medigraphic.com
ISSN 2448-8909 (Print)

2022, Number 1

<< Back Next >>

Med Crit 2022; 36 (1)

Neutrophiles, lymphocytes and platelets ratio as a predictor of acute kidney injury in sepsis by COVID-19 in the Intensive Care Unit

Contreras CM, Bravo SE, Hernández GMA, López BS, González CPL

Language: Spanish
References: 27
Page: 14-21
PDF size: 280.56 Kb.


ABSTRACT

Introduction: Acute kidney injury is found in 40% of patients with sepsis (S-AKI), since inflammation is one of the pathophysiological causes of acute kidney injury. During the pandemic, the main cause of sepsis in the ICU was secondary to COVID-19, in which an incidence of kidney injury of 36 to 75% has been reported. The pathophysiology of this complication is not yet known, but mechanisms similar to typical septic kidney injury have been demonstrated. The neutrophil, lymphocyte and platelet ratio (RNLP) has previously been associated with the presence of acute kidney injury in other settings (cardiac surgery and major abdominal surgery) and in patients with sepsis secondary to COVID-19 it may be a marker that identifies the patients at risk of presenting this complication. Objective: To determine if the ratio of neutrophils, lymphocytes and platelets is a predictor of acute kidney injury in sepsis secondary to COVID-19 in the adult ICU. Material and methods: Prospective, single-center cohort study. In patients over 18 years of age who are admitted to the ICU with a diagnosis of sepsis due to COVID-19, the RNLP will be calculated from day 1 to day 7, it is divided into 2 groups: RNLP greater than 3 and RNLP equal or less than 3, observing the presence or not of acute kidney injury during their stay, and after the outcome, for the main objective a χ2 test is performed, and a multivariate logistic regression test is performed to assess the Association of the different variables with the outcome (OR with 95% CI). Results: A population of 119 patients was studied, there was an incidence of S-AKI of 53.8% (95% CI 44-62%) in patients with sepsis secondary to COIVD-19, the majority being KDIGO I (53.2%). In the RNLP group greater than 3 I had a 68.4% incidence of S-AKI compared to the RNLP group less than or equal to 3 with 28% (p = 0.001, OR 4.255 95% CI 1.72-10.16), the patients with RNLP greater than 3 had a longer stay in the ICU (12 vs 10 days, p = 0.018), and a longer time of mechanical ventilation (11 vs 8 days, p = 0.003). Conclusion: The increase in the neutrophil, lymphocyte and platelet ratio is a risk factor and can be a prognostic for the presence of acute kidney injury in sepsis due to COVID-19 in the ICU.


REFERENCES

  1. Hotchkiss RS, Moldawer LL, Opal SM, Reinhart K, Turnbull IR, Vincent JL. Sepsis and septic shock. Nat Rev Dis Primers. 2016;2:16045.

  2. Horiguchi H, Loftus TJ, Hawkins RB, Raymond SL, Stortz JA, Hollen MK, et al. Sepsis and critical illness research center investigators. Innate immunity in the persistent inflammation, immunosuppression, and catabolism syndrome and its implications for therapy. Front Immunol. 2018;9:595. Available from: https://pubmed.ncbi.nlm.nih.gov/29670613/

  3. Delano MJ, Ward PA. The immune system's role in sepsis progression, resolution, and long-term outcome. Immunol Rev. 2016;274(1):330-353. Available in: https://pubmed.ncbi.nlm.nih.gov/27782333/

  4. Vincent JL, de Backer D, Finfer SR, Vincent JL, editors. Circulatory Shock. New Engl J Med. 2013;369(18):1726-1734. Available from: http://www.nejm.org/doi/10.1056/NEJMra1208943

  5. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801-810. Available in: https://jamanetwork.com/

  6. Moore PK, Hsu RK, Liu KD. Management of acute kidney injury: core curriculum 2018. Am J Kidney Dis. 2018;72(1):136-148. Available from: https://pubmed.ncbi.nlm.nih.gov/29478864/

  7. Chávez PJP, Sánchez VLD. Historia natural de la insuficiencia renal aguda (IRA) en las unidades de terapia intensiva (UTI) mexicanas. Estudio multicéntrico. Med Crit. 2010;24(1):18-24. Disponible en: www.medigraphic.com

  8. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-84. Available from: https://pubmed.ncbi.nlm.nih.gov/22890468/

  9. Martensson J, Bellomo R. Sepsis-induced acute kidney injury. Crit Care Clin. 201531(4):649-660. Available from: https://pubmed.ncbi.nlm.nih.gov/26410135/

  10. Poston JT, Koyner JL. Sepsis associated acute kidney injury. BMJ. 2019;364:k4891. Available from: https://pubmed.ncbi.nlm.nih.gov/30626586/

