Rice J, et al. - The tie-up between the neutrophil-to-lymphocyte ratio (NLR) and mortality was comprehensively analyzed in hospitalized patients with cirrhosis at 4 liver transplant centers, controlling for severity of acute-on-chronic liver failure (ACLF). Data shed light on the connection between NLR with death within 1 year after non-elective hospitalization. It was determined that the risk of death linked with acute immune dysregulation remained long after their initial hospitalization in these patients.

Methods

• Using data from the North American Consortium for the Study of End-stage Liver Disease, a retrospective study was carried out on patients with index hospitalizations for cirrhosis from December 2011 through December 2016.
• Data was extracted with regard to the patient demographics, NLR, model for end-stage liver disease (MELD) scores, serum levels of Na, cirrhosis stages, infections, hepatocellular carcinomas, and ACLF severity (based on number of organ failures).
• With the aid of competing risk regression analysis, mortality was assessed within 1 year after hospital discharge, accounting for competing events (liver transplant).

Results

• As per the data, the patients’ mean age was 57 years at admission, mean MELD score was 21, and mean serum level of Na was 134 mmol/L.
• It was determined that 68 subjects had no organ failure, 21 patients had 2 organ failures, 7 patients had 2 organ failures, 4 patients had 3 organ failures, and 1 patient had 4 organ failures.
• Findings displayed that 36% of the patients had confirmed or suspected infections.
• As per the univariate models, risk of death correlated with increasing NLR, up to a value of 8 (hazard ratio [HR]= 1.14; 95% CI 1.07-1.20; P < .001), and NLR quartile (for NLR range of 3-5, HR=2.17; for NLR range of >5-9, HR=2.46; for NLR quartile >9, HR=2.84 vs the lowest quartile [NLR<3]) (P ≤ .001).
• It was deduced that NLR remained statistically prominent in multivariable models, adjusting for age, MELD score, hepatocellular carcinoma, and ACLF severity.
• Furthermore, NLR presented as a statistically notable independent predictor of length of index hospital stay and mortality within 90 days after discharge.