The neutrophil-to-lymphocyte ratio (NLR) can predict the presence of bacterial infections in hospitalized patients with decompensated cirrhosis.

IF 3.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of hepatology Pub Date : 2025-04-01 DOI:10.1016/j.aohep.2025.101798

Paloma M. Diego-Salazar, Diego F. Abendaño-Rivera, Cristian Y. Sánchez-Sánchez, Karina Cazarín-Chávez, Kevin S. Vázquez-Hernandez, Fátima Higuera-de-la-Tijera

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引用次数: 0

Abstract

Introduction and Objectives

Liver cirrhosis can increase susceptibility to bacterial infections, which are often underestimated due to subtle or absent symptoms and the absence of additional biochemical markers. Early identification of these infections is limited in these patients. The objective is to determine the effectiveness of the Neutrophil-to-Lymphocyte Ratio (NLR) as a predictor of bacterial infections in hospitalized patients.

Materials and Patients

The aim of this retrospective, observational, analytical, cross-sectional study was to validate a prognostic index for patients diagnosed with liver cirrhosis and hospitalized from October 2023 to March 2024. The study included variables such as age, sex, etiology of liver disease, decompensation events leading to hospitalization, and biochemical data to calculate MELD, Child-Pugh, MELD-Na scores, and the degree of acute-on-chronic liver failure upon admission using the EASL-CLIF-ACLF, European Association for the Study of the Liver - Chronic Liver Failure Acute-on-Chronic Liver Failure score. Additionally, the presence of bacterial infection was determined through laboratory tests, imaging studies, and corresponding cultures. The Neutrophil-to-Lymphocyte Ratio was established by dividing the respective total cell counts. The study summarized the variables using descriptive statistics and constructed the area under the curve (AUC-ROC) with 95% confidence intervals. A p-value <0.01 was considered significant.

Results

A total of 183 patients were included in the study. There were 93 (50.8%) men, with an average age of 55.8 ± 10 years. The distribution by etiology was as follows: Alcohol 72 (39.3%), MASLD 55 (30.1%), Autoimmune 27 (14.8%), Hepatitis C Virus 16 (8.7%), MetALD 16 (8.7%). According to the Child-Pugh score, 91 (49.7%) were class C, 68 (37.2%) were class B, and 24 (13.1%) were class A. Acute decompensations reported were: Variceal bleeding in 90 patients (49.1%), Ascites in 79 (43.1%), and Hepatic Encephalopathy in 102 (55.7%). The degree of acute-on-chronic liver failure upon admission was established: Grade 1 in 30 patients (16.3%), grade 2 in 29 (15.8%), and grade 3 in 12 (6.5%). It was found that 111 (60.7%) patients had bacterial infections during hospitalization, which were urinary infections 69 (37.7%), spontaneous bacterial peritonitis 22 (12%), pneumonia 13 (7.1%), bacteremia 7 (3.8%). NLR ≤ 1.9 predicted bacterial infection with a sensitivity of 94% and specificity of 89% (AUC-ROC: 0.89, 95% CI 0.82-0.95, p <0.0001), compared to other scales such as Child-Pugh, MELD, or MELD-Na with AUC-ROC of 0.69 (0.62-0.77), 0.68 (0.60-0.76), 0.64 (0.56-0.72) respectively.

Conclusions

The Neutrophil-to-Lymphocyte Ratio (NLR) is highly effective in predicting bacterial infections in patients with liver cirrhosis, surpassing the Child-Pugh, MELD, and MELD-Na scales. This indicates that NLR is a valuable tool for early identification of infections in this patient population.

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中性粒细胞与淋巴细胞比值（NLR）可预测失代偿期肝硬化住院患者是否存在细菌感染。

简介和目的肝硬化可增加对细菌感染的易感性，由于症状不明显或无症状以及缺乏额外的生化标志物，这种易感性往往被低估。在这些患者中，这些感染的早期识别是有限的。目的是确定中性粒细胞与淋巴细胞比率（NLR）作为住院患者细菌感染预测因子的有效性。材料和患者这项回顾性、观察性、分析性、横断面研究的目的是验证诊断为肝硬化并在2023年10月至2024年3月期间住院的患者的预后指标。该研究纳入了诸如年龄、性别、肝病病因、导致住院的失代偿事件等变量和生化数据，以计算MELD、Child-Pugh、MELD- na评分，并使用easl - cliff - aclf，欧洲肝脏研究协会-慢性肝衰竭-急性对慢性肝衰竭评分，计算入院时急性对慢性肝衰竭的程度。此外，通过实验室检查、影像学检查和相应的培养来确定细菌感染的存在。中性粒细胞与淋巴细胞的比值是通过除以各自的总细胞计数来确定的。本研究采用描述性统计对变量进行汇总，并以95%置信区间构建曲线下面积（AUC-ROC）。p值<；0.01被认为是显著的。结果共纳入183例患者。男性93例（50.8%），平均年龄55.8±10岁。病因分布：酒精72例（39.3%），MASLD 55例（30.1%），自身免疫性27例（14.8%），丙型肝炎病毒16例（8.7%），MetALD 16例（8.7%）。根据Child-Pugh评分，C级91例（49.7%），B级68例（37.2%），a级24例（13.1%）。急性失代偿报告：静脉曲张出血90例（49.1%），腹水79例（43.1%），肝性脑病102例（55.7%）。入院时确定了急性慢性肝衰竭的程度：30例患者为1级（16.3%），29例为2级（15.8%），12例为3级（6.5%）。住院期间发生细菌感染111例（60.7%），其中尿路感染69例（37.7%），自发性细菌性腹膜炎22例（12%），肺炎13例（7.1%），菌血症7例（3.8%）。NLR≤1.9预测细菌感染的敏感性为94%，特异性为89% (AUC-ROC: 0.89, 95% CI 0.82-0.95, p <0.0001)，而Child-Pugh、MELD、MELD- na等其他量表的AUC-ROC分别为0.69（0.62-0.77）、0.68（0.60-0.76）、0.64（0.56-0.72）。结论中性粒细胞与淋巴细胞比值（NLR）在预测肝硬化患者细菌感染方面非常有效，优于Child-Pugh、MELD和MELD- na量表。这表明NLR是一个有价值的工具，早期识别感染的患者群体。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of hepatology 医学-胃肠肝病学

CiteScore

7.90

自引率

2.60%

发文量

183

审稿时长

4-8 weeks

期刊介绍： Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.