Hematological Ratios Are Associated with Acute Kidney Injury and Mortality in Patients That Present with Suspected Infection at the Emergency Department
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population and Data Collection
2.3. Hematological Ratios
2.4. Outcomes and Definitions
2.5. Statistical Analyses
3. Results
3.1. Study Population and Baseline Characteristics
3.2. Incidence of AKI
3.3. Hematological Ratios in AKI and Non-AKI Patients
3.4. Associations between Hematological Ratios and AKI
3.5. Association between Hematological Ratios and Mortality
3.6. Sensitivity Analysis
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (N = 1889) | No AKI (N = 1729) | AKI (N = 160) | |
---|---|---|---|
Demographics | |||
Age (years), median (IQR) | 62 (50–70) | 62 (49–70) | 64 (54–72) |
Sex (male), n (%) | 1029 (54.5) | 938 (54.3) | 91 (56.9) |
Comorbidities | |||
Charlson Comorbidity Index, median (IQR) | 5.0 (3.0–7.0) | 5.0 (3.0–7.0) | 5.0 (4.0–7.8) |
Hypertension, n (%) | 618 (32.7) | 551 (31.9) | 67 (41.9) |
Diabetes Mellitus, n (%) | 367 (19.4) | 324 (18.7) | 43 (26.9) |
Sever liver disease, n (%) | 20 (1.1) | 18 (1.0) | 2 (1.3) |
Congestive heart failure, n (%) | 105 (5.1) | 88 (5.6) | 17 (10.6) |
Myocardial infarction, n (%) | 174 (9.2) | 159 (9.2) | 15 (9.4) |
Peripheral vascular disease, n (%) | 144 (7.6) | 125 (7.2) | 19 (11.9) |
Cerebrovascular disease, n (%) | 203 (10.7) | 178 (10.3) | 25 (15.6) |
Kidney Transplant, n (%) | 254 (13.9) | 226 (13.1) | 28 (17.5) |
Immunocompromised, n (%) | 821 (43.5) | 748 (43.3) | 73 (45.6) |
Chronic kidney disease, n (%) | |||
Stage 1 | 6 (0.3) | 4 (0.2) | 2 (1.3) |
Stage 2 | 81 (4.3) | 78 (4.5) | 3 (1.9) |
Stage 3 | 270 (14.3) | 240 (13.9) | 30 (18.8) |
Stage 4 | 115 (6.1) | 97 (5.6) | 18 (11.3) |
Stage 5 | 39 (2.1) | 28 (1.6) | 11 (6.9) |
Medication | |||
ACE inhibitor or angiotensin-receptor blockers, n (%) | 501 (26.5) | 448 (25.9) | 53 (33.1) |
Diuretics, n (%) | 389 (20.6) | 345 (20.0) | 44 (27.5) |
PPI, n (%) | 1,003 (53.1) | 913 (52.8) | 90 (56.3) |
NSAID, n (%) | 76 (4.0) | 72 (4.2) | 4 (2.5) |
Disease severity in ED | |||
qSOFA-score ≥2, n (%) | 98 (5.2) | 86 (5.0) | 12 (7.5) |
Provisional diagnosis in the ED | |||
Lower-respiratory-tract infection, n (%) | 415 (22.0) | 374 (21.6) | 41 (25.6) |
Viral respiratory-tract infection, n (%) | 293 (15.5) | 281 (16.3) | 12 (7.5) |
Urinary-tract infection, n (%) | 334 (17.7) | 299 (17.3) | 35 (21.9) |
Gastro-intestinal infection, n (%) | 262 (13.9) | 247 (14.3) | 15 (9.4) |
Skin infection, n (%) | 131 (6.9) | 122 (7.1) | 9 (5.6) |
Other (infectious) diagnosis, n (%) | 454 (24.0) | 406 (23.5) | 48 (30.0) |
Laboratory | |||
Baseline serum creatinine (umol/L) | 79 (63.0–116.0) | 78.0 (63.0–113.0) | 99.0 (63.3–161.5) |
Baseline eGFR CKD-EPI (ml/min) | 80.6 (52.3–98.9) | 81.4 (53.9–99.1) | 61.9 (33.7–97.0) |
Total (N = 1889) | No AKI (N = 1729) | AKI (N = 160) | p-Value | |
---|---|---|---|---|
Modified delta-neutrophil index (IQR) | 1.17 (0.41–4.73) | 1.18 (0.41–4.47) | 1.15 (0.38–7.89) | 0.64 |
Neutrophil-lymphocyte ratio (IQR) | 6.92 (3.27–13.04) | 6.80 (3.17–12.73) | 8.52 (4.38–17.92) | <0.001 |
