The Study Of The Correlation Between Platelet-to-Lymphocyte Ratio And Clinical Analysis And Prognosis Among Critically Ill Patients With Acute Kidney Injury

Objective:To discuss the value of platelet-to-lymphocyte ratio(PLR)on clinical analysis and outcomespredicting for critically ill patients with acute kidney injury.Method:280 AKI cases met the inclusion criteria were identified,these patients were admitted by Intensive Care Unit(ICU)of The Second People’s Hospital of Lianyungang from June 2015 to June 2017.Data of these cases were extracted and analyzed.Meanwhile,control group include 60 people who came to this hospital for physical examination and were proven to be healthy during the same time.Difference analysis of PLR and neutrophil-to-lymphocyte ratio(NLR)between case and control groups was conducted.Patients were divided into different subgroups according to "KDIGO Clinical Practice Guideline for Acute Kidney Injury(2012)",as "AKI stage 1","AKI stage 2" and "AKI stage 3",compare PLR,NLR and some other indexes among groups.Then,Spearman correlation analysis was conducted between indexes such as PLR,NLR and scores of Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)and Sequential Organ Failure Assessment(SOFA).In the end,receiver operating characteristic(ROC)curves of PLR and NLR was obtained,compare the clinical value of them in predicting outcomes of AKI patients,and get the optimal cut-off point of PLR.Result:The number of AKI Cases that met the inclusion criteria were 280(AKI group),the number of the healthy subjects were 60(control group).Compare data of two groups,PLR,NLR and neutrophil count were higher in AKI group than in control group,the difference was statistically significant(P<0.001).Platelet count and lymphocyte count were lower in AKI group than in control group,the difference was also statistically significant(P<0.001).It is shown that the level of PLR increased as the stages of AKI getting higher through data analysis of the three subgroups "AKI stage 1","AKI stage 2"and "AKI stage 3",the difference was statistically significant(P<0.05),there is no statistically significant differences of NLR,lymphocyte count,platelet count,and neutrophil count among three subgroups(P>0.05).Through Spearman correlation analysis,there was a moderate positive correlation between PLR and scores of APACHE Ⅱ and SOFA(spearman correlation coefficient was 0.432、0.417 respectively).It showed a slight positive correlation between NLR and scores of APACHE Ⅱ and SOFA(spearman correlation coefficient was 0.181、0.146 respectively).ROC curve of PLR was closer to top left corner than the curve of NLR.AUC of PLR was 0.783 and AUC of NLR was 0.639.According to the ROC curve,the optimal cut-off point of PLR was 293,its sensitivity was 77.6%,specificity was 82.6%,95%CI was 0.712-0.854.Conclusion:1.Compare to the control group,PLR of AKI group increased obviously,the difference was statistically significant.2.The level of PLR is associated with the stages of AKI,it is possible that,a higher PLR indicate a higher stage of AKI and a more serious situation of the disease.3.PLR is more accurate than NLR in predicting unfavorable prognosis in patients with AKI.Furthermore,there is a positive correlation between PLR and scores of APACHE Ⅱ and SOFA,it also suggests that PLR is associated with the severity of the disease and it could be used as an indicator in predicting prognosis.