Assessing the outcome of patients with liver cirrhosis during hospital stay: A comparison of lymphocyte/monocyte ratio with MELD and Child-Pugh scores

Jamil, Zubia; Durrani, Asghar Aurangzeb

doi:10.5152/tjg.2018.17631

Cited by 12 publications

(25 citation statements)

References 30 publications

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“…These findings show that the lower the LMR is, the higher the PELD/MELD score would be. Our findings were in line with those of Jamil et al [22] and Zheng et al [23]. In addition, by using ROC analysis, the predictive value of these three scores in assessing the survival of cirrhotic patients was evaluated.…”

Section: Discussionsupporting

confidence: 91%

Comparison of lymphocyte-to-monocyte ratio with Child-Pugh and PELD/MELD scores to predict the outcome of children with cirrhosis

Salehi¹,

Dehghani²,

Vardenjani³

et al. 2021

ceh

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Aim of the study: Prognostic scores are highly needed to properly manage children with cirrhosis and improve their clinical outcomes. The relationship between lymphocyte-to-monocyte ratio (LMR) at the time of admission to hospital and outcome of cirrhosis has been studied in adults, but to the best of our knowledge, there is no study regarding its utility as a prognostic marker of poor outcome in children with cirrhosis. Thus, this study aimed to investigate the potential prognostic value of LMR in such patients. Material and methods: At the time of admission, LMR, Child-Pugh, and Pediatric End-stage Liver Disease/Model for End-stage Liver Disease (PELD/MELD) scores were calculated for 114 children with cirrhosis. LMR and PELD/ MELD and Child-Pugh scores were compared between the survivor and non-survivor groups. Receiver operator characteristic (ROC) curve analysis was performed and the cutoff values were calculated using the Youden index. Results: It was found that LMR had a strong negative correlation with PELD/MELD (r = -0.87, p = 0.36) and a weak negative correlation with Child-Pugh scores (r = -0.046, p = 0.63). The highest area under the curve (AUC) was found for LMR (0.861). The AUC was also good for PELD/MELD scores (0.804). The AUC values for LMR in patients under and above 6 years old were 0.675 (95% CI: 0.462-0.888) (p = 0.111) and 0.926 (95% CI: 0.852-1.000) (p < 0.001), respectively. The PELD/MELD scores were significantly higher in the low LMR group than in the high LMR group (p = 0.001). Conclusions: LMR can be used to determine the outcome of cirrhotic children older than 6 years during the hospital stay because it is easy to calculate and its efficacy is comparable to PELD/MELD scores. Meanwhile, further studies are needed to confirm these preliminary results.

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Section: Discussionsupporting

confidence: 91%

Comparison of lymphocyte-to-monocyte ratio with Child-Pugh and PELD/MELD scores to predict the outcome of children with cirrhosis

Salehi¹,

Dehghani²,

Vardenjani³

et al. 2021

ceh

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“…For predicting mortality the cut-off sensitivity and specificity of the MELD score of our study are 20.49, 55.38%, and 93.33%, respectively, while these values are higher in other studies [22]. The cut-off values of sensitivity and specificity of LMR of our study are £1.66, 61.54%, and 76%, respectively whereas in Zhang et al study, it was 2.10%, 82.6%, 78.8%, respectively [22], and in Jamil et al's study, it was £3.31, 80%, and 74.83%, respectively [25].…”

Section: Discussioncontrasting

confidence: 61%

“…In a study by Zhang et al, AUC for MELD score, which was approximately 0.9, and for LMR was 0.8 [22]. In a study by Jamil et al, the AUC of MELD, CPS, and LMR are 0.958, 0.760, and 0.807, respectively [25]. In our study, no significant difference was seen in the AUC of MELD, CPS, LMR, and CLIF SOFA to predict mortality.…”

