Combined Prognostic Nutritional Index and Neutrophil to Lymphocyte Ratio as Predictors of Acute Kidney Injury in Patients with Sepsis

Background Basic inflammatory markers, such as neutrophil/lymphocyte ratio (NLR), red cell distribution width, and platelet-to-lymphocyte ratio, have been validated to possess long-term prognostic predictive capabilities in sepsis patients. Purpose of the study: The aim of this work was to assess the combined prognostic nutritional index (PNI) and NLR as predictors of acute kidney injury (AKI) in patients with sepsis. Methods This observational cross-sectional study was carried out on 100 patients, aged ≥ 18 years old, both sexes, diagnosed with sepsis on their admission. Patients were divided into two groups based on the incidence of AKI: Group 1 (n = 53): Patients without AKI and Group 2 (n = 47): Patients with AKI. Results Procalcitonin was significantly higher in group 2compared to group 1(P = 0.003). NLR was significantly higher in group 2 compared to group 1 (P < 0.001), whereas PNI was significantly lower in group 2 compared to group 1 (P < 0.001). Univariate logistic regression identified NLR, PNI, uric acid, albumin, 48-hour creatinine, and procalcitonin as significant AKI risk factors, while multivariate analysis confirmed NLR, PNI, albumin, and 48-hour creatinine as independent predictors. Creatinine and blood urea nitrogen at 48 hours (cutoffs 1.5 and 34.56 mg/dL) showed excellent predictive performance for AKI, with 97.9% sensitivity and 100% and 92.5% specificity. NLR and PNI (cutoffs 6.52 and 35.7) was significantly predicted AKI with sensitivities of 95.7% and 98.1% and specificities of 86.9% and 70.2%, respectively (P < 0.001). Conclusions Both NLR and the PNI are significant and independent predictors of AKI in patients with sepsis. Higher NLR and lower PNI values were strongly associated with the development of AKI.