Neutrophil-to-lymphocyte ratio: an accurate method for diagnosing infection in cirrhosis

Magalhães, Rui S.; Magalhães, Joana; Sousa‐Pinto, Bernardo; Gonçalves, Tiago Cúrdia; Rosa, Bruno; Cotter, José

doi:10.1080/00325481.2021.1916258

Cited by 4 publications

(8 citation statements)

References 24 publications

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“…After the exclusion of duplicates and not relevant records, 14 studies were included in the systematic review and meta-analysis [ 14 – 27 ]. Of 14 studies, six studies were on infection with 2786 hospitalized cirrhotic patients, of whom 934 developed infection [ 18 , 20 – 22 , 24 , 26 ]. Others were on SBP with 1573 cirrhotic patients with ascites, of whom 557 developed SBP [ 14 – 17 , 19 , 23 , 25 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 960 records were retrieved in the database search and manual search of the citation list of articles. After the exclusion of duplicates and not relevant records, 14 studies were included in the systematic review and meta-analysis [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Of 14 studies, six studies were on infection with 2786 hospitalized cirrhotic patients, of whom 934 developed infection [18, 20-22, 24, 26].…”

Section: Search and Selection Of Literaturementioning

confidence: 99%

“…e overall study quality ranged from 6 to 8 stars. Fourteen studies were included in our systematic review and meta-analysis [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Seven studies were prospective [15-17, 19, 20, 23, 25] and others were retrospective [14,18,21,22,24,26,27].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Fourteen studies were included in our systematic review and meta-analysis [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Seven studies were prospective [15-17, 19, 20, 23, 25] and others were retrospective [14,18,21,22,24,26,27]. All of them were written in English.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Neutrophil to Lymphocyte Ratio and Spontaneous Bacterial Peritonitis among Cirrhotic Patients: A Systematic Review and Meta-analysis

Seyedi¹,

Nabipoorashrafi²,

Hernandez

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Background. The goal of this systematic review and meta-analysis was analyzing published studies on the role of neutrophil to lymphocyte ratio (NLR) in infection and spatially spontaneous bacterial peritonitis (SBP) among cirrhotic patients. Methods. PubMed, Web of Science, and Scopus were searched until May 24, 2022. The Newcastle–Ottawa scale was used for quality assessment. Results. Of 14 studies included in our study, six studies were on infection with 2786 hospitalized cirrhotic patients, of whom 934 developed an infection. Other studies were on SBP with 1573 cirrhotic patients with ascites, of whom 557 developed SBP. The pooled results showed that there was no difference in NLR levels between hospitalized cirrhotic patients who developed infection compared to those who did not (random-effects model: SMD = 0.63, 95% CI = −0.01–1.27, p = 0.054 ). However, cirrhotic patients with ascites who developed SBP had elevated levels of NLR compared to those who did not (random-effects model: SMD = 1.05, 95% CI = 0.52–1.57, p < 0.001 ). This difference remained significant in prospective studies (SMD = 0.94, 95% CI = 0.51–1.38, p < 0.001 ) but not in retrospective studies (SMD = 1.37, 95% CI = −0.56–3.29, p = 0.165 ), in the subgroup analysis according to the study design. The pooled sensitivity of NLR was 92.07% (95% CI = 74.85%–97.84%) and the pooled specificity was 72.58% (95% CI = 57.72%–83.69%). The pooled positive likelihood ratio, negative likelihood ratio, DOR of NLR were 3.35(95%CI = 2.06–5.46), 0.10 (95%CI = 0.03–0.38), and 30.78 (95%CI = 7.01–135.04), respectively. Conclusion. Our results support NLR to be a valid biomarker that can be readily integrated into clinical settings to help in the prevention and prediction of SBP among cirrhotic patients.

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Section: Resultsmentioning

confidence: 99%

Section: Search and Selection Of Literaturementioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Neutrophil to Lymphocyte Ratio and Spontaneous Bacterial Peritonitis among Cirrhotic Patients: A Systematic Review and Meta-analysis

Seyedi¹,

Nabipoorashrafi²,

Hernandez

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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“…So far, although NLR has been studied in cirrhosis ( Cai et al, 2017 ; Bernsmeier et al, 2020 ; Liu et al, 2021 ; Magalhães et al, 2021 ) but never after LT, further phenotyping of additional cell subsets (either neutrophils or lymphocytes) has never been conducted, especially over the pre/post-transplantation period. Explorations in the field may address the unmet clinical need in early recognition of infectious risk in cirrhotic and LT patients.…”