Section: Discussioncontrasting

confidence: 45%

The Significant Morbidity and Mortality Indicators in Patients of Cirrhosis

Mallik¹,

Singhai²,

Khadanga³

et al. 2022

Cureus

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Background: Cirrhosis progression varies greatly from patient to patient due to a variety of factors, including hepatic reserve, cirrhosis etiology, and the presence of hepatocellular cancer. As a result, determining a prognosis in a patient with cirrhosis remains a difficult task. For nearly three decades, the Child-Pugh score (CPS) has been the gold standard for determining the prognosis of cirrhosis. In the last two decades, many prognostic models and scores like a model for end-stage liver disease (MELD), chronic liver failuresequential organ failure assessment (CLIF-SOFA) score, peripheral blood lymphocyte to monocyte ratio (LMR) have been presented to predict prognosis in patients with cirrhosis and to choose the best therapy option. The aim of our study is to determine which score is more effective in predicting three-month mortality and whether these scores are equally effective in predicting short-term outcomes.Materials & methods: In this hospital-based longitudinal study, we analyzed 140 patients with cirrhosis of liver visiting All India Institute of Medical Sciences Bhopal between July 2019 and July 2020. All the 140 patients were followed up for three months to establish short-term outcomes. The blood investigations were done at the time of presentation from all the patients and after three months in the survivors. Various scores were calculated.Results: The majority of patients (47%) were in Child-Pugh class C. Mean MELD score was 13.54, LMR score was 1.96 and CLIF-SOFA score was 5. The total bilirubin, serum creatinine, international normalized ratio (INR), total leukocyte count, absolute monocyte count, CPS, MELD, CLIF-SOFA were significantly higher in a non-surviving group as compared to the surviving group, whereas the albumin and LMR significantly decreased in the non-surviving group. On performing multivariate regression, LMR and CLIF-SOFA were significant independent risk factors of mortality after adjusting for confounding factors. All the parameters had significant discriminatory power to predict mortality. Discriminatory power of CLIF-SOFA (AUC 0.808; 95% CI: 0.733 to 0.870) was excellent and discriminatory power of CPS (AUC 0.792; 95% CI: 0.716 to 0.856), MELD score (AUC 0.765; 95% CI: 0.685 to 0.832) and LMR (AUC 0.75; 95% CI: 0.669 to 0.819) was acceptable. Among all the parameters, CLIF-SOFA was the best predictor of mortality at a cut-off point of >5 with 80.80% chances of correctly predicting mortality. Conclusion:The significant morbidity and mortality indicators are high total bilirubin, high creatinine, high INR, high TLC, low platelet count, and low albumin. Among the various scores, CLIF-SOFA is a better predictor of mortality and morbidity. Low LMR and high CLIF-SOFA are significant independent risk factors of mortality at three months.

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“…The LMR was also studied in patients with liver cirrhosis by Qi [43], Jamil and Durrani [44], and Cai et al [45], but in these studies, the LMR was considered to be a marker of patient outcome, not as a marker for infection incidence. It must be mentioned that there are only a few studies regarding the LMR and liver cirrhosis, and among them, there is no evaluation of the LMR as a predictor of infection in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Lymphocyte-To-Monocyte Ratio as the Best Simple Predictor of Bacterial Infection in Patients with Liver Cirrhosis

Piotrowski

Sączewska-Piotrowska

Jaroszewicz

et al. 2020

IJERPH

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Background and aim: The aim of this study was to assess the diagnostic performance of new morphology-related indices and Child–Turcotte–Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores during hospitalization in predicting the onset of bacterial infection in patients with liver cirrhosis. Material and methods: A total of 171 patients (56.9% males; median age 59 years; total number of hospitalizations 209) with liver cirrhosis were included in this observational study. The diagnosis of cirrhosis was made on the basis of clinical, biochemical, ultrasonic, histological, and endoscopic findings. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), modified aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), Fibrosis-4 index (FIB-4), platelet-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR), and CTP and MELD scores were calculated for the cases of patients with cirrhosis. Results: Bacterial infection was diagnosed in 60 of the 209 (28.7%) hospitalizations of patients with cirrhosis. The most common infections were urinary tract infection (UTI), followed by pneumonia and sepsis. The more severe the liver failure, the greater the bacterial infection prevalence and mortality. Patients with decompensated liver cirrhosis were infected more often than subjects with compensated cirrhosis (50.0% vs. 12.9%, p = 0.003). The calculated MELD score, CTP, NLR, LMR, AAR, monocyte count, and C-reactive protein (CRP) concentration were also related to the bacterial infection prevalence, and mortality areas under the curve (AUC) were 0.629, 0.687, 0.606, 0.715, 0.610, 0.648, and 0.685, respectively. The combined model with two variables (LMR and CTP) had the best AUC of 0.757. The most common bacteria isolated from patients with UTI were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumonia. Gram-negative bacteria were also responsible for spontaneous bacterial peritonitis (SBP), and together with gram-positive streptococci and staphylococci, these microorganisms were isolated from blood cultures of patients with sepsis. Significant differences were found between CTP classification, MELD score, NLR, LMR, AAR, CRP, and PLR in patients with cirrhosis with, or without, bacterial infection. Conclusions: Bacterial infection prevalence is relatively high in patients with liver cirrhosis. Although all analyzed scores, including the LMR, NLR, aspartate aminotransferase (AST)/alanine aminotransferase (ALT), CRP, CTP, and MELD, allowed the prediction of bacterial occurrence, the LMR had the highest clinical utility, according to the area under the curve (AUC) and odds ratio (OR).

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Assessing the outcome of patients with liver cirrhosis during hospital stay: A comparison of lymphocyte/monocyte ratio with MELD and Child-Pugh scores

Cited by 12 publications

References 30 publications

Comparison of lymphocyte-to-monocyte ratio with Child-Pugh and PELD/MELD scores to predict the outcome of children with cirrhosis

Comparison of lymphocyte-to-monocyte ratio with Child-Pugh and PELD/MELD scores to predict the outcome of children with cirrhosis

The Significant Morbidity and Mortality Indicators in Patients of Cirrhosis

Lymphocyte-To-Monocyte Ratio as the Best Simple Predictor of Bacterial Infection in Patients with Liver Cirrhosis

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