Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2017

Open Access 01-12-2017 | Research

Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury

Authors: Chen-Fei Zheng, Wen-Yue Liu, Fang-Fang Zeng, Ming-Hua Zheng, Hong-Ying Shi, Ying Zhou, Jing-Ye Pan

Published in: Critical Care | Issue 1/2017

Login to get access

Abstract

Background

Inflammation plays an important role in the initiation and progression of acute kidney injury (AKI). However, evidence regarding the prognostic effect of the platelet-to-lymphocyte ratio (PLR), a novel systemic inflammation marker, among patients with AKI is scarce. In this study, we investigated the value of the PLR in predicting the outcomes of critically ill patients with AKI.

Methods

Patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3. PLR cutoff values were determined using smooth curve fitting or quintiles and were used to categorize the subjects into groups. The clinical outcomes were 30-day and 90-day mortality in the intensive care unit (ICU). Cox proportional hazards models were used to evaluate the association between the PLR and survival.

Results

A total of 10,859 ICU patients with AKI were enrolled. A total of 2277 thirty-day and 3112 ninety-day deaths occurred. A U-shaped relationship was observed between the PLR and both 90-day and 30-day mortality, with the lowest risk being at values ranging from 90 to 311. The adjusted HR (95% CI) values for 90-day mortality given risk values < 90 and > 311 were 1.25 (1.12–1.39) and 1.19 (1.08–1.31), respectively. Similar trends were observed for 30-day mortality or when quintiles were used to group patients according to the PLR. Statistically significant interactions were found between the PLR and both age and heart rate. Younger patients (aged < 65 years) and those with more rapid heart rates (≥89.4 beats per minute) tended to have poorer prognoses only when the PLR was < 90, whereas older patients (aged ≥ 65 years) and those with slower heart rates (<89.4 beats per minute) had higher risk only when the PLR was > 311 (P < 0.001 for age and P < 0.001 for heart rate).

