Study On The Diagnostic And Prognostic Value Of NLR,RDW And PNI In Sepsis Associated Acute Kidney Injury

Objective:The clinical data and prognosis of sepsis patients were compared and analyzed to understand the risk factors of sepsis associated acute kidney injury,and to explore the diagnostic and prognostic value of neutrophil-to-lymphocyte ratio(NLR),red blood cell distribution width(RDW)and prognostic nutritional index(PNI)in sepsis patients.Methods:Retrospective analysis of the clinical data of 123 sepsis patients hospitalized in the Department of Respiratory and Critical Care Medicine and the Department of Critical Care Medicine at the First Hospital of Shanxi Medical University from January 2021 to October 2022.58 patients in the SAKI group and 65 patients in the non-AKI group were classified according to whether the patients had associated acute kidney injury,and NLR,PNI,RDW and other clinical data of the two groups were compared.SPSS 26.0 software was used for data analysis,and t-test,rank sum test andX~2test were used to compare data between groups according to the type of data.Independent risk factors for SAKI were analyzed using multifactorial logistic regression,and ROC curves were plotted to analyze the early predictive value of AKI complicated by sepsis.In addition,58 patients with SAKI were divided into survival and death groups according to whether in-hospital death occurred,and the NLR,RDW,PNI and general data of the two groups were compared to explore their predictive value for the occurrence of in-hospital death in patients with SAKI.Results:1.Comparison of general data between SAKI group and non-AKI group:patients in SAKI group had higher WBC,NEU,RDW,BUN,Scr,Lac,uric acid,NLR level,SOFA score,proportion of combined hyperuricemia and in-hospital mortality than non-AKI group,and lower ALB and PNI levels than non-AKI group,with statistically significant differences(P<0.05).2.Analysis of predictors influencing concurrent AKI in patients with sepsis:(1)NLR,RDW,PNI and BUN were independent predictors of concurrent AKI in patients with sepsis(P<0.05)with ORs of 1.078,1.152,0.708 and 1.139 respectively.(2)Plotting ROC curves showed that NLR,RDW,PNI,combined NLR+RDW,combined PNI+NLR,and combined PNI+RDW could be used as predictors of SAKI.The above mentioned indicators showed good sensitivity and specificity in predicting the occurrence of SAKI,and PNI,PNI+NLR and PNI+RDW showed good diagnostic value in predicting the occurrence of SAKI.In addition,PNI+NLR and NLR+RDW combined diagnosis all had higher sensitivity than Scr alone(94.83%vs 86.21%;96.55%vs 86.21%).RDW AUC=0.650,sensitivity was 67.24%,specificity was64.62%and best cut-off point was 45.85fl;NLR AUC=0.653,sensitivity was 79.31%,specificity was 50.77%and best cut-off point was 9.587;PNI AUC=0.726,sensitivity was 51.72%,specificity was 84.62%and best cut-off point was 30.925.The combined diagnostic AUC of NLR and RDW was 0.661,with the sensitivity of 96.55%and the specificity of 35.38%;the combined diagnostic AUC of PNI+NLR was 0.723,with the sensitivity of 94.83%and the specificity of 49.23%;the combined AUC of PNI+RDW was 0.770,with the sensitivity of 86.21%and the specificity of 55.38%.3.Analysis of factors affecting the prognosis of patients with SAKI:(1)The level of RDW was higher in patients of the death group compared with the survival group(54.87±13.56 vs 47.34±8.18)fl,and the difference was statistically significant(P<0.05).(2)The results of one-way logistic regression analysis showed that RDW was a risk factor for in-hospital death in patients with SAKI(OR 1.077,95%CI1.008-1.150,P<0.05).Conclusion:1.Sepsis patients with hyperuricemia,high WBC,NEU,RDW,NLR,BUN,Scr,Lac,uric acid and SOFA scores at admission were more likely to develop AKI.Sepsis patients with low ALB and low PNI were more likely to develop AKI;NLR,RDW and BUN are independent risk factors for patients affecting SAKI.PNI is an independent protective factor for patients affecting SAKI.2.NLR,RDW,PNI,NLR+RDW,PNI+NLR,PNI+RDW showed good sensitivity and specificity in predicting the occurrence of SAKI.PNI as a single index,PNI+NLR and PNI+RDW combination have good diagnostic value in predicting the occurrence of SAKI.In addition,PNI+NLR and NLR+RDW both have higher sensitivities than Scr alone in diagnosing SAKI.3.Patients with SAKI are at high risk of in-hospital death.High levels of RDW are a risk factor for in-hospital death in patients with SAKI and have a certain predictive value for the prognosis of patients with SAKI.