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Objective <p>To evaluate the predictive value of preoperative monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for acute kidney injury (AKI) after coronary artery bypass grafting (CABG).</p> Methods <p>This retrospective single-center study enrolled 280 patients undergoing CABG at Shanghai East Hospital between January and December 2024. Eligible patients were aged ≥ 18 years, lacked prior chronic kidney disease, and had complete perioperative data. Preoperative MHR was calculated, and postoperative AKI was defined according to KDIGO criteria. Multivariate logistic regression identified independent predictors of AKI, with MHR standardized via Z-score transformation. Predictive performance was assessed using receiver operating characteristic (ROC) curves and 10-fold cross-validation; model calibration was evaluated using binned calibration plots and the Hosmer-Lemeshow test. The optimal MHR cutoff was determined by the Youden index, and patients were stratified accordingly. Postoperative serum creatinine trajectories were compared using linear mixed-effects models with Holm-adjusted pairwise tests.</p> Results <p>AKI occurred in 104 patients (37.1%). Multivariate regression revealed that preoperative MHR (per 1-SD increase: OR = 2.56, 95% CI: 1.77–3.80, <i>p</i> &lt; 0.001), triglycerides (OR = 1.81, 95% CI: 1.23–2.73, <i>p</i> = 0.003), and blood glucose (OR = 1.21, 95% CI: 1.04–1.41, <i>p</i> = 0.015) were independent risk factors for post-CABG AKI. MHR yielded an AUC of 0.743 (95% CI: 0.682–0.804), outperforming triglycerides (AUC = 0.681) and glucose (AUC = 0.626). A combined model incorporating MHR, triglycerides, and glucose achieved a superior AUC of 0.782 (95% CI: 0.726–0.839), which was significantly better than individual predictors (all DeLong <i>p</i> &lt; 0.05). Cross-validation confirmed robust performance (combined model AUC = 0.769), and calibration was excellent (mean absolute error = 0.006; Hosmer-Lemeshow <i>p</i> = 0.8149). Using the optimal cutoff (MHR &gt; 0.658), the high-MHR group exhibited a significantly higher AKI incidence (64.29% vs. 22.53%, <i>p</i> &lt; 0.001) and persistently elevated creatinine levels across all postoperative time points (CrH0–CrH72, all adjusted <i>p</i> ≤ 0.030). Subgroup analyses confirmed consistent associations between MHR and AKI across strata of age, cardiac function, hypertension, and diabetes, with no significant interaction effects.</p> Conclusions <p>Preoperative MHR is a strong independent predictor of post-CABG AKI, with improved performance when combined with triglycerides and blood glucose.</p>

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Predictive value of monocyte-to-high-density lipoprotein cholesterol ratio for acute kidney injury following coronary artery bypass grafting

  • 期刊论文

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  • 发表日期：

    2026年5月26日

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  • Xingping Lv,
  • Chen Li,
  • Tuo Shen,
  • Wei Zhou,
  • Feng Zhu

摘要

Objective

To evaluate the predictive value of preoperative monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for acute kidney injury (AKI) after coronary artery bypass grafting (CABG).

Methods

This retrospective single-center study enrolled 280 patients undergoing CABG at Shanghai East Hospital between January and December 2024. Eligible patients were aged ≥ 18 years, lacked prior chronic kidney disease, and had complete perioperative data. Preoperative MHR was calculated, and postoperative AKI was defined according to KDIGO criteria. Multivariate logistic regression identified independent predictors of AKI, with MHR standardized via Z-score transformation. Predictive performance was assessed using receiver operating characteristic (ROC) curves and 10-fold cross-validation; model calibration was evaluated using binned calibration plots and the Hosmer-Lemeshow test. The optimal MHR cutoff was determined by the Youden index, and patients were stratified accordingly. Postoperative serum creatinine trajectories were compared using linear mixed-effects models with Holm-adjusted pairwise tests.

Results

AKI occurred in 104 patients (37.1%). Multivariate regression revealed that preoperative MHR (per 1-SD increase: OR = 2.56, 95% CI: 1.77–3.80, p < 0.001), triglycerides (OR = 1.81, 95% CI: 1.23–2.73, p = 0.003), and blood glucose (OR = 1.21, 95% CI: 1.04–1.41, p = 0.015) were independent risk factors for post-CABG AKI. MHR yielded an AUC of 0.743 (95% CI: 0.682–0.804), outperforming triglycerides (AUC = 0.681) and glucose (AUC = 0.626). A combined model incorporating MHR, triglycerides, and glucose achieved a superior AUC of 0.782 (95% CI: 0.726–0.839), which was significantly better than individual predictors (all DeLong p < 0.05). Cross-validation confirmed robust performance (combined model AUC = 0.769), and calibration was excellent (mean absolute error = 0.006; Hosmer-Lemeshow p = 0.8149). Using the optimal cutoff (MHR > 0.658), the high-MHR group exhibited a significantly higher AKI incidence (64.29% vs. 22.53%, p < 0.001) and persistently elevated creatinine levels across all postoperative time points (CrH0–CrH72, all adjusted p ≤ 0.030). Subgroup analyses confirmed consistent associations between MHR and AKI across strata of age, cardiac function, hypertension, and diabetes, with no significant interaction effects.

Conclusions

Preoperative MHR is a strong independent predictor of post-CABG AKI, with improved performance when combined with triglycerides and blood glucose.