Prognostic value of the neutrophil-to-lymphocyte ratio in patients with acute-on-chronic liver failure

Chen, L.; Lou, Yiting; Chen, Y.; Yang, Jiezuan

doi:10.1111/ijcp.12408

Cited by 35 publications

(41 citation statements)

References 31 publications

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“…RDW was found to be an independent marker of short-term and long-term prognosis in intensive care units 10. NLR at admission served as an independent predictor of 3-month mortality rates in patients with acute-on-chronic liver failure 13. Increased pretreatment LMR was associated with a significantly more favourable prognosis in patients with solid tumours 12.…”

Section: Introductionmentioning

confidence: 96%

Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study

Zhao

Lin

et al. 2017

BMJ Open

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ObjectivesInflammation-based prognostic markers (neutrophil–lymphocyte ratio (NLR), prognostic nutritional index (PNI), red cell distribution width (RDW) and lymphocyte–monocyte ratio (LMR)) are associated with overall survival in some diseases. This study assessed their prognostic value in mortality and severity in acute pancreatitis (AP).DesignA retrospective cohort study.SettingPatients with AP were recruited from the emergency department at our hospital.ParticipantsA total of 359 patients with AP (31 non-survivors) were enrolled.Primary and secondary outcome measuresMortality and severity of AP were the primary and secondary outcome measures, respectively. Biochemistry and haematology results of the first test after admission were collected. Independent relationships between severe AP (SAP) and markers were assessed using multivariate logistic regression models. Mortality prediction ability was evaluated using receiver operating characteristic (ROC) curves. Overall survival was evaluated using the Kaplan-Meier method, with differences compared using the log-rank test. Independent relationships between mortality and each predictor were estimated using the Cox proportional hazard models.ResultsCompared with survivors of AP, non-survivors had higher RDW (p<0.001), higher NLR (p<0.001), lower LMR (p<0.001) and lower PNI (p<0.001) at baseline. C reactive protein (CRP; OR=8.251, p<0.001), RDW (OR=2.533, p=0.003) and PNI (OR=7.753, p<0.001) were independently associated with the occurrence of SAP. For predicting mortality, NLR had the largest area under the ROC curve (0.804, p<0.001), with a 16.64 cut-off value, 82.4% sensitivity and 75.6% specificity. RDW was a reliable marker for excluding death owing to its lowest negative likelihood ratio (0.11). NLR (HR=4.726, p=0.004), CRP (HR=3.503, p=0.003), RDW (HR=3.139, p=0.013) and PNI (HR=2.641, p=0.011) were independently associated with mortality of AP.ConclusionsNLR was the most powerful marker of overall survival in this patient series.

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Section: Introductionmentioning

confidence: 96%

Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study

Zhao

Lin

et al. 2017

BMJ Open

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“…Recently several studies have found a high Neutrophil‐to‐Lymphocyte Ratio (NLR) to be indicative of a worse prognosis in a variety of different liver disease contexts: patients on the liver transplant waiting list, those with low MELD scores, hospitalised patients with cirrhosis, patients with acute‐on‐chronic liver failure (ACLF) and patients with decompensated liver disease without ACLF . The prognostic value of NLR in these studies appears additional to standard scores of liver function and to that of total white blood cell count (WCC) alone.…”

Section: Introductionmentioning

confidence: 99%

Baseline neutrophil‐to‐lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis

Forrest

Storey

Sinha³

et al. 2019

Aliment Pharmacol Ther

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Summary Background Treating severe alcoholic hepatitis involves the exposure of patients to corticosteroids for 7 days to assess “response”. Aim To assess the prognostic and therapeutic implications of baseline neutrophil‐to‐lymphocyte ratio (NLR) in patients with severe alcoholic hepatitis. Methods Patients recruited to the STOPAH trial and an independent validation group were analysed retrospectively. Area under the receiver operating curve (AUC) analysis was performed. Kaplan‐Meier analysis was used to assess survival. Log‐rank test and odds ratio (OR) were used for comparative analysis. Results Baseline NLR was available for 789 STOPAH patients. The AUC for NLR was modest for 90‐day outcome (0.660), but was associated with infection, acute kidney injury (AKI) and severity of alcoholic hepatitis. Ninety‐day survival was not affected by prednisolone treatment if NLR < 5 or > 8 but mortality was reduced with prednisolone treatment when the NLR was 5‐8 (21.0% cf. 34.5%; P = 0.012). Prednisolone treatment increased the chance of Lille response if the NLR was ≥ 5 (56.5% cf. 41.1%: P = 0.01; OR 1.86) but increased the risk of day 7 infection (17.3% cf. 7.4%: P = 0.006; OR 2.60) and AKI (20.8% cf. 7.0%: P = 0.008; OR 3.46) if the NLR was > 8. Incorporation of NLR into a modified Glasgow alcoholic hepatitis score (mGAHS) improved the AUC to 0.783 and 0.739 for 28‐day and 90‐day outcome, respectively. Conclusion The NLR is associated with AKI and infection in severe alcoholic hepatitis. The NLR identifies those most likely to benefit from corticosteroids at baseline (NLR 5‐8). The mGAHS has a good predictive value for 28‐ and 90‐day outcomes.

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“…The ability of an organism to reproduce cells becomes weaker with age and with some diseases [6,7], especially those with life-threatening pathologies [8,9]. The decrease in human life span (LS) with age is accompanied by a reduction in lymphocytopoietic activity in organisms, a marked decline in the production of naïve T cells, and an increase in granulocyte numbers [7,10]. As the mitotic phase of renewal in the lymphocytic compartment of PB is a valuable measure of current proliferative capacity, we considered that dividing mitotic activity of the lymphoid cells in PB by the number of circulating CD133 + HSCs (specific reproductive activity, sRA) might provide a more reliable measure of the long-term functional potential for lymphocytopoiesis.…”

Section: Strongly Proliferating Cd133mentioning

confidence: 99%

Lymphocyte Reproductive Activity Normalized to Numbers of Hematopoietic Stem Cells in Blood and Rate of Death in Fatal Diseases

Shoutko¹

2017

IJGG

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Abstract:The numbers of CD133 + and CD31 + lymphocytes and those in the G2-M phases in the total fraction of circulating lymphocytes from patients with fatal liver cirrhosis and advanced lung cancer were investigated by flow cytometry during a long period of conventional treatment with OLT or palliative surgery followed by myelosuppressive chemotherapy. The relationships of specific reproductive activity, sRA (G2-M/CD133 + ), and the number of committed liver α-fetoprotein-positive (AFP + ) cells with the rate of patient deaths, characterized by exponential approximation survival curves for both diseases, were investigated. Subnormal sRA in patients after OLT and excessive sRA in LC patients above a healthy level were associated with higher death rates and lower survival, coinciding with strong immunosuppression caused by anti-rejection and anti-cancer therapies. These findings may be explained by morphogenesis (feeding) activity of circulating lymphocytes targeted toward both normal and malignant tissues rather than in terms of cellular immunity. The sRA changes may be a useful indicator for monitoring the potential for engraftment or tumor growth.

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Prognostic value of the neutrophil-to-lymphocyte ratio in patients with acute-on-chronic liver failure

Abstract: The NLR measured at admission can serve as an independent predictor for 3-month mortality rate in AoCLF patients.

Cited by 35 publications

References 31 publications

Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study

Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study

Baseline neutrophil‐to‐lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis

Lymphocyte Reproductive Activity Normalized to Numbers of Hematopoietic Stem Cells in Blood and Rate of Death in Fatal Diseases

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