  11. Peerapornratana S, Manrique-Caballero CL, Gómez H, Kellum JA. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int. 2019;96(5):1083-1099. Available from: https://pubmed.ncbi.nlm.nih.gov/31443997/

  12. Bellomo R, Kellum JA, Ronco C, Wald R, Martensson J, Maiden M, et al. Acute kidney injury in sepsis. Intensive Care Medicine. Springer Verlag. 2017;43:816-828. Available from: https://pubmed.ncbi.nlm.nih.gov/28364303/

  13. Beltrán-García J, Osca-Verdegal R, Pallardó FV, Ferreres J, Rodríguez M, Mulet S, Ferrando-Sánchez C, et al. Sepsis and coronavirus disease 2019: common features and anti-inflammatory therapeutic approaches. Crit Care Med. 2020;48(12):1841-1844. doi: 10.1097/CCM.0000000000004625.

  14. Zafer MM, El-Mahallawy HA, Ashour HM. Severe COVID-19 and sepsis: immune pathogenesis and laboratory markers. Microorganisms. 2021;9(1):159. doi: 10.3390/microorganisms9010159

  15. Khanmohammadi S, Rezaei N. Role of Toll-like receptors in the pathogenesis of COVID-19. J Med Virol. 2021;93(5):2735-2739. Available from: https://pubmed.ncbi.nlm.nih.gov/33506952/

  16. Vincent JL. COVID-19: it's all about sepsis. Future microbiology. Future Medicine. 2021;16:131-133. Available from: /pmc/articles/PMC7837372/

  17. Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020;46(7):1339-1348. Available from: https://pubmed.ncbi.nlm.nih.gov/32533197/

  18. Hirsch JS, Ng JH, Ross DW, Sharma P, Shah HH, Barnett RL, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-218. Available from: www.kidney-international.org

  19. Panitchote A, Mehkri O, Hastings A, Hanane T, Demirjian S, Torbic H, et al. Factors associated with acute kidney injury in acute respiratory distress syndrome. Ann Intensive Care. 2019;9(1):74. Available from: https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0552-5

  20. Watchorn J, Huang DY, Joslin J, Bramham K, Hutchings SD. Critically ill COVID-19 patients with acute kidney injury have reduced renal blood flow and perfusion despite preserved cardiac function: a case-control study using contrast-enhanced ultrasound. Shock (Augusta, Ga). 2021;55(4):479-487. Available from: https://pubmed.ncbi.nlm.nih.gov/32890313/

  21. Nadim MK, Forni LG, Mehta RL, Connor MJ, Liu KD, Ostermann M, et al. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nature Reviews Nephrology. 2020;16:747-764. Available from: www.ADQI.org

  22. Gameiro J, Lopes JA. Complete blood count in acute kidney injury prediction: a narrative review. Ann Intensive Care. 2019;9(1):87. Available from: https://pubmed.ncbi.nlm.nih.gov/31388845/

  23. Imran MM, Ahmad U, Usman U, Ali M, Shaukat A, Gul N. Neutrophil/lymphocyte ratio-A marker of COVID-19 pneumonia severity. Int J Clin Pract. 2021;75(4):e13698. Available from: https://pubmed.ncbi.nlm.nih.gov/32892477/

  24. Koo CH, Eun Jung D, Park YS, Bae J, Cho YJ, Kim WH, Bahk JH. Neutrophil, lymphocyte, and platelet counts and acute kidney injury after cardiovascular surgery. J Cardiothorac Vasc Anesth. 2018;32(1):212-222. Available from: https://pubmed.ncbi.nlm.nih.gov/29128485/

  25. Gameiro J, Fonseca JA, Dias JM, Milho J, Rosa R, Jorge S, Lopes JA. Neutrophil, lymphocyte and platelet ratio as a predictor of postoperative acute kidney injury in major abdominal surgery. BMC Nephrol. 2018;19(1):320. Available from: https://pubmed.ncbi.nlm.nih.gov/30419844/

  26. Gameiro J, Fonseca JA, Jorge S, Gouveia J, Lopes JA. Neutrophil, lymphocyte and platelet ratio as a predictor of mortality in septic-acute kidney injury patients. Nefrologia (Engl Ed). 2020;40(4):461-468. Available from: https://pubmed.ncbi.nlm.nih.gov/31948827/

  27. Silver SA, Beaubien-Souligny W, Shah PS, Harel S, Blum D, Kishibe T, et al. The Prevalence of Acute Kidney Injury in Patients Hospitalized With COVID-19 Infection: A Systematic Review and Meta-analysis. Kidney medicine. 2021 3(1); 83-98. https://doi.org/10.1016/j.xkme.2020.11.008




2020     |     www.medigraphic.com