The prognostic value of elevated neutrophil–lymphocyte ratio for cardiac surgery-associated acute kidney injury: A systematic review and meta-analysis |
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| Authors: | Joseph Wheatley Zhengyang Liu Joel Loth Mark P Plummer Jahan C Penny-Dimri Reny Segal Julian Smith Luke A Perry |
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| Institution: | 1. Department of Anaesthesia, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia;2. Department of Anaesthesia, Royal Melbourne Hospital, Melbourne, Victoria, Australia;3. Department of Critical Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia;4. Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, Victoria, Australia |
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| Abstract: | Background Patients undergoing cardiac surgery are at significant risk of developing postoperative acute kidney injury (AKI). Neutrophil–lymphocyte ratio (NLR) is a widely available inflammatory biomarker which may be of prognostic value in this setting. Methods We conducted a systematic review and meta-analysis of studies reporting associations between perioperative NLR with postoperative AKI. We searched Medline, Embase and the Cochrane Library, without language restriction, from inception to May 2022 for relevant studies. We meta-analysed the reported odds ratios (ORs) with 95% confidence intervals (CIs) for both elevated preoperative and postoperative NLR with risk of postoperative AKI and need for renal replacement therapy (RRT). We conducted a meta-regression to explore inter-study statistical heterogeneity. Results Twelve studies involving 10,724 participants undergoing cardiac surgery were included, with eight studies being deemed at high risk of bias using PROBAST modelling. We found statistically significant associations between elevated preoperative NLR and postoperative AKI (OR 1.45, 95% CI 1.18–1.77), as well as postoperative need for RRT (OR 2.37, 95% CI 1.50–3.72). Postoperative NLR measurements were not of prognostic significance. Conclusions Elevated preoperative NLR is a reliable inflammatory biomarker for predicting AKI following cardiac surgery. |
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| Keywords: | Acute Kidney Injury Neutrophil-lymphocyte ratio Cardiac Surgery Biomarker |
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