Neutrophil‐to‐lymphocyte ratio is associated with malnutrition risk estimated by the Royal Free Hospital–Nutritional Prioritizing Tool in hospitalized cirrhosis

Abstract

Background Liver cirrhosis is characterized by immune dysfunction, contributing to malnutrition. We previously revealed neutrophil‐to‐lymphocyte ratio (NLR) as an indicator of disordered immune system. Herein we aimed to (1) determine the optimal NLR cutoff that best predicts malnutrition risk and (2) clarify the association between NLR and nutrition status. Methods A total of 135 hospitalized patients with cirrhosis were included. Immune dysfunction was evaluated by levels of serum C‐reactive protein (CRP), NLR, and other parameters. Malnutrition was screened by a risk score referring to the Royal Free Hospital–Nutritional Prioritizing Tool (RFH‐NPT). Receiver operating characteristic (ROC) curve was implemented to determine the best NLR cutoff that predicts malnutrition risk. Correlation between NLR and indicators of hepatic and physical function (handgrip strength) were also examined. Multivariable logistic regression was used to assess the association between NLR and malnutrition risk. Results ROC curve revealed that the optimum cutoff to predict malnutrition risk was NLR > 4.2, with a sensitivity of 47.2%, specificity of 81.0%, negative predictive value of 58.0%, and positive predictive value of 74.5%, respectively. Patients with NLR > 4.2 exhibited a higher RFH‐NPT score, serum platelet‐to‐lymphocyte ratio, and CRP. A positive correlation was found between NLR values and Child‐Turcotte‐Pugh (r = 0.22; P = .010), model for end‐stage liver disease (r = 0.36; P < .001), and RFH‐NPT scores (r = 0.31; P < .001). NLR was a risk factor for malnutrition independently of alcoholic liver disease and presence of ascites. Conclusions Immune dysfunction measured by NLR was associated with malnutrition risk estimated by RFH‐NPT in cirrhosis.

Visceral Adiposity Associates With Malnutrition Risk Determined by Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

“…In contrast, SAT has been proved to uptake and deposit triglycerides, plasma FFAs, and responsible for producing leptin in charge of immune response and lipid metabolism (34)(35)(36). More recently, our results implicated that immune dysfunction measured by neutrophilto-lymphocyte ratio (NLR) is associated with malnutrition risk estimated by RFH-NPT in cirrhosis (5). Furthermore, the expression of circulating IL-6 and IL-8 was positively correlated with increased NLR values (37).…”

“…Notably, among eight screening tools for detecting the risk of malnutrition in cirrhosis, RFH-NPT represents the most accurate with a high sensitivity of 97.4% and a fair specificity of 73.3% ( 26 ). In addition, our previous work showed that malnourished status assessed by RFH-NPT is closely associated with immune dysfunction ( 5 ). Taken together, we preferentially adopt RFH-NPT in this work for identifying high risk of malnutrition in our retrospective cohort.…”

“…In an established and validated cohort of 148 patients with chronic liver disease, the RFH-NPT represented a useful predictor of clinical deterioration and poor outcome (4). Our previous work also implicated that malnutrition risk estimated by RFH-NPT is dramatically associated with distorting immune function in the context of cirrhosis (5).…”

Relationship Between Sleep–Wake Disturbance and Risk of Malnutrition in Hospitalized Patients With Cirrhosis

“…The RFH-NPT scores were calculated according to our previous depiction ( 16 ). Briefly, the risk of malnutrition was categorized into low (0 points), moderate (1 point), and high (2–7 points) in terms of RFH-NPT scores.…”

Low Levels of Serum Zinc Associate with Malnutrition Risk Assessed by the Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis

“…We and others have clarified that malnutrition is common in patients with cirrhosis and the necessity for performing nutritional screening among all subjects in the clinical practice [9][10][11]. In recent work, we used the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) as an analytic metric, which is specifically designed and recommended for cirrhotics, and found that 53.3% of 135 patients are at high malnutrition risk [9,12]. Surprisingly, even if the deleterious influences of malnutrition related to cirrhosis are well known, the unified construct of malnutrition remains elusive in the literature.…”