Neutrophil-to-Lymphocyte Ratio Associates Independently With Mortality in Hospitalized Patients With Cirrhosis

Rice, Jonathan; Dodge, Jennifer L.; Bambha, Kiran; Bajaj, Jasmohan S.; Reddy, K. Rajender; Gralla, Jane; Ganapathy, Dinesh; Mitrani, Robert; Reuter, Bradley; Palecki, Julia; Acharya, Chathur; Shaw, Jawaid; Burton, James R.; Biggins, Scott W.

doi:10.1016/j.cgh.2018.04.045

Cited by 57 publications

(59 citation statements)

References 23 publications

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“…An accumulating body of research has suggested that NLR is a reliable indicator of systemic inflammation. In patients with end‐stage liver disease, with prevalent systemic inflammation associated with poor prognosis, higher NLR is associated with poorer LC prognosis and higher mortality following LT …”

Section: Discussionmentioning

confidence: 99%

“…NLR was first of interest in the area of cancer where presence of systemic inflammation promotes carcinogenesis and the researches have spurred to confirm the NLR as reliable predictor of outcome where inflammation plays a critical role, such as mortality after cardiovascular disease, sepsis and acute coronary syndrome . In the cirrhotic population, increasing NLR correlates with an increased degree of immune dysfunction and has been validated as a significant predictor of LC prognosis, mortality following liver resection or liver transplantation for hepatocellular carcinoma (HCC) . However, the association between preoperative NLR and graft function following LDLT has not been studied.…”

Section: Introductionmentioning

confidence: 99%

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Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Kwon

Moon

Jung

et al. 2019

Liver International

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Background & Aims:Early allograft dysfunction (EAD) is predictive of poor graft and patient survival following living donor liver transplantation (LDLT). Considering the impact of the inflammatory response on graft injury extent following LDLT, we investigated the association between neutrophil-to-lymphocyte ratio (NLR) and EAD, 1year graft failure, and mortality following LDLT, and compared it to C-reactive protein (CRP), procalcitonin, platelet-to-lymphocyte ratio and the Glasgow prognostic score. Methods:A total of 1960 consecutive adult LDLT recipients (1531/429 as development/validation cohort) were retrospectively evaluated. Cut-offs were derived using the area under the receiver operating characteristic curve (AUROC), and multivariable regression and Cox proportional hazard analyses were performed.Results: The risk of EAD increased proportionally with increasing NLR, and the NLR AUROC was 0.73, similar to CRP and procalcitonin and higher than the rest. NLR ≥ 2.85 (best cut-off) showed a significantly higher EAD occurrence (20.5% vs 5.8%, P < 0.001), higher 1-year graft failure (8.2% vs 4.9%, log-rank P = 0.009) and higher 1-year mortality (7% vs 4.5%, log-rank P = 0.039). NLR ≥ 2.85 was an independent predictor of EAD (odds ratio, 1.89 [1.26-2.84], P = 0.002) after multivariable adjustment, whereas CRP and procalcitonin were not. Increasing NLR was independently associated with higher 1-year graft failure and mortality (both P < 0.001).Consistent results in the validation cohort strengthened the prognostic value of NLR. Conclusions:Preoperative NLR ≥ 2.85 predicted higher risk of EAD, 1-year graft failure and 1-year mortality following LDLT, and NLR was superior to other parameters, suggesting that preoperative NLR may be a practical index for predicting graft function following LDLT. K E Y W O R D S early allograft dysfunction, inflammatory status, living donor liver transplantation, neutrophilto-lymphocyte ratio S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Kwon H-M, Moon Y-J, Jung K-W, et al.Neutrophil-to-lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation. Liver

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Kwon

Moon

Jung

et al. 2019

Liver International

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“…Kalra et al [18] evaluated the prognostic value of NLR in liver-related death in low MELD score patients listed for liver transplantation and found that high NLR was associated with liver-related death and independent of MELD score and cirrhosis stage. In another retrospective study, Rice et al [19] found that increasing NLR was associated with the death of LC patients within 1 year after nonelective hospitalization (HR: 2.17-2.84) and remained significant after adjusting for age, MELD score, hepatocellular carcinoma, and severity of acute-on-chronic liver failure (ACLF).…”

