Advanced lung cancer inflammation index is associated with mortality in critically ill patients with acute kidney...

Nutritional and inflammatory status are closely associated with outcomes in Acute Kidney Injury (AKI). This study investigated the association between the Advanced Lung cancer Inflammation index (ALI), a composite nutrition-inflammation marker, and short-term mortality in critically ill patients with AKI.

We conducted a retrospective cohort study using the MIMIC-IV database. A total of 1887 adult ICU patients with AKI were included. ALI was calculated as body mass index × serum albumin / neutrophil-to-lymphocyte ratio. The primary outcome was all-cause in-hospital mortality, and the secondary outcome was 90-day mortality. Kaplan-Meier curves, Cox proportional hazards models, restricted cubic spline analysis, and subgroup analyses were performed.

The median age was 68.0-years, and 62.4% of patients were male. In-hospital and 90-day mortality rates were 25.2% and 33.9%, respectively. Patients in the lowest ALI tertile had significantly higher cumulative mortality than those with higher ALI. After full adjustment, higher ln(ALI) was independently associated with lower in-hospital mortality (HR = 0.86; 95% CI 0.79-0.93; p < 0.001) and lower 90-day mortality (HR = 0.81; 95% CI 0.75-0.87; p < 0.001). Restricted cubic spline analysis showed an approximately linear inverse association between ALI and in-hospital mortality.

Lower ALI was associated with higher short-term mortality in critically ill patients with AKI, but this association was substantially attenuated after full adjustment and was largely confined to non-septic AKI. This retrospective single-center analysis supports an association but does not establish clinical utility; prospective multicenter external validation is needed before ALI can be recommended for risk stratification.