Background Acute organophosphorus pesticide poisoning (AOPP) is common in rural areas where it is difficult to manage medical treatment, and it often causes injury in multiple systems and organs. The kidney is one of the important target organs of the injury. Acute kidney injury (AKI) is a main clinical presentation, but the mechanism between AOPP and AKI is not clear yet, and there remains significant unmet need for specific and sensitive serological markers for AKI diagnosis.
Objective This study explores the clinical value of neutrophil to lymphocyte ratio (NLR) in the diagnosis of AKI caused by AOPP, and provide a basis for clinical intervention, treatment, and evaluation of prognosis.
Methods A total of 56 patients diagnosed with severe AOPP were enrolled in the study from Guanyun People's Hospital from January 2016 to December 2018. According to AKI diagnostic criteria, the participants were divided into AOPP with AKI group and AOPP without AKI group. Blood routine tests were performed after 24 hours of exposure to toxicants, and the value of NLR was calculated. Other serum variables such as acetyl cholinesterase (ChE), serum creatinine (Scr), neutrophil gelatinase-associated lipocalin (NGAL), and cystatin C (Cys-C) were also detected. All the data were analyzed by t test, Spearman correlation analysis, and receiver operating characteristic (ROC) curve.
Results The incidence rate of AKI in patients with severe AOPP was 69.6%. NLR was positively correlated with Scr, NGAL, and Cys-C (r=0.358, 0.450, and 0.340, respectively, all Ps < 0.05), and was higher in the patients with AOPP complicated with AKI (21.78±5.80) than in those without AKI (17.19±3.88) (P < 0.05). The cut-off value of NLR for identifying AKI caused by AOPP was 18.4, with a sensitivity of 84.6% and a specificity of 64.7%. The area under curve (AUC) of NLR was 0.775 (95% CI:0.640-0.912), and not different from the results of Cys-C, NGAL, and Scr (P>0.05).
Conclusion NLR can be used to diagnose AKI in patients with severe AOPP because it has good specificity and sensitivity, and is easy to obtain.
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