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Nedel W, Henrique LR, Portela LV. Why should lymphocytes immune profile matter in sepsis? World J Crit Care Med 2025; 14:98791. [DOI: 10.5492/wjccm.v14.i2.98791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 12/11/2024] [Accepted: 12/19/2024] [Indexed: 02/27/2025] Open
Abstract
The global incidence of critical illness has been steadily increasing, resulting in higher mortality rates thereby presenting substantial challenges for clinical management. Among these conditions, sepsis stands out as the leading cause of critical illness, underscoring the urgent need for continued research to enhance patient care and deepen our understanding of its complex pathophysiology. Lymphocytes play a pivotal role in both innate and adaptive immune responses, acting as key regulators of the balance between pro-inflammatory and anti-inflammatory processes to preserve immune homeostasis. In the context of sepsis, an impaired immunity has been associated with disrupted lymphocytic metabolic activity, persistent pro-inflammatory state, and subsequent immunosuppression. These disruptions not only impair pathogen clearance but also predispose patients to secondary infections and hinder recovery, highlighting the importance of targeting lymphocyte dysfunction in sepsis management. Moreover, studies have identified absolute lymphocyte counts and derived parameters as promising clinical biomarkers for prognostic assessment and therapeutic decision-making. In particular, neutrophil-to-lymphocyte ratio, and lymphopenia have gained recognition in the literature as a critical prognostic markers and therapeutic target in the management of sepsis. This review aims to elucidate the multifaceted role of lymphocytes in pathophysiology, with a focus on recent advancements in their use as biomarkers and key findings in this evolving field.
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Affiliation(s)
- Wagner Nedel
- Department of Intensive Care Unit, Conceição Hospital Group, Porto Alegre 91350200, Brazil
| | - Lílian R Henrique
- Department of Intensive Care Unit, Conceição Hospital Group, Porto Alegre 91350200, Brazil
| | - Luis Valmor Portela
- Department of Biochemistry, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre 90035-003, Brazil
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Li H, Zhou Y, Zhang X, Yao R, Li N. The relationship between hemoglobin, albumin, lymphocyte, and platelet (HALP) score and 28-day mortality in patients with sepsis: a retrospective analysis of the MIMIC-IV database. BMC Infect Dis 2025; 25:333. [PMID: 40065235 PMCID: PMC11892195 DOI: 10.1186/s12879-025-10739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Accepted: 03/03/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND In recent years, the hemoglobin, albumin, lymphocyte, and platelet (HALP) score has emerged as a potential marker of immunological and nutritional status. This study aimed to evaluate the association between the HALP score and prognosis in patients with sepsis. METHODS This retrospective cohort study analyzed sepsis patients using clinical data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were classified into Low-score and High-score groups. Confounding factors were controlled through propensity score matching (PSM) analysis. The primary outcome was 28-day mortality in individuals with sepsis. Survival probabilities between groups were compared using Kaplan-Meier curves. Multivariable Cox regression analysis and a smoothing spline fitting curve were employed to investigate the relationship between the HALP score and 28-day mortality. ROC curve analysis and subgroup analysis were performed to evaluate the predictive ability of the HALP score and its components. RESULTS A total of 2,968 sepsis patients were included, with 809 (27.26%) deaths within 28 days. After PSM analysis, the High-score group had a 24% lower risk of 28-day mortality compared to the Low-score group (HR, 0.76; 95% CI, 0.64-0.91). In the unmatched cohort, the multivariable Cox regression model also indicated that the High-score group had a lower 28-day mortality risk (HR, 0.78; 95% CI, 0.67-0.91). The smoothing spline fitting curve showed a nonlinear relationship between the HALP score and 28-day mortality, with an inflection point at 24.69. When the HALP score was below 24.69, an increase of one point in the HALP score was associated with a 2% reduction in 28-day mortality (HR, 0.98; 95% CI, 0.97-0.99). The HALP score provided incremental predictive value for 28-day mortality when combined with the SOFA score. Albumin was identified as the most influential component of the HALP score. CONCLUSION Among patients with sepsis, the HALP score exhibited a nonlinear relationship with 28-day mortality. An elevated HALP score is associated with reduced 28-day, 90-day, 360-day, and in-hospital mortality among sepsis patients.