Monocyte-lymphocyte ratio (IQR) | 0.70 (0.40–1.19) | 0.70 (0.40–1.19) | 0.70 (0.43–1.31) | 0.43 |
Segmented-neutrophil-monocyte ratio (IQR) | 8.99 (5.73–14.11) | 8.83 (5.62–13.88) | 10.97 (7.03–17.10) | <0.001 |
Platelet-lymphocyte ratio (IQR) | 225.36 (137.40–387.90) | 225.06 (136.91–382.96) | 243.85 (139.47–439.62) | 0.50 |
Neutrophil-lymphocyte-and-platelets ratio (IQR) | 3.15 (1.51–6.82) | 3.03 (1.45–6.55) | 4.84 (2.01–10.24) | <0.001 |
Systemic immune-inflammation index (IQR) | 1469.48 (609.94–3226.94) | 1463.68 (586.76–3177.88) | 1612.76 (792.82–3858.33) | 0.08 |
Univariate | Multivariate | ||||
---|---|---|---|---|---|
Ratios | Crude HR (95% CI) | Adjusted HR: Model 1 a (95% CI) | Adjusted HR: Model 2 b (95% CI) | Adjusted HR: Model 3 c (95% CI) | Adjusted HR: Model 4 d (95% CI) |
Modified DNI | |||||
Tertile 1, ≤0.5931 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 0.5931–2.7088 | 0.7 (0.5–1.0) | 0.7 (0.5–1.0) | 0.7 (0.5–1.0) | 0.7 (0.5–1.0) | 0.7 (0.5–1.1) |
Tertile 3, >2.7088 | 1.0 (0.7–1.4) | 1.0 (0.7–1.4) | 1.0 (0.7–1.4) | 1.0 (0.7–1.4) | 1.0 (0.7–1.4) |
NLR | |||||
Tertile 1, ≤4.2805 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 4.2805–10.2276 | 1.4 (1.0–2.2) | 1.4 (1.0–2.1) | 1.4 (1.0–2.1) | 1.3 (0.9–2.1) | 1.3 (0.9–2.0) |
Tertile 3, >10.2276 | 2.1 (1.4–3.1) | 2.0 (1.4–3.0) | 2.0 (1.3–2.9) | 1.9 (1.3–2.9) | 1.8 (1.2–2.8) |
MLR | |||||
Tertile 1, ≤0.5057 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 0.5057–0.9830 | 1.1 (0.8–1.7) | 1.1 (0.7–1.6) | 1.1 (0.7–1.6) | 1.0 (0.7–1.6) | 1.0 (0.7–1.5) |
Tertile 3, >0.9830 | 1.2 (0.9–1.8) | 1.2 (0.8–1.7) | 1.2 (0.8–1.7) | 1.2 (0.8–1.7) | 1.1 (0.8–1.7) |
SMR | |||||
Tertile 1, ≤6.7500 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 6.7500–11.9633 | 1.8 (1.2–2.8) | 1.8 (1.2–2.7) | 1.8 (1.2–2.7) | 1.7 (1.1–2.7) | 1.7 (1.1–2.6) |
Tertile 3, >11.9633 | 2.2 (1.4–3.3) | 2.2 (1.4–3.3) | 2.1 (1.4–3.2) | 2.0 (1.3–3.1) | 2.0 (1.3–3.0) |
PLR | |||||
Tertile 1, ≤161.6468 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 161.6468–314.6356 | 0.9 (0.6–1.3) | 0.9 (0.6–1.3) | 0.8 (0.6–1.3) | 0.8 (0.6–1.2) | 0.8 (0.6–1.3) |
Tertile 3, 314.6356 | 1.1 (0.8–1.6) | 1.1 (0.7–1.6) | 1.1 (0.7–1.5) | 1.1 (0.7–1.5) | 1.0 (0.7–1.5) |
NLPR | |||||
Tertile 1, ≤1.9151 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 1.9151–5.0605 | 1.4 (1.0–2.2) | 1.4 (0.9–2.2) | 1.4 (0.9–2.2) | 1.4 (0.9–2.1) | 1.3 (0.9–2.0) |
Tertile 3, >5.0605 | 2.4 (1.6–3.5) | 2.3 (1.5–3.4) | 2.2 (1.5–3.2) | 2.2 (1.4–3.3) | 2.1 (1.4–3.2) |
SII index | |||||
Tertile 1, ≤869.43 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 869.43–2414.46 | 1.4 (1.0–2.0) | 1.3 (0.9–2.0) | 1.3 (0.9–2.0) | 1.3 (0.9–1.9) | 1.3 (0.8–1.9) |
Tertile 3, >2414.46 | 1.6 (1.1–2.4) | 1.5 (1.0–2.3) | 1.5 (1.0–2.3) | 1.5 (1.0–2.2) | 1.4 (0.9–2.1) |
Univariate | Multivariate | ||||
---|---|---|---|---|---|
Ratios | Crude HR (95% CI) | Adjusted HR: Model 1 a (95% CI) | Adjusted HR: Model 2 b (95% CI) | Adjusted HR: Model 3 c (95% CI) | Adjusted HR: Model 4 d (95% CI) |
Modified DNI | |||||
