{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T23:02:47Z","timestamp":1768258967665,"version":"3.49.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013151","name":"Scientific Research Foundation for Returned Scholars of Ministry of Education","doi-asserted-by":"publisher","award":["BYSYLXHG2019007"],"award-info":[{"award-number":["BYSYLXHG2019007"]}],"id":[{"id":"10.13039\/501100013151","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Few reports used acute kidney injury concept in the area of toxic kidney damage, especially in highland areas. Recent evidence suggests that the fibrinogen-to-albumin ratio is significantly associated with the incidence and severity of acute kidney injury, highlighting its potential clinical utility for risk stratification and prognostication in high-risk populations. We investigated the clinical characteristics and risk factors of toxic kidney injury in highland areas using the acute kidney injury criteria defined by the kidney disease improving global outcomes work group, with focus on the significance of the fibrinogen- to- albumin ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data of poisoned patients who had electronic inpatient medical records during the past ten years were retrospectively analyzed, and risk factors affecting renal function were investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixty-five inpatients fulfill the criteria with the median age of 36.7 years old, including 40 females (61.5%). Thirty-four patients (52.3%) underwent blood purification, mainly hemoperfusion (n\u2009=\u200933). Medicine poisoning accounts for 53.8% (n\u2009=\u200935), including antipsychotic sedatives (n\u2009=\u200914) and Tibetan medicine (n\u2009=\u20099). Pesticide poisoning ranks the second (27.7%, n\u2009=\u200918). And the last was toxic substances eaten as food (n\u2009=\u200912). Among them, 39 cases (60.0%) were attributed to intentional self-poisoning. Multivariate linear regression analysis revealed that the serum creatinine concentration was positively related to the fibrinogen-to-albumin ratio, and to the concentrations of uric acid and serum phosphate: The reciprocal of the highest serum creatinine concentration (\u00b5mol\/L) = 0.032\u20130.002 * uric acid concentration (\u00b5mol\/L)\/ 100 - 0.005 * serum phosphate concentration (mmol\/L) \u22120.078 * the fibrinogen-to-albumin ratio\u2009+\u2009\u03b5. The study demonstrated a dose-dependent association between elevated fibrinogen-to-albumin ratio and increased serum creatinine levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The public needs to be well informed to minimize the chance of exposure to excessive medicine, wild vegetables, toxic mushrooms, and pesticides. Traditional Tibetan medicine, unique to this plateau region, requires professional guidance for its identification, processing, and dosage. Mental well-being in plateau areas must be prioritized, and regulatory oversight of pesticides and antipsychotic sedatives need to be strengthened to mitigate the risks of overdose and toxic exposure. The serum creatinine concentration in poisoned patients in plateau regions may be affected by the fibrinogen-to-albumin ratio. Therapy against microinflammation, higher uric acid and phosphate levels may prevent further kidney injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0330776","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T18:32:11Z","timestamp":1768242731000},"page":"e0330776","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Higher fibrinogen-to-albumin ratio is associated with the severity of toxin associated acute kidney injury in high-altitude (3650 m) population: A retrospective analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6348-7747","authenticated-orcid":true,"given":"Wenling","family":"Yang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lixia","family":"Cui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"A","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianbin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quzhen","family":"Suolang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luobu","family":"Ciren","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"pone.0330776.ref001","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1159\/000517699","article-title":"Toxin-Related