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Affiliation(s)
- Huan Li
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, China
- Clinical Transfusion Research Centre, Xiangya Hospital, Central South University, Changsha, China
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, China
| | - Yiran Zhou
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, China
- Clinical Transfusion Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Xinying Zhang
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, China
- Clinical Transfusion Research Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Run Yao
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, China.
- Clinical Transfusion Research Centre, Xiangya Hospital, Central South University, Changsha, China.
| | - Ning Li
- Department of Blood Transfusion, Xiangya Hospital, Central South University, Changsha, China.
- Clinical Transfusion Research Centre, Xiangya Hospital, Central South University, Changsha, China.
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Gao T, Nong Z, Luo Y, Mo M, Chen Z, Yang Z, Pan L. Machine learning-based prediction of in-hospital mortality for critically ill patients with sepsis-associated acute kidney injury. Ren Fail 2024; 46:2316267. [PMID: 38369749 PMCID: PMC10878338 DOI: 10.1080/0886022x.2024.2316267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/03/2024] [Indexed: 02/20/2024] Open
Abstract
OBJECTIVES This study aims to develop and validate a prediction model in-hospital mortality in critically ill patients with sepsis-associated acute kidney injury (SA-AKI) based on machine learning algorithms. METHODS Patients who met the criteria for inclusion were identified in the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and divided according to the validation (n = 2440) and development (n = 9756, 80%) queues. Ensemble stepwise feature selection method was used to screen for effective features. The prediction models of short-term mortality were developed by seven machine learning algorithms. Ten-fold cross-validation was used to verify the performance of the algorithm in the development queue. The area under the receiver operating characteristic curve (ROC-AUC) was used to evaluate the differentiation accuracy and performance of the prediction model in the validation queue. The best-performing model was interpreted by Shapley additive explanations (SHAP). RESULTS A total of 12,196 patients were enrolled in this study. Eleven variables were finally chosen to develop the prediction model. The AUC of the random forest (RF) model was the highest value both in the Ten-fold cross-validation and evaluation (AUC: 0.798, 95% CI: 0.774-0.821). According to the SHAP plots, old age, low Glasgow Coma Scale (GCS) score, high AKI stage, reduced urine output, high Simplified Acute Physiology Score (SAPS II), high respiratory rate, low temperature, low absolute lymphocyte count, high creatinine level, dysnatremia, and low body mass index (BMI) increased the risk of poor prognosis. CONCLUSIONS The RF model developed in this study is a good predictor of in-hospital mortality for patients with SA-AKI in the intensive care unit (ICU), which may have potential applications in mortality prediction.
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Affiliation(s)
- Tianyun Gao
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning City, PR China
| | - Zhiqiang Nong
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning City, PR China
| | - Yuzhen Luo
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning City, PR China
| | - Manqiu Mo
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning City, PR China
| | - Zhaoyan Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning City, PR China
| | - Zhenhua Yang
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning City, PR China
| | - Ling Pan
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning City, PR China
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Xu W, Huo J, Hu Q, Xu J, Chen G, Mo J, Zhou T, Jiang J. Association between lactate dehydrogenase to albumin ratio and acute kidney injury in patients with sepsis: a retrospective cohort study. Clin Exp Nephrol 2024; 28:882-893. [PMID: 38584195 DOI: 10.1007/s10157-024-02500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Serum lactate dehydrogenase to albumin ratio (LAR) is associated with poor outcomes in malignancy and pneumonia. However, there are few studies suggesting that LAR is associated with the occurrence of acute kidney injury (AKI) in patients with sepsis, which was investigated in this study. METHODS We conducted a retrospective cohort study based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was the occurrence of AKI within 2 days and 7 days. Multivariable logistic regression models were used to calculate odds ratios to validate the association between LAR and AKI, in-hospital mortality, RRT use, and recovery of renal function, respectively. RESULTS A total of 4010 participants were included in this study. The median age of the participants was 63.5 years and the median LAR was 10.5. After adjusting for confounding variables, patients in the highest LAR quartile had a higher risk of AKI than those in the lowest LAR quartile within 2 days and 7 days, with odds ratios of 1.37 (95% confidence interval [CI]: 1.23-1.52) and 1.95 (95% CI: 1.72-2.22), respectively. The adjusted odds of AKI within 2 and 7 days were 1.16 (95% CI: 1.12-1.20) and 1.29 (95% CI: 1.24-1.35) for each 1 unit increase in LAR(log2), respectively. CONCLUSION This study demonstrated that elevated LAR was associated with poor prognosis in patients with sepsis. The risk of AKI and in-hospital mortality increased, the need for RRT increased, and the chance of recovery of renal function decreased with the increase of LAR.
