Ratios of neutrophil,lymphocyte and monocyte to high-density lipoprotein cholesterol in acute pancreatitis complicated with acute kidney injury

Objective To explore the clinical predictive values of admission neutrophil,lymphocyte and monocyte to high-density lipoprotein cholesterol ratio(NHR/LHR/MHR)in acute pancreatitis(AP)related with acute kidney injury(AKI).Methods For this retrospective cohort study,a total of 302 AP patients were divided into AKI and non-AKI groups according to the KDIGO-AKI criteria.The inter-group differences of clinical profiles were compared for NHR,LHR and MHR.Results The incidence of AKI was 21.5%(65/302).And the clinical stage was 1(n=32,10.6%),2(n=16,5.3%)and 3(n=17,5.6%).NHR,LHR and MHR were markedly higher in AKI group than those in NAKI group and the difference were statistically significant(Z=7.356,5.062 & 6.446,P<0.01).After adjusting basic renal function,gender,concomitant chronic diseases,etiology of AP,basic vital signs and blood biochemical parameters on admission,multivariate logistic forward stepwise regression analysis revealed that admission NHR(OR=1.081,95%CI 1.043~1.121,P<0.01),MHR(OR=2.445,95%CI 1.514~3.947,P<0.01)and LHR(OR=1.713,95%CI 1.306~2.246,P<0.01)were the independent risks factors for AP-AKI.ROC curve indicated that the above parameters had excellent predictive values for AP-AKI and AUC were 0.798,0.761 and 0.705 respectively(all P<0.01).For understanding the impact of blood lipid levels on the predictive values of NHR,MHR,and LHR for AP-AKI,subgroup analysis showed that AUC of the above parameters were 0.709,0.667 and 0.615 in hyperlipidemic group and 0.830,0.790 and 0.707 in non-hyperlipidemic group respectively.No statistically significant inter-group differences existed in NHR,MHR or LHR(all P>0.05).Furthermore,vasopressors,mechanical ventilation and renal replacement therapy during hospitalization were defined as special hospital interventions.Fulfilling one of the above required special treatments.And the values of AUC were 0.782,0.702 and 0.679 respectively(all P<0.05).At the same time,it had an excellent correlation with APACHE II and SIRS scores for assessing the severity of AP.Conclusions Admission NHR,MHR,LHR as the comprehensive inflammatory parameters along with complete blood count and HDL-C are positively correlated with the severity of AP and serve as independent risk factors for AP-AKI.