Conclusions

The preoperative PLR was associated in a U-shaped pattern with survival among patients with AKI. The PLR appears to be a novel, independent prognostic marker of outcomes in critically ill patients with AKI.
Literature
1.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.CrossRefPubMed
2.
Mayr VD, Dunser MW, Greil V, Jochberger S, Luckner G, Ulmer H, Friesenecker BE, Takala J, Hasibeder WR. Causes of death and determinants of outcome in critically ill patients. Crit Care. 2006;10(6):R154.CrossRefPubMedPubMedCentral
3.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813–8.CrossRefPubMed
4.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204.CrossRefPubMedPubMedCentral
5.
Hofhuis JG, van Stel HF, Schrijvers AJ, Rommes JH, Spronk PE. The effect of acute kidney injury on long-term health-related quality of life: a prospective follow-up study. Crit Care. 2013;17(1):R17.CrossRefPubMedPubMedCentral
6.
White LE, Hassoun HT, Bihorac A, Moore LJ, Sailors RM, McKinley BA, Valdivia A, Moore FA. Acute kidney injury is surprisingly common and a powerful predictor of mortality in surgical sepsis. J Trauma Acute Care Surg. 2013;75(3):432–8.CrossRefPubMed
7.
Adrie C, Pinsky MR. The inflammatory balance in human sepsis. Intensive Care Med. 2000;26(4):364–75.CrossRefPubMed
8.
9.
Mami I, Tavernier Q, Bouvier N, Aboukamis R, Desbuissons G, Rabant M, Poindessous V, Laurent-Puig P, Beaune P, Tharaux PL, et al. A novel extrinsic pathway for the unfolded protein response in the kidney. J Am Soc Nephrol. 2016;27(9):2670–83.PubMedPubMedCentral
10.
Rabb H, Griffin MD, McKay DB, Swaminathan S, Pickkers P, Rosner MH, Kellum JA, Ronco C. Inflammation in AKI: current understanding, key questions, and knowledge gaps. J Am Soc Nephrol. 2016;27(2):371–9.CrossRefPubMed
11.
Jansen MP, Emal D, Teske GJ, Dessing MC, Florquin S, Roelofs JJ. Release of extracellular DNA influences renal ischemia reperfusion injury by platelet activation and formation of neutrophil extracellular traps. Kidney Int. 2017;91(2):352–64.CrossRefPubMed
12.
Akcay A, Nguyen Q, Edelstein CL. Mediators of inflammation in acute kidney injury. Mediators Inflamm. 2009;2009:137072.CrossRefPubMed
13.
Kaplan ZS, Jackson SP. The role of platelets in atherothrombosis. Hematology Am Soc Hematol Educ Program. 2011;2011:51–61.PubMed
14.
Borissoff JI, Spronk HM, Ten CH. The hemostatic system as a modulator of atherosclerosis. N Engl J Med. 2011;364(18):1746–60.CrossRefPubMed
15.
Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, Cincin A. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens. 2014;36(4):217–21.CrossRefPubMed
16.
Azab B, Shah N, Akerman M, McGinn JJ. Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction. J Thromb Thrombolysis. 2012;34(3):326–34.CrossRefPubMed
17.
Li X, Chen ZH, Xing YF, Wang TT, Wu DH, Wen JY, Chen J, Lin Q, Dong M, Wei L, et al. Platelet-to-lymphocyte ratio acts as a prognostic factor for patients with advanced hepatocellular carcinoma. Tumour Biol. 2015;36(4):2263–9.CrossRefPubMed
18.
Tian XC, Zeng FR, Wu DH. Platelet-to-lymphocyte ratio: a prognostic factor for patients with advanced hepatocellular carcinoma? Tumour Biol. 2015;36(7):4935–6.CrossRefPubMed
19.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.CrossRefPubMedPubMedCentral
20.
Angeli P, Gines P, Wong F, Bernardi M, Boyer TD, Gerbes A, Moreau R, Jalan R, Sarin SK, Piano S, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. J Hepatol. 2015;62(4):968–74.CrossRefPubMed
21.
Proctor MJ, Morrison DS, Talwar D, Balmer SM, Fletcher CD, O’Reilly DS, Foulis AK, Horgan PG, McMillan DC. A comparison of inflammation-based prognostic scores in patients with cancer: a Glasgow Inflammation Outcome Study. Eur J Cancer. 2011;47(17):2633–41.CrossRefPubMed
22.
Yaprak M, Turan MN, Dayanan R, Akin S, Degirmen E, Yildirim M, Turgut F. Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients. Int Urol Nephrol. 2016;48(8):1343–8.CrossRefPubMed
23.
Gagnon DR, Zhang TJ, Brand FN, Kannel WB. Hematocrit and the risk of cardiovascular disease—the Framingham study: a 34-year follow-up. Am Heart J. 1994;127(3):674–82.CrossRefPubMed
24.
Doi K, Rabb H. Impact of acute kidney injury on distant organ function: recent findings and potential therapeutic targets. Kidney Int. 2016;89(3):555–64.CrossRefPubMed