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Affiliation(s)
- Weigan Xu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China.
| | - Jianyang Huo
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Qiaohua Hu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jingtao Xu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Guojun Chen
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jierong Mo
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Tianen Zhou
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jun Jiang
- First People's Hospital of Foshan, Foshan, Guangdong Province, China
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Qian S, Pan Y, Li Q, Zhang L, Duan L, Xu Y, Cao J, Cui X, Huang Y. Landscape of peripheral immunity in patients with upper urinary tract urolithiasis and the underlying correlations with renal function. BMC Urol 2024; 24:169. [PMID: 39118072 PMCID: PMC11308678 DOI: 10.1186/s12894-024-01556-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION Inflammatory and immunological responses are reported involved in the pathogenesis and progression of obstructive nephropathy (ON). This study was designed to investigate the characteristics of peripheral immunity in patients with upper urinary tract urolithiasis and analyze the underlying associations with renal function. METHODS Patients with unilateral upper urinary tract urolithiasis meeting the operation indications were prospectively enrolled. Preoperative circulating immune cells and inflammatory cytokines were detected in our clinical laboratory, and the indicators of renal function and calculi related parameters were particularly recorded. Patients were sectionalized into subgroups on the basis of the lesion of calculi. Characteristics of peripheral immunity in each subgroup were investigated by statistical approaches, and the underlying correlations with the degree of hydronephrosis (HN) and renal function were discussed in corresponding group. RESULTS Patients with ureteral calculi presented severer HN compared with renal calculi, especial middle ureteral calculi, acting as the chief culprit of ON, exhibiting the highest serum creatine and blood urea nitrogen, most impaired estimated glomerular filtration rate, and severest HN. In addition, serum interleukin-8 (IL-8) and IL-6 were demonstrated presenting statistical differences between ureteral calculi and renal calculi patients, exhibiting underlying values in comprehending ON. However, circulating immune cells were demonstrated no obvious differences among groups. CONCLUSIONS Circulating inflammatory cytokines, referred in particular to serum IL-8 and IL-6 were partially associated with kidney injury in patients with upper urinary tract urolithiasis. But the specific influences and mechanisms between them needed to be investigated furthermore.
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Affiliation(s)
- Subo Qian
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Yongdong Pan
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Quan Li
- Department of Urology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200081, China
| | - Liying Zhang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Liujian Duan
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Yan Xu
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Jianwei Cao
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China
| | - Xingang Cui
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China.
| | - Yunteng Huang
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Yangpu, Shanghai, 200092, China.
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Liu J, Zheng B, Cui Q, Zhu Y, Chu L, Geng Z, Mao Y, Wan L, Cao X, Xiong Q, Guo F, Yang DC, Hsu S, Chen C, Yan X. Single-Cell Spatial Transcriptomics Unveils Platelet-Fueled Cycling Macrophages for Kidney Fibrosis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308505. [PMID: 38838052 PMCID: PMC11304276 DOI: 10.1002/advs.202308505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/14/2024] [Indexed: 06/07/2024]
Abstract
With the increasing incidence of kidney diseases, there is an urgent need to develop therapeutic strategies to combat post-injury fibrosis. Immune cells, including platelets, play a pivotal role in this repair process, primarily through their released cytokines. However, the specific role of platelets in kidney injury and subsequent repair remains underexplored. Here, the detrimental role of platelets in renal recovery following ischemia/reperfusion injury and its contribution to acute kidney injury to chronic kidney disease transition is aimed to investigated. In this study, it is shown that depleting platelets accelerates injury resolution and significantly reduces fibrosis. Employing advanced single-cell and spatial transcriptomic techniques, macrophages as the primary mediators modulated by platelet signals is identified. A novel subset of macrophages, termed "cycling M2", which exhibit an M2 phenotype combined with enhanced proliferative activity is uncovered. This subset emerges in the injured kidney during the resolution phase and is modulated by platelet-derived thrombospondin 1 (THBS1) signaling, acquiring profibrotic characteristics. Conversely, targeted inhibition of THBS1 markedly downregulates the cycling M2 macrophage, thereby mitigating fibrotic progression. Overall, this findings highlight the adverse role of platelet THBS1-boosted cycling M2 macrophages in renal injury repair and suggest platelet THBS1 as a promising therapeutic target for alleviating inflammation and kidney fibrosis.