Acute Kidney Injury","volume":"199","author":"P Albuquerque","year":"2021","journal-title":"Contrib Nephrol"},{"issue":"4","key":"pone.0330776.ref002","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.wem.2021.09.002","article-title":"Nephrotoxic mushroom poisoning: Global epidemiology, clinical manifestations, and management","volume":"32","author":"JH Diaz","year":"2021","journal-title":"Wilderness Environ Med"},{"issue":"15","key":"pone.0330776.ref003","first-page":"2742","article-title":"Analysis of poisonous mushroom poisoning events in Guizhou, 2016-2020","volume":"48","author":"S Zhu","year":"2021","journal-title":"Modern Prevent Med"},{"issue":"1","key":"pone.0330776.ref004","first-page":"80","article-title":"Epidemiological analysis of patients with acute paraquat poisoning in China from 2008 to 2018","volume":"43","author":"WY Duan","year":"2022","journal-title":"J Hebei Med University"},{"issue":"8","key":"pone.0330776.ref005","first-page":"717","article-title":"Chinese clinical expert consensus for the diagnosis and treatment of mushroom poisoning","volume":"20","author":"ZQ Lu","year":"2019","journal-title":"J Clin Emergency"},{"issue":"9","key":"pone.0330776.ref006","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1080\/15563650.2021.1928161","article-title":"Relationship between acute kidney injury and mortality in poisoning - a systematic review and metanalysis","volume":"59","author":"D Vodovar","year":"2021","journal-title":"Clin Toxicol (Phila)"},{"issue":"1","key":"pone.0330776.ref007","first-page":"19","article-title":"Analysis of prognostic factors of acute glyphosate poisoning","volume":"23","author":"Q Han","year":"2022","journal-title":"J Clin Emerg"},{"key":"pone.0330776.ref008","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. 2012;2(1):1\u2013138."},{"key":"pone.0330776.ref009","doi-asserted-by":"crossref","first-page":"9833509","DOI":"10.1155\/2022\/9833509","article-title":"Fibrinogen-to-albumin ratio predicts postcontrast acute kidney injury in patients with Non-ST elevation acute coronary syndrome after implantation of drug-eluting stents","volume":"2022","author":"Y Qiao","year":"2022","journal-title":"J Renin Angiotensin Aldosterone Syst"},{"issue":"1","key":"pone.0330776.ref010","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12959-024-00643-2","article-title":"Cerebral venous thrombosis at high altitude: More severe symptoms and specific predisposing factors than plain areas","volume":"22","author":"Y Sha","year":"2024","journal-title":"Thromb J"},{"issue":"1","key":"pone.0330776.ref011","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1080\/16078454.2021.1946265","article-title":"Effects of long-term high-altitude exposure on fibrinolytic system","volume":"26","author":"P Jiang","year":"2021","journal-title":"Hematology"},{"issue":"4","key":"pone.0330776.ref012","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/s13105-022-00912-6","article-title":"Hypoxia: Molecular pathophysiological mechanisms in human diseases","volume":"78","author":"Y Della Rocca","year":"2022","journal-title":"J Physiol Biochem"},{"key":"pone.0330776.ref013","doi-asserted-by":"crossref","first-page":"4557","DOI":"10.2147\/DMSO.S337986","article-title":"Fibrinogen to albumin ratio as an independent risk factor for type 2 diabetic kidney disease","volume":"14","author":"K Wang","year":"2021","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"6","key":"pone.0330776.ref014","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1182\/blood-2018-07-818211","article-title":"The multifaceted role of fibrinogen in tissue injury and inflammation","volume":"133","author":"JP Luyendyk","year":"2019","journal-title":"Blood"},{"key":"pone.0330776.ref015","doi-asserted-by":"crossref","first-page":"757738","DOI":"10.3389\/fcvm.2021.757738","article-title":"Comparative risk of incident coronary heart disease across chronic inflammatory diseases","volume":"8","author":"A Sinha","year":"2021","journal-title":"Front Cardiovasc Med"},{"issue":"5","key":"pone.0330776.ref016","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1080\/10408363.2021.1879000","article-title":"Current concepts and advances in biomarkers of acute kidney injury","volume":"58","author":"Y Wen","year":"2021","journal-title":"Crit Rev Clin Lab Sci"},{"issue":"1","key":"pone.0330776.ref017","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1186\/s13054-022-04223-6","article-title":"Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: A systematic review and meta-analysis","volume":"26","author":"H-C Pan","year":"2022","journal-title":"Crit Care"},{"key":"pone.0330776.