Abstract
Objective
Acute kidney injury is commonly observed in critically ill patients with diabetes and is associated with adverse outcomes. The advanced lung cancer inflammation index score, which reflects nutritional and inflammatory status, has not been well studied in relation to acute kidney injury and subsequent kidney events in this population.
Methods
We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV database. Adult intensive care unit patients with diabetes were included. Associations of log-transformed advanced lung cancer inflammation index scores with acute kidney injury and major adverse kidney events within 30 days were assessed using logistic regression and Cox models, respectively. Restricted cubic spline analyses, eXtreme gradient boosting with SHapley Additive exPlanations interpretation, subgroup analyses, and sensitivity analyses were performed to evaluate model-based contribution, effect modification, and robustness.
Results
In total, 2337 critically ill patients with diabetes were included in the acute kidney injury occurrence analysis, of whom 1624 developed acute kidney injury. Each 1-SD increase in log-transformed advanced lung cancer inflammation scores was associated with lower odds of acute kidney injury (odds ratio, 0.90; 95% confidence interval, 0.81–0.99). Among the 1624 patients with acute kidney injury, 750 developed major adverse kidney events within 30 days. Higher log-transformed advanced lung cancer inflammation index scores were associated with a lower hazard of major adverse kidney events within 30 days (hazard ratio, 0.89; 95% confidence interval, 0.82–0.96). Dose–response analyses revealed a consistent inverse association between the advanced lung cancer inflammation index score and adverse kidney outcomes, particularly major adverse kidney events within 30 days. Machine-learning interpretation supported the contribution of the advanced lung cancer inflammation index score to model output for kidney outcomes, and sensitivity analyses yielded similar results.
Conclusions
Among intensive care unit patients with diabetes, higher advanced lung cancer inflammation index scores were associated with lower odds of acute kidney injury and a lower hazard of major adverse kidney events within 30 days after acute kidney injury. The advanced lung cancer inflammation index score may serve as a simple marker for inflammation and nutritional status associated with short-term kidney outcomes; however, its clinical utility requires validation in independent cohorts.