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Affiliation(s)
- Jun Liu
- Pediatric Institute of Soochow UniversityChildren's Hospital of Soochow UniversitySoochow UniversitySuzhou215025China
| | - Bo Zheng
- State Key Laboratory of Reproductive Medicine and Offspring HealthThe Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal HospitalGusu School of Nanjing Medical UniversitySuzhou215002China
| | - Qingya Cui
- National Clinical Research Center for Hematologic DiseasesJiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhou215006China
| | - Yu Zhu
- Pediatric Institute of Soochow UniversityChildren's Hospital of Soochow UniversitySoochow UniversitySuzhou215025China
| | - Likai Chu
- Pediatric Institute of Soochow UniversityChildren's Hospital of Soochow UniversitySoochow UniversitySuzhou215025China
| | - Zhi Geng
- Pediatric Institute of Soochow UniversityChildren's Hospital of Soochow UniversitySoochow UniversitySuzhou215025China
| | - Yiming Mao
- Department of Thoracic SurgerySuzhou Kowloon HospitalShanghai Jiao Tong University School of MedicineSuzhou215028China
| | - Lin Wan
- Pediatric Institute of Soochow UniversityChildren's Hospital of Soochow UniversitySoochow UniversitySuzhou215025China
| | - Xu Cao
- Pediatric Institute of Soochow UniversityChildren's Hospital of Soochow UniversitySoochow UniversitySuzhou215025China
| | - Qianwei Xiong
- Pediatric Institute of Soochow UniversityChildren's Hospital of Soochow UniversitySoochow UniversitySuzhou215025China
| | - Fujia Guo
- Department of MicrobiologyImmunology & Molecular GeneticsUniversity of CaliforniaLos AngelesCA90095USA
| | - David C Yang
- Department of Internal MedicineDivision of NephrologyUniversity of CaliforniaDavisCA95616USA
| | - Ssu‐Wei Hsu
- Department of Internal MedicineDivision of NephrologyUniversity of CaliforniaDavisCA95616USA
| | - Ching‐Hsien Chen
- Department of Internal MedicineDivision of NephrologyUniversity of CaliforniaDavisCA95616USA
- Department of Internal MedicineDivision of Pulmonary and Critical Care MedicineUniversity of California DavisDavisCA95616USA
| | - Xiangming Yan
- Pediatric Institute of Soochow UniversityChildren's Hospital of Soochow UniversitySoochow UniversitySuzhou215025China
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Zhang K, Han Y, Gao YX, Gu FM, Cai T, Hu R, Gu ZX, Liang JY, Zhao JY, Gao M, Li B, Cui D. Association between Red Blood Cell Distribution Width and In-Hospital Mortality among Congestive Heart Failure Patients with Diabetes among Patients in the Intensive Care Unit: A Retrospective Cohort Study. Crit Care Res Pract 2024; 2024:9562200. [PMID: 39104663 PMCID: PMC11300080 DOI: 10.1155/2024/9562200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/10/2024] [Accepted: 06/24/2024] [Indexed: 08/07/2024] Open
Abstract
Background Elevated red blood cell distribution width (RDW) levels are strongly associated with an increased risk of mortality in patients with congestive heart failure (CHF). Additionally, heart failure has been closely linked to diabetes. Nevertheless, the relationship between RDW and in-hospital mortality in the intensive care unit (ICU) among patients with both congestive heart failure (CHF) and diabetes mellitus (DM) remains uncertain. Methods This retrospective study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, a comprehensive critical care repository. RDW was assessed as both continuous and categorical variables. The primary outcome of the study was in-hospital mortality at the time of hospital discharge. We examined the association between RDW on ICU admission and in-hospital mortality using multivariable logistic regression models, restricted cubic spline analysis, and subgroup analysis. Results The cohort consisted of 7,063 patients with both DM and CHF (3,135 females and 3,928 males). After adjusting for potential confounders, we found an association between a 9% increase in mortality rate and a 1 g/L increase in RDW level (OR = 1.09; 95% CI, 1.05∼1.13), which was associated with 11 and 58% increases in mortality rates in Q2 (OR = 1.11, 95% CI: 0.87∼1.43) and Q3 (OR = 1.58, 95% CI: 1.22∼2.04), respectively, compared with that in Q1. Moreover, we observed a significant linear association between RDW and in-hospital mortality, along with strong stratified analyses to support the findings. Conclusions Our findings establish a positive association between RDW and in-hospital mortality in patients with DM and CHF.
