Neutrophil/Albumin Ratio: Can using it a predictor tool for mortality in critically Ill patient with acute kidney injury?

Abstract

Background: Acute kidney injury (AKI), commonly referred to as acute renal failure (ARF), is the rapid or sudden deterioration of renal filtration capacity. Elevated serum creatinine levels or azotemia (increased blood urea nitrogen [BUN] levels) are prevalent markers of this condition.

Objective: To evaluate the neutrophil/albumin ratio as a predictor of hospital mortality in critically ill patients with acute renal damage.

Methods: Seventy cases necessitated an intensive care unit stay exceeding two days. The Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE) criteria were employed to ascertain the existence and stage of acute kidney injury in adult patients with AKI.

Results: There is a notable increase in respiratory rate (RR) and heart rate (HR) in the deceased individuals compared to the survived cases. There was a notable escalation in AKI stages (3rd and 5th), utilization of vasopressors, and renal replacement therapy in deceased participants compared to those who survived. Both SOFA and SAPSII scores were considerably elevated in deceased cases compared to survivors. In the laboratory tests of included survivors and deceased participants, there was no significant variation in glucose levels between the two groups. In the serum electrolytes, there was a notable reduction in sodium and an elevation in potassium and bicarbonate levels in the deceased group. In the CBC, there was a notable reduction in hematocrit and hemoglobin levels in the deceased group. Platelet levels were markedly reduced in the deceased group. Concerning coagulation indices, there was a notable elevation in prothrombin time, APTT, and INR in the deceased group. No statistically significant differences in serum urea levels among the groups. Individuals who did not survive exhibited reduced serum creatinine and albumin levels compared to those who did. A statistically significant rise was observed in the ratio of neutrophil percentage to albumin level in the deceased. A threshold value of 12.14 for the Neutrophil to Albumin Ratio shown a significant correlation with death in patients. Sensitivity attained 95.2% and specificity was recorded at 89.8%. A cutoff value of 3.5 for SOFA and 14 for SAPSII shown a significant correlation with death in patients. Sensitivity attained 10% while specificity was 95.9%. A substantial positive correlation existed between mortality and coronary artery disease, atrial fibrillation, renal and liver diseases, pneumonia, and malignancy.

Conclusion: The results of this experiment indicate that the Neutrophil to Albumin Ratio is an effective predictor of in-hospital death in critically sick patients with AKI. The cutoff value of 12.14 for this ratio demonstrated high sensitivity (95.2%) and moderate specificity (89.8%), signifying its robust capacity to identify patients at risk of mortality.