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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.