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Affiliation(s)
- Kai Zhang
- Cardiovascular Surgery DepartmentSecond Hospital of Jilin University, Changchun, China
| | - Yu Han
- Department of OphthalmologyFirst Hospital of Jilin University, Changchun, China
| | - Yu Xuan Gao
- Cardiovascular Surgery DepartmentSecond Hospital of Jilin University, Changchun, China
| | - Fang Ming Gu
- Cardiovascular Surgery DepartmentSecond Hospital of Jilin University, Changchun, China
| | - Tianyi Cai
- Department of OphthalmologySecond Hospital of Jilin University, Changchun, China
| | - Rui Hu
- Department of OphthalmologySecond Hospital of Jilin University, Changchun, China
| | - Zhao Xuan Gu
- Cardiovascular Surgery DepartmentSecond Hospital of Jilin University, Changchun, China
| | - Jia Ying Liang
- Cardiovascular Surgery DepartmentSecond Hospital of Jilin University, Changchun, China
| | - Jia Yu Zhao
- Cardiovascular Surgery DepartmentSecond Hospital of Jilin University, Changchun, China
| | - Min Gao
- Department of Cancer CenterThe First Hospital of Jilin University, Changchun, China
| | - Bo Li
- Cardiovascular Surgery DepartmentSecond Hospital of Jilin University, Changchun, China
| | - Dan Cui
- Cardiovascular Surgery DepartmentSecond Hospital of Jilin University, Changchun, China
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Lashen SA, Salem P, Ibrahim E, Abd Elmoaty D, Yousif WI. Hematological ratios in patients with acute decompensation and acute-on-chronic liver failure: prognostic factors. Eur J Gastroenterol Hepatol 2024; 36:952-960. [PMID: 38829945 DOI: 10.1097/meg.0000000000002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND AND AIMS Acute-on-chronic liver failure (ACLF) is the most severe form of acutely decompensated cirrhosis and is characterized by the presence of intense systemic inflammation. Leucocyte quantification can serve as an indirect indicator of systemic inflammation. In our study, we investigated the predictive value of hematological ratios (neutrophils to lymphocytes, monocyte to lymphocytes, platelets to lymphocytes, lymphocytes to C-reactive protein, and neutrophils to lymphocytes and platelets) in acute decompensation (AD) and ACLF patients and their relation to disease severity and early mortality. PATIENTS AND METHODS We included 60 patients with ACLF and AD, and 30 cirrhotic controls. Clinical data were collected, and survival was followed for 1 and 6 months. Blood samples were analyzed at admission for differential leucocytes and assessed for liver and renal function tests. The leukocyte ratios were calculated and compared, and their correlation with liver function indicators and prognosis was assessed. RESULTS All ratios were significantly higher in AD and ACLF patients compared to control (except for lymphocyte to C-reactive protein ratio which was significantly lower), and were positively correlated with Child-Pugh score, model for end-stage liver disease (MELD)-Na, and ACLF severity scores. Multivariate regression revealed that neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and MELD-Na were independent prognostic factors of 1-month and 6-month mortality. A unique prognostic nomogram incorporating MELD-Na, neutrophil to lymphocyte ratio, and monocyte to lymphocyte ratio could be proposed for predicting prognosis in AD and ACLF patients. CONCLUSIONS Cheap, easy, and noninvasive hematological ratios are introduced as a tool for early identification and risk stratification of AD and ACLF patients.
