A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure

BMC Gastroenterology

Jianghua Yang¹  Xueping Yu²  Haoxiang Zhu³  Xueyun Zhang³  Jian Sun⁴  Jiming Zhang⁵  Zhongliang Shen⁵  Richeng Mao⁵  Jiefei Wang⁶  Zhiping Qian⁶  Hongying Guo⁶ 

[1] Department of Infectious Diseases, First Affiliated Hospital of Wannan Medical College, 241000, Wuhu, China;Department of Infectious Diseases, First Hospital of Quanzhou, Affiliated to Fujian Medical University, 362000, Quanzhou, China;Department of Infectious Diseases, Huashan Hospital, Fudan University, 200040, Shanghai, China;Department of Infectious Diseases, Huashan Hospital, Fudan University, 200040, Shanghai, China;Department of Infectious Diseases, First Affiliated Hospital of Wannan Medical College, 241000, Wuhu, China;Department of Infectious Diseases, Huashan Hospital, Fudan University, 200040, Shanghai, China;Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, 200040, Shanghai, China;Department of Severe Hepatopathy, Shanghai Public Health Clinical Centre, Fudan University, 201508, Shanghai, China;

关键词: Acute-on-chronic liver failure;    Asian Pacific Society for the Study of the Liver ACLF Research Consortium;    Prognosis;    Bacterial infection;    Neutrophil-to-lymphocyte ratio;    Lactate;    Cirrhosis;   

DOI  :  10.1186/s12876-021-02007-w

来源: Springer

【 摘 要 】

BackgroundAlthough the Asian Pacific Association for the Study of the Liver acute-on-chronic liver failure (ACLF) research consortium (AARC) ACLF score is easy to use in patients with hepatitis b virus-related ACLF (HBV-ACLF), serum lactate is not routinely tested in primary hospitals, and its value may be affected by some interference factors. Neutrophil-to-lymphocyte ratio (NLR) is used to assess the status of bacterial infection (BI) or outcomes in patients with various diseases. We developed an NLR-based AARC ACLF score and compared it with the existing model.MethodsA total of 494 HBV-ACLF patients, enrolled in four tertiary academic hospitals in China with 90-day follow-up, were analysed. Prognostic performance of baseline NLR and lactate were compared between cirrhotic and non-cirrhotic subgroups via the receiver operating curve and Kaplan–Meier analyses. A modified AARC ACLF (mAARC ACLF) score using NLR as a replacement for lactate was developed (n = 290) and validated (n = 204).ResultsThere were significantly higher baseline values of NLR in non-survivors, patients with admission BI, and those with higher grades of ACLF compared with the control groups. Compared with lactate, NLR better reflected BI status in the cirrhotic subgroup, and was more significantly correlated with CTP, MELD, MELD-Na, and the AARC score. NLR was an independent predictor of 90-day mortality, and was categorized into three risk grades (< 3.10, 3.10–4.78, and > 4.78) with 90-day cumulative mortalities of 8%, 21.2%, and 77.5% in the derivation cohort, respectively. The mAARC ACLF score, using the three grades of NLR instead of corresponding levels of lactate, was superior to the other four scores in predicting 90-day mortality in the derivation (AUROC 0.906, 95% CI 0.872–0.940, average P < 0.001) and validation cohorts (AUROC 0.913, 95% CI 0.876–0.950, average P < 0.01), with a considerable performance in predicting 28-day mortality in the two cohorts.ConclusionsThe prognostic value of NLR is superior to that of lactate in predicting short-term mortality risk in cirrhotic and non-cirrhotic patients with HBV-ACLF. NLR can be incorporated into the AARC ACLF scoring system for improving its prognostic accuracy and facilitating the management guidance in patients with HBV-ACLF in primary hospitals.

【 授权许可】

CC BY