{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T23:52:29Z","timestamp":1784850749535,"version":"3.55.0"},"reference-count":57,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020207","name":"Sichuan Provincial Health Commission","doi-asserted-by":"crossref","award":["2025-106"],"award-info":[{"award-number":["2025-106"]}],"id":[{"id":"10.13039\/501100020207","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Key Research and Development Program of China","award":["2023YFC2411800"],"award-info":[{"award-number":["2023YFC2411800"]}]},{"name":"Science and Technology Department of Sichuan Province","award":["2024YFHZ0329"],"award-info":[{"award-number":["2024YFHZ0329"]}]},{"name":"\u201cFrom 0 To 1\u201d Innovation Research Project of Sichuan University","award":["2023SCUH0065"],"award-info":[{"award-number":["2023SCUH0065"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The platelet-to-lymphocyte ratio (PLR), a readily available marker that integrates systemic inflammatory burden and immune competence, has emerged as a cost-effective prognostic biomarker in critical care medicine. Elevated PLR has been linked to adverse outcomes across a spectrum of critical illnesses, yet its utility in predicting prognosis among patients with septic acute kidney injury (AKI) remains undefined. Moreover, little is known about how in-hospital trajectories of PLR influence survival outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This retrospective study employed data from the Medical Information Mart for Intensive Care IV and West China Hospital of Sichuan University. The primary endpoints were 28-day and 90-day all-cause mortality. The association between baseline PLR\/changes in PLR (\u0394PLR) and 28-day and 90-day mortality was investigated by survival analysis and Cox proportional hazards models. \u0394PLR was calculated as PLR at discharge minus PLR at admission. Patients were stratified based on optimal PLR cut-off values determined from the training cohort, and results were validated internally and externally. Predefined subgroup analyses probed for effect modification across key clinical populations, and mediation analysis was conducted to quantify intermediate variables linking PLR\/\u0394PLR dynamics to patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      A total of 1,478 patients were included in the baseline-PLR cohort and 982 in the \u0394PLR cohort. In the training set, an elevated baseline PLR (\u2265335.44) was associated with significantly higher 28-day mortality (26.56%\n                      <jats:italic>vs.<\/jats:italic>\n                      18.66%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.009) and 90-day mortality (46.48%\n                      <jats:italic>vs.<\/jats:italic>\n                      35.61%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.003). These findings were confirmed in both the internal validation cohort and an external cohort, and remained robust after adjustment for demographic, clinical and laboratory confounders. Conversely, lower \u0394PLR also predicted the 28-day (14.81%\n                      <jats:italic>vs.<\/jats:italic>\n                      6.94%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.007; HR = 2.261,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.005) and 90-day mortality (24.07%\n                      <jats:italic>vs.<\/jats:italic>\n                      15.41%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.029; HR = 1.702,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.017), as well as prolonged hospital stay (28.64\n                      <jats:italic>vs.<\/jats:italic>\n                      21.64 days,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.004). The associations between PLR or \u0394PLR and mortality remained robust after adjusting for confounding factors. Subgroup analyses indicated that the prognostic value of PLR was particularly pronounced in non-urinary tract infection patients, and a low baseline PLR conferred a significant survival benefit in male patients. Mediation analysis revealed that changes in white blood cell count (\u0394WBC) mediated 27.99% of the association between \u0394PLR and 28-day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both baseline PLR and its dynamic change during hospitalization may serve as significant predictors of mortality in septic AKI. PLR-based indices could aid in risk stratification and early identification of high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.20522","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T08:32:36Z","timestamp":1767688356000},"page":"e20522","source":"Crossref","is-referenced-by-count":1,"title":["Platelet-lymphocyte ratio and its dynamic changes predict mortality in septic acute kidney injury patients: a retrospective multi-center study using U.S. database and Chinese hospital data"],"prefix":"10.7717","volume":"14","author":[{"given":"Caihong","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University,  Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, West China Hospital of Sichuan University\/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University,  Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongxiu","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University,  Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingjing","family":"Guan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University,  Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinglei","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University,  Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binyu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University,  Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Kidney Diseases, West China Hospital of Sichuan University,  Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Institute of Kidney Diseases, West China Hospital of 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