Prognostic impact of neutrophil‐to‐lymphocyte ratio in cirrhosis: A propensity score matching analysis with a prespecified cut‐point

Deng, You; Fan, Xiaofei; Ran, Ying; Xu, Xin; Lin, Lin; Cui, Binxin; Hou, Lijun; Zhao, Tianming; Ya, Wang; Su, Zhengyan; Jiang, Xihui; Zhao, Wei; Wang, Bangmao; Sun, Chao

doi:10.1111/liv.14211

Cited by 17 publications

(10 citation statements)

References 19 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In chronic viral hepatitis B and C, NLR predicted response to anti-viral therapy[ 16 - 21 ]. In cirrhosis, NLR was associated with worse outcomes[ 22 - 27 ]. In alcoholic hepatitis, NLR predicted mortality and identified patients likely to require steroid treatment[ 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review

Bannaga

Arasaradnam

2020

WJG

View full text Add to dashboard Cite

BACKGROUND Hepatocellular carcinoma (HCC) is a frequent cause of cancer related death globally. Neutrophil to lymphocyte ratio (NLR) and albumin bilirubin (ALBI) grade are emerging prognostic indicators in HCC. AIM To study published literature of NLR and ALBI over the last five years, and to validate NLR and ALBI locally in our centre as indicators of HCC survival. METHODS A systematic review of the published literature on PubMed of NLR and ALBI in HCC over the last five years. The search followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses. Additionally, we also investigated HCC cases between December 2013 and December 2018 in our centre. RESULTS There were 54 studies describing the relation between HCC and NLR and 95 studies describing the relation between HCC and ALBI grade over the last five years. Our local cohort of patients showed NLR to have a significant negative relationship to survival ( P = 0.011). There was also significant inverse relationship between the size of the largest HCC nodule and survival ( P = 0.009). Median survival with alpha fetoprotein (AFP) < 10 KU/L was 20 mo and with AFP > 10 KU/L was 5 mo. We found that AFP was inversely related to survival, this relationship was not statically significant ( P = 0.132). Mean survival for ALBI grade 1 was 37.7 mo, ALBI grade 2 was 13.4 months and ALBI grade 3 was 4.5 mo. ALBI grades performed better than Child Turcotte Pugh score in detecting death from HCC. CONCLUSION NLR and ALBI grade in HCC predict survival better than the conventional alpha fetoprotein. ALBI grade performs better than Child Turcotte Pugh score. These markers are done as part of routine clinical care and in cases of normal alpha fetoprotein, these markers could give a better understanding of the patient disease progression. NLR and ALBI grade could have a role in modified easier to learn staging and prognostic systems for HCC.

show abstract

Section: Introductionmentioning

confidence: 99%

Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review

Bannaga

Arasaradnam

2020

WJG

View full text Add to dashboard Cite

show abstract

“…More recently, more and more evidence shows that NLR is a clinically relevant prognostic parameter in patients with liver cirrhosis. A propensity score matching study revealed that NLR over 8.9 may serve as a robust cutoff value for identifying cirrhotic patients at high risk of 90-day mortality ( 12 ). Rice et al ( 28 ) revealed that 2.84-folds risk of death was demonstrated in cirrhotic patients with NLR >9 when compared to NLR <3.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with severe end-stage liver diseases (e.g., ACLF), NLR was identified as an effective biomarker for hospital mortality prediction (11). A previous study reported that increased NLR independently predicted the short-term mortality in cirrhotic patients with AD (12). A nomogram including NLR was used for individual risk stratification and selection of therapeutic strategies (13).…”

Section: Introductionmentioning

confidence: 99%

Baseline Neutrophil-to-Lymphocyte Ratio Is Independently Associated With 90-Day Transplant-Free Mortality in Patients With Cirrhosis

Liu

Xia

et al. 2021

Front. Med.

