Predictive Value Of Platelet-to-lymphocyte Ratio And Monocyte-to-lymphocyte Ratio In Acute Kidney Injury Of Patients With Sepsis

Objective: Our objective was to explore the predictive value of platelet-to-lymphocyte ratio(PLR)and monocyte-to-lymphocyte ratio(MLR)in acute kidney injury(AKI)of sepsis patients.Methods: We conducted a single-center’s retrospective study of patients with sepsis admitted to intensive care unit(ICU),at Affiliated Hospital of Qingdao University from June 2018 to May 2020.We evaluated the patients with sepsis into AKI group and non-AKI group(N-AKI group),according to the inclusion criteria and exclusion criteria.The PLR,MLR and related clinical indicators of the two groups at admission were statistically analyzed.Spearman correlation analysis was used to analyze the correlation between PLR,MLR and related clinical indicators of sepsis-AKI patients at admission.According to the staging criteria of AKI,patients in the AKI group were divided into stage 1 group,stage 2 group and stage 3 group.One-way ANOVA was used to analyze the PLR,MLR and related clinical indicators of patients with sepsis AKI at admission.Logistic regression model was used to explore independent predictors of AKI in sepsis patients.The ROC curve was drawn to investigate the predictive value of PLR and MLR in sepsis-AKI patients at admission.Results: A total of 221 patients with sepsis were collected,including 95 patients(43.0%)in AKI group and 126 patients(57.0%)in N-AKI group.There were 62 patients(28.1%)with septic shock,including 35 patients(36.8%)in AKI group and 27 patients(21.4%)in N-AKI group.The PLR and MLR of AKI group were lower than those of N-AKI group at admission(P < 0.001).The PLR and MLR at admission were significantly negatively correlated with SOFA score(P < 0.05).One-way ANOVA analysis of patients with various stages of sepsis AKI showed that: the systolic blood pressure of stage 1 was higher than that of stage 3(P < 0.05);the mean arterial pressure of stage 1 was higher than that of stage 3(P < 0.05);the urea nitrogen of stage 1 was lower than that of stage 3(P < 0.01);the serum creatinine of stage 2 was lower than that of stage 3(P < 0.05);the serum creatinine of stage 1 was lower than that of stage 3(P <0.01);the procalcitonin of stage 1 was lower than that of stage 3(P < 0.01);the D-dimer of stage 1 was lower than that of stage 3(P < 0.01);the total bilirubin of stage 1 was lower than that of stage 3(P < 0.05);the SOFA score of stage 2 was less than that of stage 3(P< 0.01);the SOFA score of stage 1 was less than that of stage 3(P < 0.001);the APACHE II score of stage 1 was less than that of stage 3(P < 0.01).There was no statistical significance of PLR and MLR among different stages of AKI group(P > 0.05).Multiariable Logistic regression analysis showed that PLR,MLR,SOFA score,APACHEⅡ score were independent predictors of AKI in patients with sepsis.PLR showed the best predictive value for diagnosis of AKI in patients with sepsis with the cut-off value of127.875(AUC 0.646),and MLR with the best cut-off value of 0.455(AUC 0.638),followed by SOFA score 7.5(AUC 0.739),and Apache Ⅱ score 17.5(AUC 0.692).Conclusion: PLR and MLR raise possibility to distinguish the occurrence of AKI between patients with sepsis.