Evidence map›Paper›PMID 42774122›Full record

ArticleFrontiers in cardiovascular medicine2026

Perioperative neutrophil-to-lymphocyte ratio trajectories and creatinine-defined acute kidney disease after cardiac surgery: a study using the INSPIRE database.

Feifan Hu, Yefang Qian, Lanxin Hu, Duanqi Zhu, Yuzhi Jiang, Ke Ding, Xinglong Liu, Hongwei Shi, Lihai Chen, Hao Cheng and 1 more

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Article in Frontiers in cardiovascular medicine, 2026. 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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5 · Who and what money

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11 authors.

Feifan Hu *Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Yefang Qian *Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Lanxin HuDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Duanqi ZhuDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Yuzhi JiangDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Ke DingDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Xinglong LiuDepartment of Affective Disorders II, Hebei Provincial Mental Health Center, The Sixth Clinical Medical College of Hebei University, Baoding, China.
Hongwei ShiDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Lihai ChenDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Hao ChengDepartment of Anesthesiology and Pain Medicine, Geriatric Hospital of Nanjing Medical University, Nanjing, China.
Yali GeDepartment of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Acute kidney disease (AKD) encompasses persistent or newly developing renal dysfunction beyond 7 days after surgery. Associations between perioperative neutrophil-to-lymphocyte ratio (NLR) changes and AKD after cardiac surgery remain unclear. We identified NLR trajectories and examined their associations with overall, persistent, and delayed AKD. Methods: This retrospective, hypothesis-generating cohort study used the single-center INSPIRE database. Adults with NLR available in at least four of five perioperative windows were classified using group-based trajectory modeling. The primary outcome was AKD during postoperative days 8-90. Time-to-event, competing-risk, follow-up-weighted, early-AKI-stage, expanded-confounder, and medication-exposure sensitivity analyses were performed. Mortality and postoperative in-hospital hemodialysis/continuous renal replacement therapy (CRRT) records were exploratory secondary outcomes. Results: Of 2,265 patients assigned to a trajectory, 1,975 had day-8-90 creatinine follow-up; 298 developed AKD. Three data-driven trajectories were identified: low-response (T1), intermediate peak-recovery (T2), and high persistent-response (T3). Adjusted odds of overall AKD were higher for T2 vs. T1 (OR: 2.02, 95% CI: 1.35-3.04) and T3 vs. T2 (OR: 1.42, 95% CI: 1.02-1.96), with the clearest gradient for persistent AKD. Kaplan-Meier curves differed for overall and persistent AKD (both log-rank Conclusions: Perioperative NLR trajectories were associated with creatinine-defined AKD after cardiac surgery, most clearly with persistent AKD. Concordant findings for mean perioperative and late postoperative NLR suggest that the magnitude and persistence of NLR elevation were more informative than relative within-patient variability.

Indexed as

acute kidney diseasecardiac surgerygroup-based trajectory modelinginflammationneutrophil-to-lymphocyte ratiopersistent AKD

Identifiers

PMID42774122
PMCPMC13593457

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