The Predictive Role of Systemic Inflammatory Markers in the Development of Acute Kidney Failure and Mortality in Patients with Abdominal Trauma

Abstract

Background: Abdominal trauma is defined as a variety of injuries to the abdominal wall, solid or hollow intra-abdominal organs, and various intra-abdominal vessels. Recently, there has been a significant amount of interest in the establishment of a reliable biomarker that can predict the outcome in patients with an abdominal injury. The purpose of this study is to confirm the predictive role of inflammatory biomarkers and underlying risk factors and the risk of acute kidney insufficiency (AKI) developing and mortality in abdominal trauma patients; Materials and methods: The current study was intended as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a diagnosis of abdominal trauma confirmed through a CT scan admitted to the County Emergency Clinical Hospital of Targu-Mureș, Romania between January 2017, and December 2021; Results: Non-survivor patients had a greater age (p = 0.02), as well as a higher prevalence of ischemic heart disease (IHD) (p = 0.007), history of myocardial infarction (MI) (p = 0.002), peripheral arterial disease (PAD) (p = 0.01), chronic kidney disease (CKD) (p = 0.01), and all risk factors (p = 0.0004 and p < 0.0001). In terms of injured organs, we have in the second group a higher incidence of kidney injury (p = 0.003) and hemoperitoneum (p = 0.008). Multivariate analysis showed a high baseline value for all inflammatory biomarkers that are independent predictors of adverse outcomes for all recruited patients. Furthermore, for all hospitalized patients, the history of MI (p = 0.03; p = 0.001; and p = 0.003), PAD (p = 0.01; p = 0.01; and p = 0.002), obesity (for all p < 0.0001), CKD (p < 0.001; p = 0.01; and p = 0.001), and kidney injury (p = 0.02; p = 0.004; and p = 0.01) were independent predictors of all outcomes. Moreover, IHD (p = 0.008 and p = 0.02), tobacco (p < 0.0001 and p = 0.02), and hemoperitoneum (p = 0.009 and p = 0.01) were predictors of mortality and composite endpoint, but not for AKI risk, as well as atrial fibrillation [AF] (p = 0.04) as predictors of the composite endpoint Conclusions: Higher monocyte to lymphocyte ratio (MLR), platelets to lymphocyte ratio (PLR), systemic inflammatory index (SII), neutrophil to lymphocyte ratios (NLR), aggregate inflammatory systemic index (AISI), and systemic inflammatory response index (SIRI) levels at admission, according to our data, highly predict AKI risk and death.

Keywords: abdominal trauma; acute kidney insufficiency; aggregate inflammatory systemic index; monocyte-to-lymphocyte ratio; neutrophil-to-lymphocyte ratio; platelet-to-lymphocyte ratio; systemic inflammatory index; systemic inflammatory response index.

Figure 1

ROC curve analysis concerning the AKI risk (A) NLR (AUC: 0.777; p < 0.0001), (B) MLR (AUC: 0.744; p < 0.0001), (C) PLR (AUC: 0.751; p < 0.0001), (D) SII (AUC: 0.796; p < 0.0001), (E) SIRI (AUC: 0.790; p < 0.0001), and (F) AISI (AUC: 0.802; p < 0.0001); blue line – ROC curve; green line – diagonal line.

Figure 2

ROC curve analysis concerning the mortality (A) NLR (AUC: 0.870; p < 0.0001), (B) MLR (AUC: 0.800; p < 0.0001), (C) PLR (AUC: 0.865; p < 0.0001), (D) SII (AUC: 0.893; p < 0.0001), (E) SIRI (AUC: 0.846; p < 0.0001), and (F) AISI (AUC: 0.859; p < 0.0001); blue line – ROC curve; green line – diagonal line.

Figure 3

ROC curve analysis concerning the composite endpoint (A) NLR (AUC: 0.835; p < 0.0001), (B) MLR (AUC: 0.817; p < 0.0001), (C) PLR (AUC: 0.841; p < 0.0001), (D) SII (AUC: 0.862; p < 0.0001), (E) SIRI (AUC: 0.855; p < 0.0001), and (F) AISI (AUC: 0.873; p < 0.0001); blue line – ROC curve; green line – diagonal line.