Clinical analysis of pulmonary infection in hemodialysis patients

Progress in the application of the neutrophil-to-lymphocyte ratio in dialysis-related complications

The neutrophil-to-lymphocyte ratio (NLR) is a novel predictive biomarker that reflects systemic inflammatory status and is routinely measured in blood tests. Owing to its ease of use and affordability, it is being increasing used as a prognostic indicator of cardiovascular disease, tumors, autoimmune disorders, and kidney disease. In recent years, a number of studies have demonstrated the clinical utility of the NLR in identifying and predicting complications associated with hemodialysis and peritoneal dialysis, including cardiovascular disease and infection. This review aimed to provide a new perspective on the application of the NLR as a valuable tool enabling clinicians to better assess the occurrence and prognosis of complications in patients undergoing dialysis.

Comparison of qSOFA Score, SIRS Criteria, and SOFA Score as predictors of mortality in patients with sepsis

Objectives

Early diagnosis and treatment of sepsis are associated with a better outcome. With the change in the definition of sepsis, SOFA score and qSOFA score (heart rate, systolic blood pressure and Glasgow coma scale) were introduced and SIRS criteria were removed. This study compared the qSOFA score, SIRS criteria and SOFA score as predictors of mortality in patients with sepsis.

Design

Prospective observational study.

Setting

Department of General Medicine of a tertiary hospital.

Participants

The study included 116 patients.

Interventions

SOFA scores (range, 0 [best] to 24 [worst] points), SIRS status (range, 0 [best] to 4 [worst] criteria), and qSOFA scores (range, 0 [best] to 3 [worst] points) were calculated using physiological and laboratory parameters recorded within the first 24 hours of ICU admission.

Main outcome measures

SOFA, qSOFA, and SIRS scores were calculated and measured using physiological and laboratory parameters. Patients were followed till mortality (non-survivors) or discharge from the hospital (survivors). Data were analysed using software SPSS version 20.

Results

54 (46.6%) of included patients died. Higher SOFA, qSOFA, and SIRS scores; tachycardia; hypotension; hypoxemia; basophilia; hypoproteinemia; hypoalbuminemia; and need for inotropic support and mechanical ventilation significantly associated with increased mortality. The area under the receiver operating curve for qSOFA ≥2 (0.678; p=0.001) and SOFA (0.74; p=0.000) were comparable and significant, whereas SIRS ≥2 (0.580, p=0.139) was not statistically significant.

Conclusions

A qSOFA score of greater than 2 is comparable to SOFA and is better than SIRS score greater than 2 for predicting mortality.

Funding

None indicated.

The clinical significance of neutrophil-lymphocyte ratio in patients treated with hemodialysis complicated with lung infection

ABSTRACT

The goal of this work was to investigate the potential significance of neutrophil-lymphocyte ratio (NLR) in patients treated with maintenance hemodialysis (MHD).Herein, we retrospectively reviewed the electronic medical records of 100 patients with end-stage renal failure who were treated with MHD. All patients enrolled in this study met the inclusion criteria and were followed. The differences in each indicator between the two groups were compared using the Wilcoxon rank-sum test. On the other hand, Spearman correlation and logistic regression analysis were used to explore the correlation and risk factors for pulmonary infection between NLR and other indicators. Finally, we determined the optimal cut-off values for NLR, hypersensitive c-reactive protein (hs-CRP), and procalcitonin (PCT) diagnosis of pulmonary infection using the receiver operating characteristic curve.We found that NLR was positively correlated with age, PCT, hs-CRP, and hospital stay, but negatively correlated with hemoglobin, red blood cell, and Albumin. The expression levels of PCT, hs-CRP, and NLR in the infected group decreased significantly than those before treatment. Multiple regression analysis revealed that NLR is an important independent risk factor for MHD patients with pulmonary infection. Additionally, receiver operating characteristic curve analysis showed that the sensitivity, specificity, and area under the curve were 87.76%, 100%, and 0.920 when using NLR combined with hs-CRP to predict pulmonary infection in MHD patients, whereas that of NLR combined with PCT were 87.76%, 96.08%, and 0.944, respectively.Findings from this study suggested that NLR is an independent risk factor for MHD patients with pulmonary infection, which can effectively predict pulmonary infection. Moreover, sensitivity and specificity were greatly enhanced when using NLR combined with PCT/hs-CRP to predict pulmonary infection in MHD patients.

Analysis of the correlation between serum resistin and the variability of erythropoietin responsiveness in patients with chronic kidney disease

Chronic kidney disease (CKD) is commonly accompanied by inflammation and anemia; however, the pathogenesis of CKD is unclear. Expression of resistin, a cysteine-rich secretory plasma protein, is correlated with the expression of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and lipoprotein-associated phospholipase A2, indicating that resistin may be involved in inflammatory events. In addition, inflammation inhibits the activity of erythropoietin (EPO) and, thus, erythropoiesis. The aim of the present study was to analyze the correlation between serum resistin and the variability of EPO responsiveness in CKD patients. The levels of serum creatinine (SCr), C-reactive protein (CRP), total cholesterol, triglycerides, IL-6 and serum resistin were measured in the samples obtained from 138 CKD patients and healthy control subjects. The levels of serum resistin in the CKD groups with and without hemodialysis were significantly higher than those observed in the normal control group (P<0.01) and the levels of serum resistin in the hemodialysis CKD group were higher than those observed in the CKD group without dialysis (P<0.01). The levels of serum resistin in patients in the randomly selected CKD group (with hemodialysis) were positively correlated with the duration of dialysis and the levels of SCr and CRP (P<0.05), however, were negatively correlated with the estimated glomerular filtration rate. The EPO resistance index (ERI) was identified to be associated with body mass index and the levels of CRP and resistin; furthermore, EPO reactivity was correlated with the level of resistin and ERI. The levels of serum resistin were correlated with the variability in EPO responsiveness that was observed in the CKD patients. Therefore, the measurement of serum resistin may aid with understanding the mechanisms, clinical diagnosis and treatment of CKD.