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. 2024 Apr 30;29(1):260.
doi: 10.1186/s40001-024-01850-3.

Association between the neutrophil-to-lymphocyte ratio and in-hospital mortality in patients with chronic kidney disease and coronary artery disease in the intensive care unit

Jingjing Luo  1 , Yufan Zhou  1 , Yu Song  1 , Dashuai Wang  2 , Meihong Li  3 , Xinling Du  4 , Jihong Kang  5 , Ping Ye  6 , Jiahong Xia  7
Affiliations

Association between the neutrophil-to-lymphocyte ratio and in-hospital mortality in patients with chronic kidney disease and coronary artery disease in the intensive care unit

Jingjing Luo et al. Eur J Med Res. .

Abstract

Background: The objective of this study was to investigate the correlation between neutrophil-to-lymphocyte ratios (NLR) and the risk of in-hospital death in patients admitted to the intensive care unit (ICU) with both chronic kidney disease (CKD) and coronary artery disease (CAD).

Methods: Data from the MIMIC-IV database, which includes a vast collection of more than 50,000 ICU admissions occurring between 2008 and 2019, was utilized in the study and eICU-CRD was conducted for external verification. The Boruta algorithm was employed for feature selection. Univariable and multivariable logistic regression analyses and multivariate restricted cubic spline regression were employed to scrutinize the association between NLR and in-hospital mortality. The receiver operating characteristic (ROC) curves were conducted to estimate the predictive ability of NLR.

Results: After carefully applying criteria to include and exclude participants, a total of 2254 patients with CKD and CAD were included in the research. The findings showed a median NLR of 7.3 (4.4, 12.1). The outcomes of multivariable logistic regression demonstrated that NLR significantly elevated the risk of in-hospital mortality (OR 2.122, 95% confidence interval [CI] 1.542-2.921, P < 0.001) after accounting for all relevant factors. Further insights from subgroup analyses unveiled that age and Sequential Organ Failure Assessment (SOFA) scores displayed an interactive effect in the correlation between NLR and in-hospital deaths. The NLR combined with traditional cardiovascular risk factors showed relatively great predictive value for in-hospital mortality (AUC 0.750).

Conclusion: The findings of this research indicate that the NLR can be used as an indicator for predicting the likelihood of death during a patient's stay in the intensive care unit, particularly for individuals with both CAD and CKD. The results indicate that NLR may serve as a valuable tool for assessing and managing risks in this group at high risk. Further investigation is required to authenticate these findings and investigate the mechanisms that underlie the correlation between NLR and mortality in individuals with CAD and CKD.

Keywords: Chronic kidney disease; Coronary artery disease; In-hospital mortality; MIMIC-IV database; Neutrophil-to-lymphocyte ratio.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
The selection flowchart of CKD and CAD patients from the MIMIC-IV database. MIMIC Medical Information Mart for Intensive Care
Fig. 2
Fig. 2
The Boruta algorithm conducted the feature selection for the relationship between NLR and in-hospital mortality. The horizontal axis shows the name of each variable, while the vertical axis represents the Z-value of each variable. The box plot depicts the Z-value of each variable in the model calculation, with green boxes representing important variables, yellow representing tentative attributes, and red representing unimportant variables. NLR neutrophil-to-lymphocyte ratio, scr serum creatinine, eGFR estimated glomerular filtration rate, ACS acute coronary syndrome, HT hypertension, max maximum, min minimum, WBC white blood cell, RBC red blood cell, ALT alanine aminotransferase, INR International Normalized Ratio, PT prothrombin time, SOFA sequential organ failure assessment, HR heart rate, SpO2 oxyhemoglobin saturation
Fig. 3
Fig. 3
Top 30 important variables for the relationship between NLR and in-hospital mortality based on the percentage of the increase in mean square error and the increase in node purity. NLR neutrophil-to-lymphocyte ratio, max maximum, min minimum, WBC white blood cell, ALT alanine aminotransferase, PT prothrombin time, SOFA sequential organ failure assessment, SpO2 oxyhemoglobin saturation, %IncMSE the percentage of the increase in mean square error, IncNodePurity the increase in node purity
Fig. 4
Fig. 4
The nonlinear association between the NLR and in-hospital mortality after full adjustment via multivariable RCS regression. The cutoff value in the plot of in-hospital death risk was 7.32. NLR, neutrophil-to-lymphocyte ratio; RCS, restricted cubic spline
Fig. 5
Fig. 5
The predictive value of NLR. The combined model (A) which added NLR to traditional risk factors had a more accurate prediction (AUC 0.750) than traditional risk factors model (AUC 0.708, P < 0.001 by DeLong’s test). NLR had good predictive values in the external database (B). AUC, area under curves; NLR, neutrophil-to-lymphocyte ratio
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