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.toxlet.2016.06.001","article-title":"Mechanism-specific injury biomarkers predict nephrotoxicity early following glyphosate surfactant herbicide (GPSH) poisoning","volume":"258","author":"F Mohamed","year":"2016","journal-title":"Toxicol Lett"},{"issue":"3","key":"pone.0330776.ref019","doi-asserted-by":"crossref","first-page":"136","DOI":"10.22141\/2307-1257.12.3.2023.416","article-title":"Correlation of urinary neutrophil gelatinase-associated lipocalin levels as an early diagnostic marker for acute kidney injury in patients with sepsis","volume":"12","author":"SY Kadari","year":"2023","journal-title":"KIDNEYS"},{"issue":"2","key":"pone.0330776.ref020","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1177\/1076029617729216","article-title":"Biomarkers of endothelial, renal, and platelet dysfunction in stage 5 chronic kidney disease hemodialysis patients with heart failure","volume":"24","author":"R McMillan","year":"2018","journal-title":"Clin Appl Thromb Hemost"},{"key":"pone.0330776.ref021","article-title":"Fibrinogen\/Albumin ratio: A more powerful prognostic index for patients with end-stage renal disease","author":"Y Zou","year":"2020","journal-title":"Eur J Clin Invest"},{"issue":"1","key":"pone.0330776.ref022","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s11255-022-03297-z","article-title":"Neutrophil-to-lymphocyte ratio-a new diagnostic and prognostic marker of acute kidney injury. Barriers to broad clinical application","volume":"55","author":"H Schiffl","year":"2023","journal-title":"Int Urol Nephrol"},{"issue":"10","key":"pone.0330776.ref023","first-page":"916","article-title":"Value of neutrophil to lymphocyte ratio in diagnosis of acute renal injury after organophosphorus pesticide poisoning","volume":"36","author":"J Li","year":"2019","journal-title":"J Environ Occup Med"},{"key":"pone.0330776.ref024","doi-asserted-by":"crossref","first-page":"109778","DOI":"10.1016\/j.intimp.2023.109778","article-title":"Neutrophil-to-Lymphocyte ratio as a prognostic marker of mortality and disease severity in septic Acute kidney injury Patients: A retrospective study","volume":"116","author":"W Wei","year":"2023","journal-title":"Int Immunopharmacol"},{"issue":"4","key":"pone.0330776.ref025","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1007\/s00268-022-06878-2","article-title":"Association of preoperative neutrophil-to-lymphocyte ratio with postoperative acute kidney injury and mortality following major noncardiac surgeries","volume":"47","author":"J Wang","year":"2023","journal-title":"World J Surg"},{"key":"pone.0330776.ref026","doi-asserted-by":"crossref","first-page":"1159089","DOI":"10.3389\/fimmu.2023.1159089","article-title":"Preoperative inflammatory markers predict postoperative clinical outcomes in patients undergoing heart valve surgery: A large-sample retrospective study","volume":"14","author":"H Tian","year":"2023","journal-title":"Front Immunol"},{"issue":"2","key":"pone.0330776.ref027","doi-asserted-by":"crossref","first-page":"2258983","DOI":"10.1080\/0886022X.2023.2258983","article-title":"Correlation between neutrophil-to-lymphocyte ratio and contrast-induced acute kidney injury and the establishment of machine-learning-based predictive models","volume":"45","author":"F Zhou","year":"2023","journal-title":"Ren Fail"},{"issue":"4","key":"pone.0330776.ref028","first-page":"55","article-title":"Neutrophil-to-lymphocyte ratio predicts long-term all-cause mortality in patients with chronic kidney disease stage 5","volume":"59","author":"K