View full text Add to dashboard Cite

Background: Patients with cirrhosis have an increased risk of short-term mortality, however, few studies quantify the association between neutrophil-to-lymphocyte ratio (NLR) and 90-day transplant-free mortality in cirrhotic patients.Methods: We prospectively analyzed 3,970 patients with chronic liver diseases from two multicenter cohorts in China (January 2015 to December 2016 and July 2018 to January 2019). Restricted cubic splines (RCS) were used to analyze the relation of NLR and all-causes 90-day transplant-free mortality in cirrhosis.Results: A total of 2,583 cirrhotic patients were enrolled in our study. Restricted cubic splines showed that the odds ratio (OR) of all causes 90-day transplant-free mortality started to increase rapidly until around NLR 6.5, and then was relatively flat (p for non-linearity <0.001). The risk of 90-day transplant-free mortality in cirrhotic patients with NLR < 6.5 increased with an increment of 23% for every unit increase in NLR (p < 0.001). The patients with NLR < 4.5 had the highest risk (OR: 2.34, 95% CI 1.66–3.28). In multivariable-adjusted stratified analyses, the increase in the incidence of 90-day transplant-free mortality with NLR increasing was consistent (OR >1.0) across all major prespecified subgroups, including infection group (OR: 1.04, 95% CI 1.00–1.09) and non-infection (OR: 1.06, 95% CI 1.02–1.11) group. The trends for NLR and numbers of patients with organ failure varied synchronously and were significantly increased with time from day 7 to day 28.Conclusions: We found a non-linear association between baseline NLR and the adjusted probability of 90-day transplant-free mortality. A certain range of NLR is closely associated with poor short-term prognosis in patients with cirrhosis.

show abstract

“…Clinical usefulness and net benefit of MELDNa-5MGS score were estimated with decision-curve analysis. 17 The trends of mortality with respect to 5MGS and MELDNa-5MGS score increment were determined using the Cochran-Armitage test as previously described. 18 We considered p < 0.05 as statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Incorporation of frailty estimated by gait speed within MELD-Na and the predictive potential for mortality in cirrhosis

Deng

Lin

Fan

et al. 2020

Therapeutic Advances in Chronic Disease

Self Cite

View full text Add to dashboard Cite

Background: The 5 m gait speed (5MGS), a simple and reliable performance metric and surrogate indicator of frailty, consistently predicts adverse events in elders. Additionally, MELD-Na (model for end-stage liver disease-sodium) scores fail to capture nutritional and functional decline of cirrhotic patients that may confer excess mortality. We hypothesized that 5MGS might be associated with all-cause mortality, and that inclusion of frailty assessment within MELD-Na could improve the prediction of mortality in cirrhosis. Methods: 5MGS was measured at baseline in 113 hospitalized cirrhotic patients. Survival status over 2 years and cirrhosis-related complications were recorded. We evaluated the prognostic value of 5MGS (as a continuous variable and as a dichotomous variable). The definition of slow versus preserved 5MGS was 0.8 ms−1 based on previous publication. Using Cox proportional hazards regression, a novel MELDNa-5MGS score was derived. Receiver operating characteristics (ROC) curves estimated discrimination between the new score model and established prognostic indices. Results: The continuous 5MGS and slow 5MGS were independent predictors of all-cause mortality [5MGS: hazard ratio (HR) 0.133 (0.047–0.347), p < 0.001; slow 5MGS: HR 4.805 (1.536–15.026), p < 0.007]. The equation derived from Cox regression analysis was as follows: MELDNa-5MGS: MELD-Na score + 11 × slow 5MGS. The 2-year mortality in patients with high MELDNa-5MGS score was significantly higher ( p < 0.001). Discriminatory power was significantly better for MELDNa-5MGS than MELD-Na score (AUC: 0.802 versus 0.724, p = 0.014 for 1 year; 0.773 versus 0.709, p = 0.044 for 2 years). Conclusion: In cirrhotic patients, 5GMS is an independent risk factor of mortality. Modification of MELD-Na to include frailty estimated by low 5GMS is related to improved prognostication of mortality.

show abstract

Prognostic impact of neutrophil‐to‐lymphocyte ratio in cirrhosis: A propensity score matching analysis with a prespecified cut‐point

Cited by 17 publications

References 19 publications

Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review

Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review

Baseline Neutrophil-to-Lymphocyte Ratio Is Independently Associated With 90-Day Transplant-Free Mortality in Patients With Cirrhosis

Incorporation of frailty estimated by gait speed within MELD-Na and the predictive potential for mortality in cirrhosis

Contact Info

Product

Resources

About