Association between neutrophil-to-platelet ratio and acute kidney injury among patients undergoing cardiac surgery: An analysis based on Medical Information Mart for Intensive Care

An increase in neutrophils and a decrease in platelets have been correlated with a heightened risk of acute kidney injury (AKI) following cardiac surgery. However, the combined metric of neutrophil-to-platelet ratio (NPR) and its association with post-surgery AKI risk has not yet been investigated. To explore the relationship between NPR and AKI risk within seven days following cardiac surgery. Data were downloaded from Medical Information Mart for Intensive Care, including patients after cardiac surgery. Both univariate and multivariate logistic regression models were employed to explore association between NPR and AKI risk within seven days post-operatively. A restricted cubic spline was employed to evaluate non-linear nature of this association. Subgroup analyses were performed to examine variations across different cohorts. 1702 patients were included, with an AKI incidence of 20.21% within the postoperative seven-day period. Logistic regression analysis revealed that, in fully adjusted models, the highest tertile (T3, NPR ≥ 7.453) was significantly associated with an elevated AKI risk within seven days post-surgery (OR = 1.500, 95%CI: 1.086–2.076, P = 0.014). There was no significant non-linear relationship between NPR and AKI risk ( P -overall = <0.001, P -non-linear = 0.468). Notably, a significant interaction was observed in the subgroup receiving platelet transfusion ( P interaction = 0.005). In adults undergoing cardiac surgery, an elevated NPR was linked to higher AKI risk. This finding offers a novel marker for the early identification of patients at high risk for AKI post-surgery. Se han correlacionado el incremento de neutrófilos y la reducción de plaquetas con un aumento del riesgo de lesión renal aguda (LRA) tras la cirugía cardiaca. Sin embargo, no se ha investigado la métrica combinada de la relación neutrófilos-plaquetas (NPR) y su asociación con el riesgo posquirúrgico de LRA. Explorar la relación entre NPR y el riesgo de LRA dentro del plazo de 7 días desde la cirugía cardiaca. Los datos fueron descargados de Medical Information Mart for Intensive Care (MIMIC), incluyendo los pacientes tras la cirugía cardiaca. Se utilizaron modelos de regresión logística tanto univariantes como multivariantes para explorar la asociación ente NPR y el riesgo de LRA dentro del plazo posquirúrgico de 7 días. Se utilizó un spline cúbico restringido para evaluar la naturaleza no lineal de esta asociación. Se realizaron análisis de subgrupo para examinar las variaciones en las diferentes cohortes. Se incluyeron 1.702 pacientes, con una incidencia de LRA del 20,21% dentro del periodo postoperatorio de 7 días. El análisis de regresión logística reveló que, en modelos totalmente ajustados, el tercil más alto (T3, NPR ≥ 7,453) estuvo significativamente asociado a la elevación del riesgo de LRA dentro del plazo posquirúrgico de 7 días (OR = 1,500; IC 95%: 1,086-2,076; p = 0,014). No existió relación no lineal significativa entre NPR y el riesgo de LRA (P-general ≤ 0,001; P-no lineal = 0,468. De manera notable, se observó una interacción significativa en el subgrupo que recibió la trasfusión de plaquetas (P interacción = 0,005). En los adultos sometidos a cirugía cardiaca, se vincula una NPR elevada a un mayor riesgo de LRA. Este hallazgo ofrece un marcador novedoso para la identificación temprana de los pacientes con alto riesgo de LRA posquirúrgica.