Woziwodzka","year":"2019","journal-title":"Folia Med Cracov"},{"issue":"1","key":"pone.0330776.ref029","doi-asserted-by":"crossref","first-page":"70","DOI":"10.3109\/0886022X.2015.1104990","article-title":"Neutrophil-lymphocyte ratio predicts cardiovascular and all-cause mortality in hemodialysis patients","volume":"38","author":"BL Neuen","year":"2016","journal-title":"Ren Fail"},{"issue":"3","key":"pone.0330776.ref030","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1007\/s40620-021-01162-3","article-title":"Neutrophil-to-lymphocyte ratio is a marker for acute kidney injury progression and mortality in critically ill populations: A population-based, multi-institutional study","volume":"35","author":"J-J Chen","year":"2022","journal-title":"J Nephrol"},{"issue":"1","key":"pone.0330776.ref031","doi-asserted-by":"crossref","first-page":"15438","DOI":"10.1038\/s41598-022-19772-7","article-title":"The neutrophil to lymphocyte ratio and serum albumin as predictors of acute kidney injury after coronary artery bypass grafting","volume":"12","author":"M Ishikawa","year":"2022","journal-title":"Sci Rep"},{"issue":"5","key":"pone.0330776.ref032","first-page":"56","article-title":"Analysis of 102 cases with kidney injury caused by acute organophosphorus pesticide poisoning","author":"DX Zheng","year":"2005","journal-title":"FJ Medical J"},{"issue":"2","key":"pone.0330776.ref033","doi-asserted-by":"crossref","first-page":"184","DOI":"10.3390\/toxics11020184","article-title":"Multi-omics analyses reveal the mechanisms of early stage kidney toxicity by diquat","volume":"11","author":"H Zhang","year":"2023","journal-title":"Toxics"},{"issue":"2","key":"pone.0330776.ref034","doi-asserted-by":"crossref","first-page":"2283590","DOI":"10.1080\/0886022X.2023.2283590","article-title":"Clinical and pathological characteristics of diquat poisoning-related acute kidney injury","volume":"45","author":"Z Xia","year":"2023","journal-title":"Ren Fail"},{"issue":"9","key":"pone.0330776.ref035","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1080\/15563650.2023.2262113","article-title":"Clinical and pathological characteristics of acute kidney injury caused by diquat poisoning","volume":"61","author":"D-H Zeng","year":"2023","journal-title":"Clin Toxicol (Phila)"},{"issue":"10","key":"pone.0330776.ref036","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1080\/15563650.2023.2268981","article-title":"2022 Annual Report of the National Poison Data System\u00ae (NPDS) from America\u2019s Poison Centers\u00ae: 40th Annual Report","volume":"61","author":"DD Gummin","year":"2023","journal-title":"Clin Toxicol (Phila)"},{"issue":"1","key":"pone.0330776.ref037","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1038\/s41572-024-00526-w","article-title":"Altitude illnesses","volume":"10","author":"H Gatterer","year":"2024","journal-title":"Nat Rev Dis Primers"},{"issue":"4","key":"pone.0330776.ref038","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-051777","article-title":"Chronic high-altitude exposure and the epidemiology of ischaemic stroke: A systematic review","volume":"12","author":"E Ortiz-Prado","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0330776.ref039","doi-asserted-by":"crossref","first-page":"110078","DOI":"10.1016\/j.abb.2024.110078","article-title":"Intermittent high altitude hypoxia induced liver and kidney injury leading to hyperuricemia","volume":"758","author":"L Pu","year":"2024","journal-title":"Arch Biochem Biophys"},{"key":"pone.0330776.ref040","doi-asserted-by":"crossref","first-page":"110331","DOI":"10.1016\/j.pnpbp.2021.110331","article-title":"Evaluation of the effects of altitude on biological signatures of inflammation and anxiety- and depressive-like behavioral responses","volume":"111","author":"KT Nguyen","year":"2021","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330776","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T18:32:18Z","timestamp":1768242738000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330776"}},"subtitle":[],"editor":[{"given":"Shivkumar","family":"Gopalakrishnan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0330776","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]}}}