The Neutrophil Percentage-to-Albumin Ratio Is Associated with All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury

Wang, Benji; Li, Diwen; Cheng, Bihuan; Ying, Binyu; Gong, Yuqiang

doi:10.1155/2020/5687672

Cited by 34 publications

(31 citation statements)

References 40 publications

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“…In this study, we found that lower albumin levels on admission can predict the outcome of COVID‐19 independent of other known indicators such as lymphocyte count or comorbidities 3 . This result is consistent with a previous study reporting hypoalbuminemia or decline of albumin, which is associated with the severity of ARDS 23 or acute kidney injury 24 . A meta‐analysis showed that about 80.4% of patients with abnormal liver function in COVID‐19 had hypoalbuminemia, which was associated with prognosis and outcome 25…”

Section: Discussionsupporting

confidence: 92%

Hypoalbuminemia predicts the outcome of COVID‐19 independent of age and co‐morbidity

Huang

Cheng

Kumar

et al. 2020

Journal of Medical Virology

275

241

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The coronavirus disease 2019 has evolved into a pandemic rapidly. Most of the literature show that the elevated liver enzymes in COVID-19 are of little clinical significance. Lower albumin level is seen in severe COVID-19 and is not parallel to the changes in alanine aminotransferase and aspartate aminotransferase levels. We aimed to explore the impact of hypoalbuminemia in COVID-19. This retrospective cohort study included adult patients with confirmed COVID-19. The relationship between hypoalbuminemia and death was studied using binary logistic analysis. A total of 299 adult patients were included, 160 (53.5%) were males and the average age was 53.4 ± 16.7 years. The median time from the onset of illness to admission was 3 days (interquartile ranges, 2-5). Approximately one-third of the patients had comorbidities.Hypoalbuminemia (<35 g/L) was found in 106 (35.5%) patients. The difference in albumin was considerable between survivors and non-survivors (37.6 ± 6.2 vs 30.5 ± 4.0, P < .001). Serum albumin level was inversely correlated to white blood cell (r = -.149, P = .01) and neutrophil to lymphocyte ratio (r = −.298, P < .001). Multivariate analysis showed the presence of comorbidities (OR, 6.816; 95% CI, lymphopenia (OR, 13.130; 95% CI,) and hypoalbuminemia (OR, 6.394; 95% CI, 1.315-31.092) were independent predictive factors for mortality. In conclusion, hypoalbuminemia is associated with the outcome of COVID-19. The potential therapeutic value of albumin infusion in COVID-19 should be further explored at the earliest.

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Section: Discussionsupporting

confidence: 92%

Hypoalbuminemia predicts the outcome of COVID‐19 independent of age and co‐morbidity

Huang

Cheng

Kumar

et al. 2020

Journal of Medical Virology

275

241

View full text Add to dashboard Cite

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“…Our findings were consistent with the results of studies that evaluated the prognostic value of NPARs in other clinical settings including STEMI [ 16 ], acute kidney injury [ 17 ], septic shock [ 18 ], rectal cancer [ 19 ], and palliative pancreatic cancer [ 20 ]. Additionally, several studies have investigated other measurable laboratory markers related to the inflammatory response in CS.…”

Section: Discussionsupporting

confidence: 90%

“…One recent study showed that hypoalbuminemia was a frequent finding early in CS and was associated with mortality independent of other risk factors [ 15 ]. Recently, several studies have combined these two markers and found that the neutrophil percentage-to-albumin ratio (NPAR) could serve as an inflammation-based prognostic predictor in patients with STEMI [ 16 ], acute kidney injury [ 17 ], septic shock [ 18 ], rectal cancer [ 19 ], or palliative pancreatic cancer [ 20 ]. Nevertheless, to the best of our knowledge, no previous study has explored the prognostic value of NPARs in critically ill patients with CS.…”

Section: Introductionmentioning

confidence: 99%

The Neutrophil Percentage-to-Albumin Ratio as a New Predictor of All-Cause Mortality in Patients with Cardiogenic Shock