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Affiliation(s)
| | | | | | - Dalia Abd Elmoaty
- Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Zhang K, Han Y, Gao YX, Gu FM, Cai T, Gu ZX, Yu ZJ, Min G, Gao YF, Hu R, Huang MX. Association between the triglyceride glucose index and length of hospital stay in patients with heart failure and type 2 diabetes in the intensive care unit: a retrospective cohort study. Front Endocrinol (Lausanne) 2024; 15:1354614. [PMID: 38800470 PMCID: PMC11127565 DOI: 10.3389/fendo.2024.1354614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/25/2024] [Indexed: 05/29/2024] Open
Abstract
Background The coexistence of heart failure and diabetes is prevalent, particularly in Intensive Care Units (ICU). However, the relationship between the triglyceride-glucose (TyG) index, heart failure, diabetes, and the length of hospital stay (LHS) in patients with cerebrovascular disease in the ICU remains uncertain. This study aims to investigate the association between the TyG index and LHS in patients with heart failure and diabetes. Methods This retrospective study utilized the Medical Information Mart for Intensive Care (MIMIC)-IV database to analyze patients with diabetes and heart failure. Participants were categorized into quartiles based on the TyG index, and the primary outcome was LHS. The association between the TyG index at ICU admission and LHS was examined through multivariable logistic regression models, restricted cubic spline regression, and subgroup analysis. Results The study included 635 patients with concurrent diabetes and heart failure. The fully adjusted model demonstrated a positive association between the TyG index and LHS. As a tertile variable (Q2 and Q3 vs Q1), the beta (β) values were 0.88 and 2.04, with a 95% confidence interval (95%CI) of -0.68 to 2.44 and 0.33 to 3.74, respectively. As a continuous variable, per 1 unit increment, the β (95% CI) was 1.13 (0.18 to 2.08). The TyG index's relationship with LHS showed linearity (non-linear p = 0.751). Stratified analyses further confirmed the robustness of this correlation. Conclusion The TyG index exhibited a linearly positive association with the LHS in patients with both heart failure and diabetes. Nevertheless, prospective, randomized, controlled studies are imperative to substantiate and validate the findings presented in this investigation.
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Affiliation(s)
- Kai Zhang
- Cardiovascular Surgery Department, The Second Hospital of Jilin University, Changchun, China
| | - Yu Han
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
| | - Yu Xuan Gao
- Cardiovascular Surgery Department, The Second Hospital of Jilin University, Changchun, China
| | - Fang Ming Gu
- Cardiovascular Surgery Department, The Second Hospital of Jilin University, Changchun, China
| | - Tianyi Cai
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China
| | - Zhao Xuan Gu
- Cardiovascular Surgery Department, The Second Hospital of Jilin University, Changchun, China
| | - Zhao Jia Yu
- Cardiovascular Surgery Department, The Second Hospital of Jilin University, Changchun, China
| | - Gao Min
- Department of Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Ya Fang Gao
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China
| | - Rui Hu
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China
| | - Mao Xun Huang
- Cardiovascular Surgery Department, The Second Hospital of Jilin University, Changchun, China
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Nlandu Y, Makulo JR, Essig M, Sumaili E, Lumaka A, Engole Y, Mboliasa MF, Mokoli V, Tshiswaka T, Nkodila A, Bukabau J, Longo A, Kajingulu F, Zinga C, Nseka N. Factors associated with acute kidney injury (AKI) and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit: a single-center prospective study. Ren Fail 2023; 45:2263583. [PMID: 37870858 PMCID: PMC11001370 DOI: 10.1080/0886022x.2023.2263583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a complication of severe coronavirus disease 2019 (COVID-19). Kidney damage associated with COVID-19 could take specific features due to environmental and socio-cultural factors. This study evaluates the incidence of AKI, the associated factors, and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit. METHODS In a prospective cohort study conducted in the intensive care unit (ICU) of the Centre Médical de Kinshasa (CMK), consecutive patients admitted for COVID-19 were screened for the presence of AKI between 27 March, 2020 and 27 January 2022. