı olarak daha yüksekti (her ikisi için p <0.001).
Hematokrit, trombosit ve kırmızı kan hücreleri dağılım genişliği değerleri her
iki grupta benzerdi (p >0.05). Akut pankreatit hastalarında akut böbrek
hasarı gelişimini bağımsız olarak predikte eden faktörleri belirlemek için
yapılan multivariate regresyon analizinde yaş (OR: 0.964, %95 CI: 0.925-1.004,
p: 0.008), nötrofil lenfosit oranı (OR: 1.096, %95 CI: 1.028-1.170, p: 0.005)
ve BISAP skoru (OR: 6.582, %95 CI: 2.810-15.414, p <0.001)  bağımsız etkili faktörler olarak belirlendi. Akut
böbrek hasarını öngörmede nötrofil lenfosit oranının ROC eğrisinin altında
kalan alan (area under curve) 0.813 (%95 CI 0.742-0.883), 11.24 kesme değeri
için duyarlılık %73.4 ve özgüllük ise %81.4 olarak tespit edildi. Sonuç: Hastaneye kabulde bakılan nötrofil
lenfosit oranı akut pankreatitli hastalarda akut böbrek hasarı gelişimini
predikte etmede faydalı bir belirteç olabilir.

Anahtar Kelimeler

Akut pankreatit, nötrofil lenfosit oranı, akut böbrek hasarı

Kaynakça

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