Section: Prognostic Biomarkers Of Survival Ratementioning

confidence: 99%

Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis

Chen

Wan

Wang

et al. 2020

BioMed Research International

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Liver cirrhosis is the terminal stage of most chronic liver conditions, with a high risk of mortality. Careful evaluation of the prognosis of cirrhotic patients and providing precise management are crucial to reduce the risk of mortality. Although the liver biopsy and hepatic venous pressure gradient (HVPG) can efficiently evaluate the prognosis of cirrhotic patients, their application is limited due to the invasion procedures. Child-Pugh score and the model for end-stage liver disease (MELD) score had been widely used in the assessment of cirrhotic prognosis, but the defects of subjective variable application in Child-Pugh score and unsuitability to all phases of liver cirrhosis in MELD score limit their prognostic values. In recent years, continuous efforts have been made to investigate the prognostic value of body fluid biomarkers for cirrhotic patients, and promising results have been reported. Since the collection of fluid specimens is easy, noninvasive, and repeatable, fluid biomarkers can be ideal indicators to predict the prognosis of cirrhosis. Here, we reviewed noninvasive fluid biomarkers in different prognostic functions, including the prediction of survival and complication development.

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“…Kalra et al showed NLR ≥ 4 was closely relevant to increased 90‐day liver‐related death in low MELD (MELD ≤ 20) outpatient subjects waiting for transplantation . Intriguingly, a multicenter study by Rice et al revealed that NLR > 9 was associated with more than three‐fold risk of 90‐day mortality (HR 3.78, 95% CI 1.80‐7.83) compared with the lowest quartile (NLR < 3) . The latter study recruited a unique population, who were predisposed to infection and development of ACLF, representing high mortality.…”

Section: Discussionmentioning

confidence: 99%

“…11 Intriguingly, a multicenter study by Rice et al revealed that NLR > 9 was associated with more than three-fold risk of 90-day mortality (HR 3.78, 95% CI 1.80-7.83) compared with the lowest quartile (NLR < 3). 12 The latter study recruited a unique population, who were predisposed to infection and development of ACLF, representing high mortality. On subgroup analysis, we found that NLR > 8.9 was still associated with increased death risk even in younger and lower MELD cirrhotics, allowing the generalization of NLR as a prognostic surrogate.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of neutrophil‐to‐lymphocyte ratio in cirrhosis: A propensity score matching analysis with a prespecified cut‐point

Deng

Fan

Ran

et al. 2019

Liver International

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Background & Aims An elevated neutrophil‐to‐lymphocyte ratio (NLR) has received attention as a prognostic surrogate across chronic liver diseases. However, an exact threshold has not been fully elucidated. Methods A total number of 589 patients with cirrhosis (LC) were included. The value of NLR was calculated and its optimal cut‐off was initially determined by X‐tile program. Independent predictors of 90‐day mortality were identified with Cox regression model. The Kaplan‐Meier method was used to generate survival curves. To reduce influences of selection bias and possible confounders, a 1:2 propensity score matching (PSM) was performed. Results The X‐tile indicated that the difference in survival was most significant for NLR more than 8.9. Serum NLR > 8.9 was an independent indicator in the entire cohort and PSM subset (HR 4.268, 95% CI 2.211‐8.238, P < .001; HR 4.209, 95% CI 1.448‐12.238, P = .008 respectively). Subgroup analysis showed that NLR > 8.9 was an independent risk factor of 90‐day mortality regardless of age, gender, CTP or MELD score. Conclusions The value of NLR more than 8.9 is a feasible cut‐off across clinical settings among applicable population. The adding of NLR to other conventional predictive systems has the potential to provide incremental value without extra economic cost.

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Neutrophil-to-Lymphocyte Ratio Associates Independently With Mortality in Hospitalized Patients With Cirrhosis

Cited by 57 publications

References 23 publications

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Fluid Biomarkers for Predicting the Prognosis of Liver Cirrhosis

Prognostic impact of neutrophil‐to‐lymphocyte ratio in cirrhosis: A propensity score matching analysis with a prespecified cut‐point

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