U-Shape Relationship of White Blood Cells with Acute Kidney Injury and Mortality in Critically Ill Patients

Abstract

Low or high counts of white blood cells (WBCs) and WBC subtypes can be a predictor of morbidity and mortality in several clinical settings. However, the correlations of WBC and its subtypes with acute kidney injury (AKI) and mortality remain unresolved in critically ill patients. The counts of WBC and subtypes, such as neutrophil, lymphocyte, monocyte, and eosinophil, were measured in 2,079 patients admitted to the intensive care unit (ICU) from June 2004 through June 2010. The non-linear relationship between WBC counts and AKI risk was initially explored by a restricted cubic spline analysis. The odds ratios (ORs) for AKI and 1-year mortality were calculated after adjustment for multiple covariates. The relationship between WBC counts and AKI risk was U-shaped. Accordingly, we divided patients into quintiles according to the counts of WBC or subtypes. The 1 st and 5 th quintiles of WBC counts had greater ORs for AKI (1.42 and 2.05, respectively) and mortality (1.40 and 1.36, respectively) compared with the 3 rd quintile. After stratification by WBC subtype, the 5 th quintile of neutrophil counts and the 1 st quintiles of lymphocyte and monocyte counts tended to have higher ORs for AKI (1.69, 1.40, and 1.77, respectively). For mortality, the 1 st quintiles of neutrophil, lymphocyte, and eosinophil counts were associated with higher mortality compared with the 3 rd quintile (the ORs were 1.48, 1.57, and 1.42, respectively). Both leukopenia and leukocytosis are associated with AKI and mortality risk in critically ill patients. This result may be attributable to the change in the subtype counts.

Value of Neutrophil Counts in Predicting Surgery-Related Acute Kidney Injury and the Interaction of These Counts With Diabetes in Chronic Kidney Disease Patients With Hypertension

“…The presence of neutrophils has proven to be a predictor of morbidity and mortality in several clinical settings. 15 However, few studies have determined the correlation between neutrophil counts and AKI, and the linear relationship observed between neutrophil counts and AKI is consistent with a previous report, 28 which found a U-shaped relationship between white blood cells (WBCs) and AKI in critically ill patients. When these authors analyzed the relationships between subtypes of WBCs and AKI, the adjusted ORs associated with a quartile increase in neutrophils (and no other WBC subtype) were 0.99 (95% CI, 0.71–1.40), 0.83 (95% CI, 0.59–1.16), 1 (Reference), 1.23 (95% CI, 0.87–1.75), and 1.69 (95% CI, 1.41–2.51).…”

Are Pre and Postoperative Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG?

“…Several inflammatory biomarkers including white blood cell (WBC) count, leukocyte subtypes, platelet, CRP, NLR and PLR have been demonstrated to be important prognostic predictors in various cardiovascular diseases [ 14 ] . Each WBC subtype, including neutrophils, lymphocytes, monocytes, and eosinophils, has a discrete role in inflammation, host defense, and repair [ 15 ] . Each of these components are one of the immunologic factors that play a pivotal role in most processes of organ damage and this role can apply to the issue of kidney damage [ 16 ] .…”

Frailty as a Predictor of Acute Kidney Injury in Hospitalized Elderly Patients: A Single Center, Retrospective Cohort Study

“…First, frail patients and patients with AKI had similar characteristics including high WBC and low body mass index, hemoglobin, and albumin levels (Tables 1 and 2 ). Previous studies reported that a high WBC/body mass index is associated with AKI in critically ill patients[ 23 , 24 ]. Hypoalbuminemia and anemia were also reported to be independently associated with AKI[ 25 , 26 ].…”