Neutrophil-Lymphocyte Ratio Predicts Short-Term Mortality in Patients Hospitalized for Acute Decompensation of Cirrhosis

Abstract

BACKGROUND: Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis. OBJECTIVE: Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17). METHODS: In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients. RESULTS: In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour. CONCLUSION: NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.

The Association Between Peripheral Blood Neutrophil-to-Lymphocyte Ratio and Cirrhosis Complications in Adults with Compensated Liver Cirrhosis in Ahvaz, Iran

“…Maccali et al also directly associated the NLR with the MELD score and other markers of disease severity, highlighting this parameter as an important predictor of adverse outcomes and mortality. In that study, the NLR was higher in patients with bacterial infections than those without bacterial infections (4.95 vs. 3.49) (25). In the study by Kwon et al (8), the NLR in liver cirrhosis patients with infections was significantly higher than in those without infections (8.3 vs. 4.9), acting to identify patients at risk of poor outcomes and predict 1-month survival.…”

The Value of Neutrophil-to-Lymphocyte Ratio to Identify Bacterial Infection and Predict Short-Term Mortality in Patients with Acutely Decompensated Cirrhosis

“…First, during the initial stages of infections, the innate immune response dominates the host’s reaction. According to current knowledge, after the activation of pattern recognition molecules, the process follows a very similar pathway regardless of the response being triggered by DAMPs or PAMPs (inducing a similar set of response elements via activation of common, conserved early response pathways) [ 11 , 28 , 36 , 37 ]. The binding of DAMPs and PAMPs to pattern recognition molecules induces the release of inflammatory cytokines, acute-phase proteins, the formation of reactive oxygen and nitrogen species, the induction of antigen-presenting cells and, finally, the initiation of adaptive immune responses.…”

“…In liver cirrhosis, NLR is expected to increase with disease progression, but there are insufficient data [ 10 ]. The value of NLR is influenced by ongoing infection, trauma, hemorrhage, etc., so, within a given Child–Turcotte–Pugh (CTP) stage, NLR is supposed to be higher in the presence of infection and associated with worse survival [ 11 , 12 ].…”

Neutrophils: tissue and circulating signatures of pediatric non-alcoholic fatty liver disease

“…Moreover, Kalra et al proved that high NLR can determine the risk for cirrhotic decompensation, independently of Model for End-Stage Liver Disease (MELD) score and stage of cirrhosis (Kalra et al, 2017). In similar fashion, Maccali et al concluded that the early identification of NLR increase, in the first 48 h of hospitalization, predicts short-term mortality for patients with acute decompensation of liver cirrhosiscaused by various etiologies, including NAFLD (Maccali et al, 2021).…”