Keywords: Neutrophil-lymphocyte ratio, Neutrophil-lymphocyte-platelet ratio, Acute kidney injury, Cardiac surgery

Background & objective: Hypoperfusion, ischemia-reperfusion injury, intravascular hemolysis, neurohumoral activation, inflammation, oxidative stress, nephrotoxins, and mechanical factors contribute to the development of Acute Kidney Injury (AKI) following on-pump coronary artery bypass grafting (CABG). Inflammatory biomarkers such as the Neutrophil-Lymphocyte Ratio (NLR) and Neutrophil-Lymphocyte-Platelet Ratio (NLPR) have been proposed as potential markers for postoperative inflammation. Elevated NLR and NLPR values have been associated with AKI and 5-year mortality. This study aims to evaluate whether NLR and NLPR can serve as predictive tools in identifying patients at risk of developing AKI after cardiac surgery.

Methodology: This retrospective analytical study compares the NLR and NLPR with the incidence of AKI in patients post-cardiac surgery in the intensive care unit (ICU) at Adam Malik Hospital, Medan. The study includes all ICU patients who underwent cardiac surgery between January 1, 2023, and December 31, 2023. Data were analyzed using SPSS statistical software.

Results: A significant difference was found in NLR values between the AKI group (16.62±10.2) and the non-AKI group (14.76±12.6), with a p-value of 0.007. The sensitivity was 57%, and specificity was 44%, with a cutoff value of 17.10. Similarly, the NLPR values were significantly different between the AKI group (13.26±8.40) and the non-AKI group (9.9±5.79), with a p-value of 0.013. Sensitivity was 54%, and specificity was 50.8%, with a cutoff value of 18.42.

Conclusions: NLR and NLPR are significantly associated with the occurrence of AKI after cardiac surgery. Both ratios are valuable predictive tools for identifying patients at risk of AKI following surgery.

Abbreviations: ADQI: Acute Dialysis Quality Initiative AKI: Acute Kidney Injury, CABG: Coronary Artery Bypass Grafting, CAD: Coronary Artery Disease, ICU: Intensive Care Unit, NLR: Neutrophil-Lymphocyte Ratio, NLPR: Neutrophil-Lymphocyte-Platelet Ratio,

Keywords: Neutrophil-lymphocyte ratio; Neutrophil-lymphocyte-platelet ratio; Acute kidney injury; Cardiac surgery

Citation: Hutapea DAG, Silaen ELR, Kurniawan H. Comparison of neutrophil-lymphocyte ratio and neutrophil-lymphocyte-platelet ratio in relation to acute kidney injury (AKI) in a cardiac surgery intensive care unit (CICU) patients. Anaesth. pain intensive care 2025;29(4):334-40. DOI: 10.35975/apic.v29i4.2818

Received: April 06, 2025; Revised: May 13, 2024; Accepted: May 25, 2025