25.
Velibey Y, Oz A, Tanik O, Guvenc TS, Kalenderoglu K, Gumusdag A, Akdeniz E, Bozbay M, Tekkesin AI, Guzelburc O, et al. Platelet-to-lymphocyte ratio predicts contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology. 2017;68(5):419–27.CrossRefPubMed
26.
Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, Eller P, Rief P, Hackl G, Pilger E, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One. 2013;8(7):e67688.CrossRefPubMedPubMedCentral
27.
Balta S, Demirkol S, Kucuk U. The platelet lymphocyte ratio may be useful inflammatory indicator in clinical practice. Hemodial Int. 2013;17(4):668–9.PubMed
28.
Mehta RL, Pascual MT, Gruta CG, Zhuang S, Chertow GM. Refining predictive models in critically ill patients with acute renal failure. J Am Soc Nephrol. 2002;13(5):1350–7.CrossRefPubMed
29.
Chertow GM, Soroko SH, Paganini EP, Cho KC, Himmelfarb J, Ikizler TA, Mehta RL. Mortality after acute renal failure: models for prognostic stratification and risk adjustment. Kidney Int. 2006;70(6):1120–6.CrossRefPubMed
30.
Paganini EP, Halstenberg WK, Goormastic M. Risk modeling in acute renal failure requiring dialysis: the introduction of a new model. Clin Nephrol. 1996;46(3):206–11.PubMed
31.
Akca S, Haji-Michael P, de Mendonca A, Suter P, Levi M, Vincent JL. Time course of platelet counts in critically ill patients. Crit Care Med. 2002;30(4):753–6.CrossRefPubMed
32.
Oguzulgen IK, Ozis T, Gursel G. Is the fall in platelet count associated with intensive care unit acquired pneumonia? Swiss Med Wkly. 2004;134(29-30):430–4.PubMed
33.
Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med. 2002;30(8):1765–71.CrossRefPubMed
34.
Vanderschueren S, De Weerdt A, Malbrain M, Vankersschaever D, Frans E, Wilmer A, Bobbaers H. Thrombocytopenia and prognosis in intensive care. Crit Care Med. 2000;28(6):1871–6.CrossRefPubMed
35.
Parker RI. Etiology and significance of thrombocytopenia in critically ill patients. Crit Care Clin. 2012;28(3):399–411.CrossRefPubMed
36.
Oh HJ, Shin DH, Lee MJ, Ko KI, Kim CH, Koo HM, Doh FM, Kwon YE, Kim YL, Nam KH, et al. Urine output is associated with prognosis in patients with acute kidney injury requiring continuous renal replacement therapy. J Crit Care. 2013;28(4):379–88.CrossRefPubMed
37.
Sawhney S, Mitchell M, Marks A, Fluck N, Black C. Long-term prognosis after acute kidney injury (AKI): what is the role of baseline kidney function and recovery? A systematic review. BMJ Open. 2015;5(1):e6497.CrossRef
38.
Cruz DN, Bagshaw SM, Maisel A, Lewington A, Thadhani R, Chakravarthi R, Murray PT, Mehta RL, Chawla LS. Use of biomarkers to assess prognosis and guide management of patients with acute kidney injury. Contrib Nephrol. 2013;182:45–64.CrossRefPubMed
39.
Sairam S, Domalapalli S, Muthu S, Swaminathan J, Ramesh VA, Sekhar L, Pandeya P, Balasubramaniam U. Hematological and biochemical parameters in apparently healthy Indian population: defining reference intervals. Indian J Clin Biochem. 2014;29(3):290–7.CrossRefPubMed
40.
Kweon OJ, Lee MK, Kim HJ, Chung JW, Choi SH, Kim HR. Neutropenia and neutrophil-to-lymphocyte ratio in a healthy Korean population: race and sex should be considered. Int J Lab Hematol. 2016;38(3):308–18.CrossRefPubMed
41.
Metadata
Title
Prognostic value of platelet-to-lymphocyte ratios among critically ill patients with acute kidney injury
Authors
Chen-Fei Zheng
Wen-Yue Liu
Fang-Fang Zeng
Ming-Hua Zheng
Hong-Ying Shi
Ying Zhou
Jing-Ye Pan
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2017
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-017-1821-z

Other articles of this Issue 1/2017

Critical Care 1/2017 Go to the issue

Commentary

Retinal involvement in sepsis: from the eye of the patient to the eye of the beholder

Research

Could remifentanil reduce duration of mechanical ventilation in comparison with other opioids for mechanically ventilated patients? A systematic review and meta-analysis

Letter

The importance of diastolic dysfunction in the development of weaning-induced pulmonary oedema

Research

Detecting impaired myocardial relaxation in sepsis with a novel tissue Doppler parameter (septal e′/s′)

Research

Circulating microparticle levels are reduced in patients with ARDS

Letter

Video vs direct laryngoscopy in the ICU: are we asking the right question?