Introduction
The neutrophil-lymphocyte ratio (NLR) has been used as a predictor of survival in critically ill patients. However, there are scarce studies that evaluate the relationship between NLR and alcoholic hepatitis.
Aims & Methods
Objectives: To determine the association between NLR with mortality and the degree of acute-on-chronic liver failure (ACLF).
A longitudinal, retrospective, observational and descriptive cohort study was conducted. The subjects met criteria for alcohol hepatitis established by the National Institute on Alcohol Abuse and Alcoholism. Patients with concomitant infections or conditions that could alter the NLR were excluded.
Statistical analysis was performed with the Jamovi program. To compare clinical values, Student's T-test or Mann Whitney U test were performed according to the distribution of the data. The association analysis between NLR and 30-day mortality, as well as the association between NLR and ACLF degrees, were carried out using a point-biserial correlation. An ROC curve was performed using GraphPad Prism version 10.2.3 and Microsoft Excel software to establish the cutoff point of the neutrophil-lymphocyte ratio, as well as determine the sensitivity and specificity of the model to predict 28-day mortality.
Results
Eighty-nine patients were included, 86 (96%) men and 3 (4%) women. There was significant difference between patients who died within 28 days compared with those who survived (Table 1). The mean NLR value in patients who survived was approximately four times the value presented in patients who died within 28 days (p < 0.001). A gradual increase in severity-dependent NLR was identified based on the CLIF-C ACLF SCORE. The cutoff point of the neutrophil-lymphocyte ratio was >12.9 (AUC 0.986), with a p value <0.0001, sensitivity 92.7% and specificity 94.1% (95% CI).
| Table 1. Comparison of clinical data and severity scales between surviving and non-surviving subjects at 28 days. |
Variable
| Death in the first 28 days (n=55)
| Survivors after 28 days (n=34)
| p
|
Age
| 45.7 ± 9.1
| 46.0 ± 12.3
| 0.909
|
Leukocytes (x103 mm3)
| 23.3 ± 8.3
| 11.7 ± 5.4
| < 0.001
|
NLR
| 30.5 (17.2, 32.1)
| 7.0 (5.0, 8.8)
| < 0.001
|
CLIF-C ACLF Score
| 56.1 ± 6.6
| 49.3 ± 8.9
| < 0.001
|
MADDREY Score
| 79.2 (55.5, 98.2)
| 69.2 (40.5, 102.0)
| 0.111
|
MELD Score
| 35.3 ± 11.5
| 26.8 ± 9.3
| < 0.001
|
BT (mg/dL)
| 24.1 ± 10.7
| 16.4 ± 10.0
| 0.001
|
Cr (mg/dL)
| 2.16 (1.46, 3.54)
| 1.16 (0.73, 2.30)
| 0.004
|
Conclusion
The association between high NLR levels and mortality within 28 days is confirmed. Furthermore, there is an association between NLR and the severity of ACLF. Therefore, the NLR could be a useful prognostic factor in the clinical practice for alcoholic hepatitis.
References
Forrest, E. H., Storey, N., Sinha, R., Atkinson, S. R., Vergis, N., Richardson, P., Masson, S., Ryder, S., Thursz, M. R., Allison, M., Fraser, A., Austin, A., McCune, A., Dhanda, A., Katarey, D., Potts, J., Verma, S., Parker, R., Hayes, P. C., & Group, =STOPAH N L R. (2019). Baseline neutrophil-to-lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis. Alimentary Pharmacology & Therapeutics, 50(4), 442–453. https://doi.org/10.1111/apt.15335
Velarde-Ruiz Velasco, J. A., Higuera-de la Tijera, M. F., Castro-Narro, G. E., Zamarripa-Dorsey, F., Abdo-Francis, J. M., Aiza Haddad, I., Aldana Ledesma, J. M., Bielsa-Fernández, M. v, Cerda-Reyes, E., Cisneros-Garza, L. E., Contreras-Omaña, R., Reyes-Dorantes, A., Fernández-Pérez, N. J., García-Jiménez, E. S., Icaza-Chávez, M. E., Kershenobich-Stalnikowitz, D., Lira-Pedrín, M. A., Moreno-Alcántar, R., Pérez-Hernández, J. L., … Torre-Delgadillo, A. (2020). Consenso Mexicano de hepatitis alcohólica. Revista de Gastroenterología de México, 85(3), 332–353. https://doi.org/https://doi.org/10.1016/j.rgmx.2020.04.002
Disclosure
No conflict of interest.