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was occurrence of AKI. The secondary outcome was 48 days' mortality and recovery of the renal function at intensive care unit (ICU) discharge. Survival (time-to death) curves were built using the Kaplan Meier methods. Multivariate analyses were performed by logistic regression to identify factors associated with AKI and Cox regression to explore the association between AKI and in-hospital mortality. The significance level of the p-value was set at 0.05. RESULTS The median(IQR) sequential organ failure assessment score (SOFA) score and mean age of patients (215) including in our cohort were respectively 3(2-4) and 58.9 ± 14.9 years. The incidence of AKI was 28.4% with stages 1, 2, or 3 AKI accounted for 39.3%, 11.5%, and 49.2%, respectively. Hemodialysis was required in 16 out 215 (7.4%) patients. Dyspnea (adjusted odds ratio (aOR):2.27 [1.1--4.57] p = 0.021), SOFA ≥5 (aOR:3.11[1.29-7.53] p = 0.012), AST/ALT ratio (aOR: 1.53 [1.09-1.79] p = 0.015), N/L ratio (aOR:2.09 [1.09-3.20] p = 0.016), mechanical ventilation (aOR: 3.20 [1.66-10.51] p = 0.005) and Amikacin (aOR: 2.91 [1.37-6.18] p = 0.006) were the main factors associated with AKI. Patients with AKI had a mortality rate of 52.5% and 67.2% of the survivors did not recover kidney function at the end of hospitalization. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93-4.65] p = 0.013) compared to non-AKI patients. CONCLUSIONS AKI was present in three out of ten COVID-19 patients. The most significant factors associated with AKI were dyspnea, SOFA ≥ 5, AST/ALT and N/L ratio, mechanical ventilation and Amikacin. AKI has been associated with an almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI.
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Affiliation(s)
- Yannick Nlandu
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Robert Makulo
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie Essig
- Nephrology Department, Ambroise Paré Hospital, AP-HP University Paris-Saclay, Boulogne-Billancourt, France
| | - Ernest Sumaili
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aimé Lumaka
- Center for Human Genetics, Department of Pediatrics, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Yannick Engole
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie-France Mboliasa
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Vieux Mokoli
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Trésor Tshiswaka
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aliocha Nkodila
- Department of Family Medicine and Primary Care, Protestant University in Congo, Kinshasa, Democratic Republic of Congo
| | - Justine Bukabau
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Augustin Longo
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - François Kajingulu
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Chantal Zinga
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nazaire Nseka
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Bravo-Santibáñez E, Hernández-González MA, López-Briones S, Contreras-Chávez M. [Association of neutrophil, lymphocyte, platelet ratio with acute kidney injury in sepsis]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:342-347. [PMID: 37216673 PMCID: PMC10441577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/30/2022] [Indexed: 05/24/2023]
Abstract
Background Acute kidney injury (AKI) is frequent in sepsis (25 to 51%), with high mortality (40 to 80%) and long-term complications. Despite its importance we do not have accessible markers in intensive care. In other entities (post-surgical and COVID-19) the neutrophil/lymphocyte and platelet (N/LP) ratio has been associated with acute kidney injury; however, this relationship has not been studied in a pathology with a severe inflammatory response such as sepsis. Objective To demonstrate the association between N/LP with AKI secondary to sepsis in intensive care. Material and methods Ambispective cohort study in patients over 18 years who were admitted to intensive care with a diagnosis of sepsis. The N/LP ratio was calculated from admission up to the seventh day and up to the diagnosis of AKI and outcome. Statistical analysis was performed with chi squared test, Cramer's V and multivariate logistic regression. Results Out of the 239 patients studied, the incidence of AKI developed in 70%. 80.9% of patients with N/LP ratio > 3 had AKI (p < 0.0001, Cramer's V 0.458, OR 3.05, 95% CI 1.602-5.8) and increased renal replacement therapy (21.1 vs. 11.1%, p = 0.043). Conclusion N/LP ratio > 3 has a moderate association with AKI secondary to sepsis in the intensive care unit.
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Affiliation(s)
- Edgar Bravo-Santibáñez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Departamento de Enseñanza. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Martha Alicia Hernández-González
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Departamento de Enseñanza. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Sergio López-Briones
- Universidad de Guanajuato, División Ciencias de la Salud, Laboratorio de Biología Molecular. León, Guanajuato, MéxicoUniversidad de GuanajuatoMéxico
| | - Marisol Contreras-Chávez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Unidad de Cuidados Intensivos. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
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