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

Janka, Tamás; Tornai, Dávid; Papp, Mária; Vitális, Zsuzsanna

doi:10.3390/diagnostics13182954

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…Previously, COVID-19-related studies showed that NLR was more sensitive than the absolute neutrophil, or lymphocyte count, as a marker of the SI response [20,21] Horvatits et al [22] indicate that elevated NLR is correlated with hepatic lobular injury, hepatic fibrosis, and fatty liver. Also, they concluded that immune dysfunction is connected to the high NLR.…”

Section: Discussionmentioning

confidence: 99%

Hematological ratios in patients with acute decompensation and acute-on-chronic liver failure: prognostic factors

Lashen,

Salem,

Ibrahim

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Background and aims Acute-on-chronic liver failure (ACLF) is the most severe form of acutely decompensated cirrhosis and is characterized by the presence of intense systemic inflammation. Leucocyte quantification can serve as an indirect indicator of systemic inflammation. In our study, we investigated the predictive value of hematological ratios (neutrophils to lymphocytes, monocyte to lymphocytes, platelets to lymphocytes, lymphocytes to C-reactive protein, and neutrophils to lymphocytes and platelets) in acute decompensation (AD) and ACLF patients and their relation to disease severity and early mortality. Patients and methods We included 60 patients with ACLF and AD, and 30 cirrhotic controls. Clinical data were collected, and survival was followed for 1 and 6 months. Blood samples were analyzed at admission for differential leucocytes and assessed for liver and renal function tests. The leukocyte ratios were calculated and compared, and their correlation with liver function indicators and prognosis was assessed. Results All ratios were significantly higher in AD and ACLF patients compared to control (except for lymphocyte to C-reactive protein ratio which was significantly lower), and were positively correlated with Child-Pugh score, model for end-stage liver disease (MELD)-Na, and ACLF severity scores. Multivariate regression revealed that neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and MELD-Na were independent prognostic factors of 1-month and 6-month mortality. A unique prognostic nomogram incorporating MELD-Na, neutrophil to lymphocyte ratio, and monocyte to lymphocyte ratio could be proposed for predicting prognosis in AD and ACLF patients. Conclusions Cheap, easy, and noninvasive hematological ratios are introduced as a tool for early identification and risk stratification of AD and ACLF patients.

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Section: Discussionmentioning

confidence: 99%

Hematological ratios in patients with acute decompensation and acute-on-chronic liver failure: prognostic factors

Lashen,

Salem,

Ibrahim

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Neutrophil to Lymphocyte Ratio Predicts Infections in First Week of Acute Pancreatitis

Kumbhar,

Kurien,

Joseph

et al. 2024

Preprint

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Background Differentiating infections from sterile inflammation is crucial in early AP management. Aim This study aimed to analyse the source, microbiological profile, and impact of infections in AP and to assess the capability of Neutrophil to Lymphocyte Ratio(NLR) and procalcitonin to discriminate between sterile inflammation and infections in the first week of illness. Methods Consecutive patients presenting within 5 days of symptom onset were included. Microbiological profiles and serious adverse events(SAEs:in-hospital mortality or discharge in critical state)were analysed. Blood count obtained at fever onset was used for calculating the NLR. The ability of NLR and procalcitonin to discriminate infection from sterile inflammation in the first week was assessed. Results Of 505 AP patients, 150 developed fevers. 48(32%)had sterile inflammation while 102(68%)had infections. Within infections,44 had infected pancreatic necrosis, 68 had extra-pancreatic infections,and 10 had both.Lower respiratory tract infection was the most common extra-pancreatic infection.Of 54 patients with culture-positive infections, 36(66.7%)had grown multidrug-resistant(MDR) organisms. Fungal isolates were identified in 5 patients. Patients with infections had higher SAE incidence(21.6% vs 4.2%,p = 0.007)than those with sterile inflammation. The SAE incidence was higher with MDR infections than those without MDR(37.5% vs 9.3%,p < 0.01).Most patients(n = 98,65.3%) developed fever during the first week of illness(sterile inflammation(n = 43)& infections(n = 55)).NLR demonstrated good accuracy in discriminating infections from sterile inflammation in the first week(AUROC 0.70,p = 0.001),outperforming procalcitonin(AUROC 0.54,p = 0.58). Conclusions Infections in AP occur early in the course of illness. NLR could serve as a reliable biomarker to distinguish infections from sterile inflammation in the early course of AP,aiding timely management. Patients with MDR infections have higher serious adverse outcomes.

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The Value of Neutrophil-to-Lymphocyte Ratio in Predicting Mortality After Transjugular Intrahepatic Portosystemic Shunt Placement

Tang,

Zhou,

Wang

et al. 2024

JIR

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Background and Aims The objective of this study was to investigate the effect of neutrophil-to-lymphocyte ratio (NLR) on the survival of cirrhotic patients with esophagogastric variceal bleeding (EGVB) treated with transjugular intrahepatic portosystemic shunt (TIPS). Methods A total of 293 patients treated with TIPS were included. The receiver operator characteristic curve (ROC) was used to calculate the optimal cut-off values of parameters such as NLR. The Kaplan-Meier curve and Cox proportional risk model were used to evaluate the effects of NLR and other variables on 2-year all-cause mortality. Results The area under the ROC for NLR was 0.634, with an optimal cutoff value of 4.9. Two-year mortality rates for patients with high (≥4.9) and low (<4.9) NLR were 22.1% and 9.3%, respectively (Log rank test: P = 0.002). After correcting for confounders, multivariate analysis demonstrated that NLR ≥ 4.9 (HR = 2.741, 95% CI 1.467–5.121, P = 0.002), age ≥ 63 (HR = 3.403, 95% CI 1.835–6.310, P < 0.001), and gender (male) (HR = 2.842, 95% CI 1.366–5.912, P = 0.001) were independent risk factors for the mortality outcome. Considering the stratification of early and selective TIPS treatment, high NLR still significantly increased the risk of mortality for patients (Log rank test: P = 0.007, HR = 2.317, 95% CI 1.232–4.356). Conclusion NLR can help to predict survival in EGVB patients after TIPS, and the type of TIPS should also be considered in practical applications.

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

Cited by 3 publications

References 34 publications

Hematological ratios in patients with acute decompensation and acute-on-chronic liver failure: prognostic factors

Hematological ratios in patients with acute decompensation and acute-on-chronic liver failure: prognostic factors

Neutrophil to Lymphocyte Ratio Predicts Infections in First Week of Acute Pancreatitis

The Value of Neutrophil-to-Lymphocyte Ratio in Predicting Mortality After Transjugular Intrahepatic Portosystemic Shunt Placement

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