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Neutrophil, lymphocyte and platelet ratio as an early predictor of delayed graft function in kidney transplant patients
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Introdução: O desenvolvimento de função tardia do enxerto (FTE) está associado a piores outcomes a curto e longo prazo após transplante renal. A inflamação tem um papel chave no desenvolvimento de FTE. O rácio neutrófilos, linfócitos e plaquetas (NLP) constitui um biomarcador de inflamação sistémica de baixo custo e pode ser facilmente calculado a partir de um hemograma completo. Esperámos avaliar se o rácio NLP poderia ser usado como um preditor precoce de FTE após transplante renal.
Métodos: Realizámos um estudo retrospetivo de uma coorte de pacientes adultos submetidos a transplante renal no Centro Hospitalar Universitário Lisboa Norte, entre 1 de janeiro de 2010 e 31 de dezembro de 2020. O rácio NLP foi calculado às 24h após o transplante. O outcome primário foi o desenvolvimento de FTE. A regressão logística foi calculada para determinar fatores significativos que pudessem contribuir para FTE.
Resultados: Incluímos 527 pacientes, dos quais 17.8% desenvolveram FTE. O uso de imunoglobulina anti-linfócitos T derivada de coelhos foi semelhante entre os grupos e não se associou ao desenvolvimento de FTE (p=0.078). Enxertos de doadores em paragem cardiocirculatória (OR 13.989, 95% CI 4.741, 41.274, p<0.001), maior tempo de isquémia quente (OR 1.035, 95% CI 1.007, 1.064, p=0.014) e maior rácio NLP 24 horas pós-transplante (OR 1.009, 95% CI 1.002, 1.016, p=0.015) foram preditores independentes de FTE. A creatinina à data da alta (3.3 ± 2.2 versus 1.4 ± 0.5, p<0.001) foi maior em pacientes com FTE.
Conclusão: Na nossa coorte, um rácio NLP mais elevado às 24h pós transplante foi um preditor independente de FTE. Isto reflete o impacto da inflamação nos outcomes de transplante renal e destaca o papel do rácio NLP como um marcador sensível da resposta inflamatória sistémica após transplante renal.
Introduction: The development of delayed graft function (DGF) has been associated with worse short-term and long-term outcomes after kidney transplantation (KT). Inflammation plays a key role in the development of DGF. The neutrophil to lymphocyte and platelet (NLP) ratio constitutes an affordable biomarker of systemic inflammation and can be easily determined from a complete blood cell count. We aimed to assess whether postoperative NLP ratio may be used as an early predictor of DGF in KT patients. Methods: We conducted a retrospective cohort of adult patients submitted to KT at the Centro Hospitalar Universitário Lisboa Norte, between 1 January 2010 and 31 December 2020. NLP was calculated at 24h post-KT. Primary outcome was development of DGF. Logistic regression was calculated to determine significant factors which may have contributed to DGF. Results: We included 527 patients, with DGF occurring in 17.8% of them. Use of rabbit anti-thymocyte immunoglobulin for induction therapy was similar between groups and was not associated with the development of DGF (p=0.078). Grafts from non-heart- -beating donors (OR 13.989, 95% CI 4.741, 41.274, p<0.001), longer warm ischemia time (OR 1.035, 95% CI 1.007, 1.064, p=0.014) and higher NLP ratio 24 hours after transplantation (OR 1.009, 95% CI 1.002, 1.016, p=0.015) were independent predictors of DGF. Creatinine at discharge (3.3 ± 2.2 versus 1.4 ± 0.5, p<0.001) was higher in patients with DGF. Conclusion: In our cohort, a higher NLP ratio at 24 hours after KT was an independent predictor of DGF. This reflects the impact of inflammation on KT outcomes and highlights the role of the NLP ratio as a sensitive marker of systemic inflammatory response after KT.
Introduction: The development of delayed graft function (DGF) has been associated with worse short-term and long-term outcomes after kidney transplantation (KT). Inflammation plays a key role in the development of DGF. The neutrophil to lymphocyte and platelet (NLP) ratio constitutes an affordable biomarker of systemic inflammation and can be easily determined from a complete blood cell count. We aimed to assess whether postoperative NLP ratio may be used as an early predictor of DGF in KT patients. Methods: We conducted a retrospective cohort of adult patients submitted to KT at the Centro Hospitalar Universitário Lisboa Norte, between 1 January 2010 and 31 December 2020. NLP was calculated at 24h post-KT. Primary outcome was development of DGF. Logistic regression was calculated to determine significant factors which may have contributed to DGF. Results: We included 527 patients, with DGF occurring in 17.8% of them. Use of rabbit anti-thymocyte immunoglobulin for induction therapy was similar between groups and was not associated with the development of DGF (p=0.078). Grafts from non-heart- -beating donors (OR 13.989, 95% CI 4.741, 41.274, p<0.001), longer warm ischemia time (OR 1.035, 95% CI 1.007, 1.064, p=0.014) and higher NLP ratio 24 hours after transplantation (OR 1.009, 95% CI 1.002, 1.016, p=0.015) were independent predictors of DGF. Creatinine at discharge (3.3 ± 2.2 versus 1.4 ± 0.5, p<0.001) was higher in patients with DGF. Conclusion: In our cohort, a higher NLP ratio at 24 hours after KT was an independent predictor of DGF. This reflects the impact of inflammation on KT outcomes and highlights the role of the NLP ratio as a sensitive marker of systemic inflammatory response after KT.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Função tardia do enxerto Transplante renal Linfócitos Neutrófilos Plaquetas Nefrologia