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Association of preoperative neutrophil–lymphocyte ratio with acute kidney injury in patients with non-cardiac surgery: difference among surgical types

  • Nephrology - Original Paper
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Abstract

Purpose

To examine the relationship between Neutrophil–Lymphocyte Ratio (NLR) and Acute Kidney Injury (AKI) in patients undergoing noncardiac surgery, and subgroup analysis was performed for different types of non-cardiac surgery.

Methods

The present retrospective cohort study included 10,159 adult patients who underwent major noncardiac surgery at Nanfang Hospital, Southern Medical University, between 2008 and 2018. Postoperative AKI was defined as an increase in serum creatinine level of at least 0.3 mg/dl within 48 h, or 1.5 times higher than baseline within 7 days postoperatively according to the Kidney Disease Improving Global Outcome. The correlation between preoperative NLR and postoperative AKI was determined by stepwise multivariate logistic regression analysis, and the predictive value of NLR was evaluated by the receiver operating characteristics curve (ROC) analysis.

Results

Four hundred and eighty-five (4.77%) patients developed AKI postoperatively. Preoperative NLR was independently associated with postoperative AKI in all patients undergoing non-cardiac surgery (Odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00–1.06). The optimal cut-off value of NLR was 2.12 according ROC analysis. The OR and 95% CI of AKI for NLR > 2.12 was 1.48 (1.21–1.81) compared with NLR ≤ 2.12. In addition, the positive association was mainly shown in patients undergone digestive system surgery with a cut-off value of 2.12 but not in neurological and musculoskeletal system surgeries.

Conclusion

The present study confirmed the association of preoperative NLR with postoperative AKI in digestive system surgical patients. A NLR value of 2.12 may be a useful cut-off to evaluate the risk of AKI.

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Data availability

The data used in this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We appreciated the enrolled patients and their families for their cooperation.

Funding

This study was supported by the Key Program of National Natural Science Foundation, Beijing, China (81730058 to Ke-Xuan Liu) and the National Natural Science Foundation, Beijing, China (82172141 to Ke-Xuan Liu).

Author information

Author notes

  1. Yang-Tian Yan and Hua-Min Liu have contributed equally to the study as first co-authors.

Authors and Affiliations

  1. Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China

    Yang-Tian Yan, Hua-Min Liu, Jia-Ming Liu, Cai Li, Bing-Cheng Zhao & Ke-Xuan Liu

  2. Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China

    Yi-Fan Kong

Authors
  1. Yang-Tian Yan
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  2. Hua-Min Liu
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  4. Jia-Ming Liu
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  5. Cai Li
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  6. Bing-Cheng Zhao
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  7. Ke-Xuan Liu
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Contributions

YY and HL wrote the article and performed the data analysis; YK provided statistical test and verification; JL and CL provided clinical guidance; BZ and KL drafted and critically revised the manuscript. YY and BZ organized database. KL contributed to the study concept and design, and reviewed the article.

Corresponding authors

Correspondence to Bing-Cheng Zhao or Ke-Xuan Liu.

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Conflict of interest

The authors have no conflict of interests to disclose.

Ethics statement

This study was conducted in accordance with the Declaration of Helsinki, and the study protocol was reviewed and approved by the Medical Ethics Committee of Nanfang Hospital, Southern Medical University under the approval number NFEC-2019–081. All subjects provided written informed consent in the baseline and follow up.

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Yan, YT., Liu, HM., Kong, YF. et al. Association of preoperative neutrophil–lymphocyte ratio with acute kidney injury in patients with non-cardiac surgery: difference among surgical types. Int Urol Nephrol 55, 2647–2656 (2023). https://doi.org/10.1007/s11255-023-03567-4

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  • DOI: https://doi.org/10.1007/s11255-023-03567-4

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