Tertile 1, ≤0.5931 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 0.5931–2.7088 | 0.8 (0.5–1.1) | 0.9 (0.5–1.4) | 0.8 (0.5–1.4) | 0.8 (0.5–1.3) | 0.8 (0.5–1.4) |
Tertile 3, >2.7088 | 1.2 (0.8–1.9) | 1.3 (0.8–2.0) | 1.3 (0.8–2.1) | 1.3 (0.8–2.1) | 1.3 (0.8–2.0) |
NLR | |||||
Tertile 1, ≤4.2805 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 4.2805–10.2276 | 1.3 (0.7–2.1) | 1.1 (0.6–1.9) | 1.2 (0.7–2.0) | 1.2 (0.7–2.1) | 1.2 (0.7–2.1) |
Tertile 3, >10.2276 | 1.9 (1.2–3.1) | 1.6 (1.0–2.6) | 1.7 (1.0–2.8) | 1.8 (1.1–23.0) | 1.7 (1.0–2.9) |
MLR | |||||
Tertile 1, ≤0.5057 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 0.5057–0.9830 | 0.9 (0.5–1.5) | 0.8 (0.5–1.3) | 0.8 (0.5–1.3) | 0.8 (0.5–1.4) | 0.8 (0.5–1.3) |
Tertile 3, >0.9830 | 1.5 (0.9–2.2) | 1.2 (0.7–1.9) | 1.2 (0.7–1.9) | 1.2 (0.8–2.0) | 1.2 (0.7–1.9) |
SMR | |||||
Tertile 1, ≤6.7500 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 6.7500–11.9633 | 1.6 (1.0–2.7) | 1.5 (0.9–2.5) | 1.5 (0.9–2.5) | 1.5 (0.9–2.5) | 1.5 (0.9–2.5) |
Tertile 3, >11.9633 | 1.9 (1.1–3.1) | 1.8 (1.1–2.9) | 1.9 (1.1–3.2) | 2.0(1.1–3.3) | 1.8 (1.1–3.1) |
PLR | |||||
Tertile 1, ≤161.6468 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 161.6468–314.6356 | 1.1 (0.7–1.9) | 1.1 (0.6–1.8) | 1.1 (0.6–1.8) | 1.1 (0.6–1.9) | 1.2 (0.7–2.1) |
Tertile 3, 314.6356 | 2.0 (1.2–3.2) | 1.8 (1.1–2.9) | 1.7 (1.0–2.8) | 1.8 (1.1–2.9) | 1.7 (1.1–2.8) |
NLPR | |||||
Tertile 1, ≤1.9151 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 1.9151–5.0605 | 2.6 (1.5–4.4) | 2.3 (1.3–3.9) | 2.4 (1.4–4.2) | 2.6 (1.5–4.5) | 2.5 (1.4–4.4) |
Tertile 3, >5.0605 | 2.2 (1.3–3.9) | 1.8 (1.0–3.2) | 2.0 (1.2–3.6) | 2.2 (1.3–4.0) | 2.1 (1.2–3.7) |
SII index | |||||
Tertile 1, ≤869.43 | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) | 1.0 (reference) |
Tertile 2, 869.43–2414.46 | 0.6 (0.3–1.0) | 0.5 (0.3–0.9) | 0.5 (0.3–1.0) | 0.6 (0.3–1.0) | 0.6 (0.3–1.1) |
Tertile 3, >2414.46 | 1.9 (1.2–2.9) | 1.7 (1.1–2.6) | 1.7 (1.1–2.7) | 1.8 (1.2–2.9) | 1.8 (1.1–2.8) |
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de Hond, T.A.P.; Ocak, G.; Groeneweg, L.; Oosterheert, J.J.; Haitjema, S.; Khairoun, M.; Kaasjager, K.A.H. Hematological Ratios Are Associated with Acute Kidney Injury and Mortality in Patients That Present with Suspected Infection at the Emergency Department. J. Clin. Med. 2022, 11, 1017. https://doi.org/10.3390/jcm11041017
de Hond TAP, Ocak G, Groeneweg L, Oosterheert JJ, Haitjema S, Khairoun M, Kaasjager KAH. Hematological Ratios Are Associated with Acute Kidney Injury and Mortality in Patients That Present with Suspected Infection at the Emergency Department. Journal of Clinical Medicine. 2022; 11(4):1017. https://doi.org/10.3390/jcm11041017
Chicago/Turabian Stylede Hond, Titus A. P., Gurbey Ocak, Leonie Groeneweg, Jan Jelrik Oosterheert, Saskia Haitjema, Meriem Khairoun, and Karin A. H. Kaasjager. 2022. "Hematological Ratios Are Associated with Acute Kidney Injury and Mortality in Patients That Present with Suspected Infection at the Emergency Department" Journal of Clinical Medicine 11, no. 4: 1017. https://doi.org/10.3390/jcm11041017