Section: Introductionmentioning

confidence: 99%

Assessment of neutrophil subsets and immune checkpoint inhibitor expressions on T lymphocytes in liver transplantation: A preliminary study beyond the neutrophil-lymphocyte ratio

et al. 2023

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Background: Advanced stages of cirrhosis are characterized by the occurrence of progressive immune alterations known as CAID (Cirrhosis Associated Immune Dysfunction). In advanced cirrhosis, liver transplantation (LT) remains the only curative treatment. Sepsis, shares many similarities with decompensated cirrhosis in terms of immuno-inflammatory response. In both conditions, the neutrophil-lymphocyte ratio (NLR) is associated with poor outcomes. Based on alterations in sepsis, we hypothesized that we could observe in cirrhotic and LT patients more detailed neutrophil and lymphocyte phenotypes. To this end, along with leukocyte count, we assessed immature neutrophils, LOX-1+ MDSC and PD-1 and TIM-3 lymphocyte expressions in cirrhotic patients before transplantation in association with liver disease severity and during the first month after transplantation.Methods: We conducted a prospective monocentric study including cirrhotic patients registered on LT waiting-list. Blood samples were collected at enrolment before LT and for 1 month post-LT. In addition to NLR, we assessed by whole blood flow cytometry the absolute count of immature neutrophils and LOX-1+ MDSC as well as the expressions of immune checkpoint receptors PD-1 and TIM-3 on T lymphocytes.Results: We included 15 healthy volunteers (HV) and 28 patients. LT was performed for 13 patients. Pre-LT patients presented with a higher NLR compared to HV and NLR was associated with cirrhosis severity. Increased immature neutrophils and LOX-1+ MDSC counts were observed in the most severe patients. These alterations were mainly associated with acute decompensation of cirrhosis. PD-1 and TIM-3 expressions on T lymphocytes were not different between patients and HV. Post-LT immune alterations were dominated by a transitory but tremendous increase of NLR and immature neutrophils during the first days post-LT. Then, immune checkpoint receptors and LOX-1+ MDSC tended to be overexpressed by the second week after surgery.Conclusion: The present study showed that NLR, immature neutrophils and LOX-1+ MDSC counts along with T lymphocyte count and checkpoint inhibitor expression were altered in cirrhotic patients before and after LT. These data illustrate the potential interest of immune monitoring of cirrhotic patients in the context of LT in order to better define risk of sepsis. For this purpose, larger cohorts of patients are now necessary in order to move forward a more personalised care of LT patients.

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Mac-2-Binding Protein Glycosylation Isomer to Albumin Ratio Predicts Bacterial Infections in Cirrhotic Patients

Wu,

Hsieh,

Lee

et al. 2024

Dig Dis

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Introduction Mac-2-binding protein glycosylation isomer (M2BPGi) is a novel biomarker for liver fibrosis, but little is known about its role in cirrhosis-associated clinical outcomes. This study aimed to investigate the predictive role of M2BPGi in cirrhosis-associated complications. Methods One hundred and forty-nine cirrhotic patients were retrospectively enrolled. Patients were followed up for one year and cirrhosis-associated clinical events were recorded. Receiver operating characteristic curve (ROC) analysis was used to establish the values of the predictive models for cirrhotic outcomes. and Cox proportional hazards regression models were used to identify predictors of clinical outcomes, Results Sixty (40.3%) patients experienced cirrhosis-associated clinical events and had higher M2BPGi levels compared to those without events (8.7 vs. 5.1 cut-off index, p < 0.001). The most common cirrhosis-associated complications were bacterial infections (24.2%). On ROC analysis, M2BPGi to albumin ratio (M2BPGi/albumin) had comparable discriminant abilities for all cirrhosis-associated events [area under the ROC curve (AUC) = 0.74] compared with M2BPGi, Child-Pugh, Model for End-Stage Liver Disease, Albumin-Bilirubin scores, and neutrophil to lymphocyte ratio and was superior to M2BPGi alone for all bacterial infectious events (AUC = 0.80). Cox regression analysis revealed that the M2BPGi/albumin, but not M2BPGi alone, independently predicted all cirrhosis-associated events [Hazar ratio (HR) = 1.34, p = 0.038] and all bacterial infectious events (HR = 1.51, p = 0.011) within one year. However, M2BPGi/albumin did not predict other cirrhotic complications and transplant free survival. Discussion/Conclusion M2BPGi/albumin might serve as a potential prognostic indicator for patients with cirrhosis, particularly for predicting bacterial infections.

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Neutrophil-to-lymphocyte ratio: an accurate method for diagnosing infection in cirrhosis

Cited by 4 publications

References 24 publications

Neutrophil to Lymphocyte Ratio and Spontaneous Bacterial Peritonitis among Cirrhotic Patients: A Systematic Review and Meta-analysis

Neutrophil to Lymphocyte Ratio and Spontaneous Bacterial Peritonitis among Cirrhotic Patients: A Systematic Review and Meta-analysis

Assessment of neutrophil subsets and immune checkpoint inhibitor expressions on T lymphocytes in liver transplantation: A preliminary study beyond the neutrophil-lymphocyte ratio

Mac-2-Binding Protein Glycosylation Isomer to Albumin Ratio Predicts Bacterial Infections in Cirrhotic Patients

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