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

Abstract

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).

Predictors of spontaneous bacterial peritonitis in Romanian adults with liver cirrhosis: Focus on the neutrophil‑to‑lymphocyte ratio

“…NLR is a non-invasive marker that can be used to predict the occurrence of in-hospital infections in patients with decompensated liver cirrhosis (17). In a study conducted by Piotrowski et al, an association between NLR and the presence of infection in patients with liver cirrhosis was identified but with low diagnostic accuracy (AUC=0.606) (18).…”

Association of Lymphocyte to Monocyte Ratio and Risk of in-Hospital Mortality in Patients with Cardiogenic Shock: A Propensity Score Matching Study

“…Accumulating studies have demonstrated that LMR was a readily available and independent prognostic biomarker in predicting the poor prognosis of patients with various clinical conditions, including liver cirrhosis, cerebral venous sinus thrombosis, colorectal cancer and peripheral arterial occlusive disease. 14–17 Moreover, numerous investigators have detected the predictive effect of LMR in predicting the clinical outcomes in some inflammatory diseases. Cherfane et al explored the predictive value of LMR in ulcerative colitis (UC) and found that low LMR might be effective, readily available, and low-cost biomarkers to identify disease activity in UC patients.…”

“…LMR has long been introduced as an inflammatory marker in various clinical conditions, including liver cirrhosis, cerebral venous sinus thrombosis, colorectal cancer and peripheral arterial occlusive disease. 14–17 Moreover, LMR were also reported to be associated with adverse outcome in various cardiovascular diseases including myocardial infarction, heart failure and aortic dissection. 18–20 As mentioned above, a systemic inflammatory status contributes to poor prognosis in CS patients.…”

The lymphocyte/monocyte ratio and red blood cell transfusion during radical retropubic prostatectomy

“…Therefore, the LM ratio is being studied as a potential prognosis predictor in cancer patients [11,[37][38][39]. Besides being a novel marker of the baseline inflammatory response, the LM ratio decreases in several clinical conditions, including bacterial infections, osteoporosis, stroke, acute rheumatic fever, and coronary artery atherosclerosis [14,16,[40][41][42][43]. Because an unexpected decrease in the LM ratio may be associated with poor outcomes in various clinical circumstances, its clinical application as a prognostic factor is being closely investigated.…”

“…The LM ratio can predict the prognosis of patients with colorectal, ovarian, and esophageal cancers [11][12][13]. In addition, it may also be associated with infection in patients with liver cirrhosis, prediction of osteoporosis, and mortality of patients with coronavirus disease 2019 [14][15][16][17]. Furthermore, in patients with head and neck cancer, low lymphocyte count is related to increased tissue adhesion or tissue damage [18].…”