Prognostic Value of the Baseline and Early Changes in Monocyte-to-Lymphocyte Ratio for Short-Term Mortality among Critically Ill Patients with Acute Kidney Injury

Abstract

(1) Background: Inflammation plays an important role in the onset and progression of acute kidney injury (AKI). Despite this, evidence regarding the prognostic effect of the monocyte-to-lymphocyte ratio (MLR), a novel systemic inflammation marker, among patients with AKI is scarce. This study sets out to investigate the prognostic potential of both baseline and early changes in MLR for short-term mortality among critically ill patients with AKI. (2) Method: Eligible patients with AKI from the Medical Information Mart for Intensive Care IV database were retrospectively analyzed. MLR cutoff values were determined using maximally selected rank statistics and tertiles. The clinical outcomes were 30-day and 90-day mortality in the intensive care unit. A restricted cubic splines model and Cox proportional hazards models were utilized to evaluate the association between the baseline MLR and short-term mortality. Then, the trends in MLR over time were compared between the 30-day survivors and non-survivors using a generalized additive mixed model (GAMM). (3) Result: A total of 15,986 patients were enrolled. Multivariable Cox regression analysis identified baseline MLR ≥ 0.48 as an independent risk factor predicting 30-day mortality (HR 1.33, 95%CI 1.24, 1.45, p < 0.001) and 90-day mortality (HR 1.34, 95%CI 1.23, 1.52, p < 0.001) after adjusting for potential confounders. Similar trends were observed for 30-day and 90-day mortality when tertiles were used to group patients. The restricted cubic splines model revealed a non-linear association between MLR and 30-day and 90-day mortality (both p for non-linear < 0.001, both p for overall < 0.001). The area under the curve of 0.64 for MLR was higher than that of monocytes (0.55) and lymphocytes (0.61). In the subgroup analyses, despite the noted significant interactions, the direction of the observed association between MLR and 30-day mortality was consistent across most prespecified subgroups, except for shock and black ethnicity. The GAMM results highlighted that, as time went on, MLR in the 30-day survival group consistently declined, whereas MLR in the non-survival group rose within 15 days post-ICU admission. The difference between the two groups persisted significantly even after adjusting for confounders (p = 0.006). (4) Conclusion: A higher baseline MLR was identified as an independent risk factor predicting 30-day and 90-day mortality. The early increase in MLR was associated with high 30-day mortality, suggesting that dynamic monitoring of MLR could potentially better predict survival in critically ill patients with AKI.

Association between monocyte to lymphocyte ratio and diabetic foot ulcer in the population of the US with diabetes based on the 1999-2004 National Health and Nutrition Examination Survey data: a retrospective cross-sectional study

“…The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and MLR are indicators of these immune cells. Numerous studies have demonstrated that these markers can predict the presence of systemic inflammation and may be helpful in the diagnosis of various disorders ( 8 , 20 , 21 , 31 ). Recently, some studies have shown that the high MLR is associated with the occurrence and progression of diabetes complications, including diabetic nephropathy, DR, and PAD ( 7 , 22 – 24 , 32 ).…”

“…It has been widely studied in various inflammation-related disorders, such as cancer, tuberculosis and cardiovascular diseases, and has proven to be a reliable biomarker of systemic inflammation ( 17 – 19 ). Elevated MLR has been associated with poor prognosis and accelerated disease progression in several disorders, including acute kidney injury and hematoma after cerebral contusion ( 20 , 21 ). Recently, some studies have shown that the MLR is associated with the occurrence and progression of diabetes complications, including diabetic nephropathy, diabetic retinopathy (DR), and PAD ( 7 , 22 – 24 ).It is reasonable to assume that MLR may play a significant role in the onset and progression of DFU, given the mounting body of research emphasizing its importance in diabetes complications ( 7 , 22 – 24 ).…”