The Gender Associations of Neutrophil Lymphocyte Ratio in Acute Kidney Injury and Chronic Kidney Disease

Abstract

Introduction: The neutrophil lymphocyte ratio (NLR) is a cheap and readily available tool that is becoming increasingly recognized as a marker of pan-systemic inflammation. Gender differences have been identified in various inflammatory responses and play significant roles in the etiopathologic, epidemiological, clinical and prognostic profile of most disease entities. We assess gender association with the NLR. Methods: One hundred and eighty eight participants (44 with acute kidney injury and I44 with chronic kidney disease were studied. Data on socio-demographics, clinical and laboratory findings such as NLR, serum electrolytes, albumin, uric acid and urine albumin creatinine ratio (UACR) were documented and gender associations of participants’ variables were determined. Results: The NLR was higher in CKD than AKI, P=0.04, higher in females, P<0.001 and aged, P<0.001. The NLR was positively related to the platelet-lymphocyte ratio (PLR), albumin creatinine ratio, P=0.01 and the severity of the inflammatory condition. The men had higher serum albumin, creatinine, uric acid and UACR. The uric acid was higher in AKI than in CKD, P=0.04. The systolic blood pressure was higher in AKI than CKD, P<0.001. The serum bicarbonate was lower in AKI than CKD, P=0.04. In the elderly population, the proportion of females was more, P<0.001. Female gender (OR-3.22, 95% CI-1.88-3.78), aging (OR-6.20, CI-3.17-9.58), smoking (OR-5.86, CI-4.52-8.95), elevated systolic blood pressure (OR-3.75, 95% CI-1.83-4.03) and elevated serum creatinine (OR-5.73, 95% CI-1.65-5.89) independently predicted elevated NLR. Conclusion: The NLR is a readily available and cheap tool that was positively correlated with the age, BMI, blood pressure and inflammatory markers such as serum uric acid and UACR. It was higher in CKD than AKI, and in females. Being positively related to other inflammatory markers, it can be used in assessing the severity, prognosticating and perhaps predicting the outcome of inflammatory conditions.