Liu

Ling

et al. 2020

BioMed Research International

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Background. Although the neutrophil percentage-to-albumin ratio (NPAR) has proven to be a robust systemic inflammation-based predictor of mortality in a wide range of diseases, the prognostic value of the NPAR in critically ill patients with cardiogenic shock (CS) remains unknown. This study aimed at investigating the association between the admission NPAR and clinical outcomes in CS patients using real-world data. Methods. Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included all-cause in-hospital, 30-day, and 365-day mortality in CS patients. First, the NPAR was analyzed as a continuous variable using restricted cubic spline Cox regression models. Second, X-tile analysis was used to calculate the optimal cut-off values for the NPAR and divide the cohort into three NPAR groups. Moreover, multivariable Cox regression analyses were used to assess the association of the NPAR groups with mortality. Results. A total of 891 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between the NPAR and in-hospital and 30-day mortality was observed (all P values for nonlinear trend<0.001). According to the optimal cut-off values by X-tile, NPARs were divided into three groups: group I ( NPAR < 25.3 ), group II ( 25.3 ≤ NPAR < 34.8 ), and group III ( 34.8 ≤ NPAR ). Multivariable Cox analysis showed that higher NPAR was independently associated with increased risk of in-hospital mortality (group III vs. group I: hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.72-3.92, P < 0.001 ), 30-day mortality (group III vs. group I: HR 2.42, 95% CI 1.65-3.54, P < 0.001 ), and 365-day mortality (group III vs. group I: HR 6.80, 95% CI 4.10-11.26, P < 0.001 ) in patients with CS. Conclusions. Admission NPAR was independently associated with in-hospital, 30-day, and 365-day mortality in critically ill patients with CS.

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“…A meta-analysis has shown that about 80.4% of COVID-19 patients with abnormal liver function had hypoalbuminemia, associated with a poor prognosis and outcome [ 23 ]. Moreover, hypoalbuminemia has also been associated with the severity of acute respiratory distress syndrome [ 24 ] and acute kidney injury [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal involvement in COVID-19 patients: a retrospective study from a Greek COVID-19 referral hospital

Tsibouris¹,

Ekmektzoglou

Agorogianni

et al. 2020

aog

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Background Much attention has been paid to the study and reporting of gastrointestinal (GI) symptoms in COVID-19 patients. Moreover, an increasing number of COVID-19 patients have been noted to experience hepatic and pancreatic injury. In this study, we retrospectively investigated symptoms and laboratory findings related to the GI system in a single center in Athens, Greece, and assessed the role of these parameters in relation to survival and disease severity. Method We retrospectively studied 61 adult COVID-19 patients admitted to the Army Share Fund Hospital (NIMTS) in Athens, Greece, from April 6th to May 6 th , 2020. Results Sixty-one COVID-19 cases were assessed in the study period. Regarding both survival and disease severity, diarrhea was the most common finding. The multivariate analysis revealed that elevated serum aspartate aminotransferase levels and low serum albumin levels were associated with worse patient survival (odds ratio [OR] 1.029, 95% confidence interval [CI] 1.007-1.05, P=0.0088; and OR 0.219, 95%CI 0.066-0.723, P=0.0127, respectively). As far as disease severity is concerned, only a low serum albumin level (measured at hospital admission) was correlated with more severe disease (OR 0.025, 95%CI 0.004-0.161, P=0.0001). Conclusions Outpatients with new-onset GI symptoms should be considered for COVID-19 testing in a high COVID-19 prevalence setting, as these symptoms are observed more and more in clinical settings. As prospective studies begin to emerge, clinicians will have more robust research data to diagnose COVID-19 patients earlier and identify patients in need of more intensive treatment.

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The Neutrophil Percentage-to-Albumin Ratio Is Associated with All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury

Cited by 34 publications

References 40 publications

Hypoalbuminemia predicts the outcome of COVID‐19 independent of age and co‐morbidity

Hypoalbuminemia predicts the outcome of COVID‐19 independent of age and co‐morbidity

The Neutrophil Percentage-to-Albumin Ratio as a New Predictor of All-Cause Mortality in Patients with Cardiogenic Shock

Gastrointestinal involvement in COVID-19 patients: a retrospective study from a Greek COVID-19 referral hospital

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