ArticleBMC nephrology2025
Platelet-to-hemoglobin ratio as a novel prognostic biomarker in sepsis-associated AKI: a multicenter cohort study.
Article in BMC nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeSepsis-Associated Acute Kidney Injury (SA-AKI) is a major complication in critically ill patients, yet early predictive biomarkers remain limited. Given the interplay between coagulation, inflammation, and microcirculatory dysfunction in SA-AKI pathogenesis. This study aimed to evaluate the association between platelet-to-hemoglobin ratio (PHR) and SA-AKI development in multicenter intensive care unit (ICU) cohorts.
methodsWe extracted patient data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) and electronic Intensive Care Unit (eICU) databases. Based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria, patients were stratified into AKI (n = 4,825) and non-AKI (n = 3,390) cohorts. Multiple statistical approaches—including multivariable logistic regression, propensity score matching (PSM), and inverse probability weighting (IPW)—were employed to adjust for confounders. The primary outcome was SA-AKI incidence.
resultsElevated PHR was consistently associated with increased SA-AKI risk. In the adjusted logistic regression model, PHR remained independently predictive (OR 1.06, 95% CI: 1.05–1.07; P < 0.001). This association was validated through PSM (OR 1.12, 95% CI: 1.11–1.13; P < 0.001) and IPW (OR 1.03, 95% CI: 1.02–1.03; P < 0.001). The incidence of AKI significantly increases when PHR > 20. Generalized additive model (GAM) analysis revealed a linear correlation between PHR > 22 and SA-AKI mortality (P < 0.001), though PHR showed no significant association with AKI severity (P = 0.029). Our study demonstrates that the emerging biomarker PHR alone achieved an AUC of 0.845 for prognostic prediction and 0.584 for diagnostic performance. When combined with SOFA and SAPS-II, the prognostic model (Model 4) significantly improved (AUC = 0.906 and 0.713), outperforming individual components.
conclusionsPHR demonstrates a statistically significant association with SA-AKI risk in our analyses, its modest discriminative capacity highlights its role as a complementary rather than standalone predictor. These findings support further validation of PHR as a pragmatic biomarker to identify high-risk sepsis patients who may benefit from intensified hemodynamic or coagulation monitoring. CLINICAL TRIAL NUMBER: Not applicable.
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