Is There a Role for the Neutrophil-to-Lymphocyte Ratio for Rebleeding and Mortality Risk Prediction in Acute Variceal Bleeding? A Comparative 5-Year Retrospective Study.

IF 3 Q2 MEDICINE, RESEARCH & EXPERIMENTAL
Sergiu Marian Cazacu, Dragos Ovidiu Alexandru, Alexandru Valentin Popescu, Petrica Popa, Ion Rogoveanu, Vlad Florin Iovanescu
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Abstract

(1) Background: Acute variceal bleeding (AVB) represents an important cause of upper gastrointestinal bleeding (UGIB). Several prognostic scores may be useful for assessing mortality and rebleeding risk, with the Glasgow-Blatchford score (GBS) and Rockall score being the most commonly used for non-variceal bleeding. Scores assessing liver failure (MELD and Child) do not reflect bleeding severity. The neutrophil-to-lymphocyte ratio (NLR) increases in UGIB and can predict survival and rebleeding. (2) Methods: We analyzed the predictive role of NLR, GBS, Rockall, AIMS65, Child, and MELD for mortality (48 h, 5-day, in-hospital, and 6-week) and rebleeding in AVB patients admitted to our hospital from 2017 to 2021. ROC analysis was performed, and a multivariate analysis with logistic regression was used to construct a simplified model. (3) Results: A total of 415 patients were admitted. NLR exhibited fair accuracy for 48-h mortality (AUC 0.718, 95% CI 0.597-0.839, p < 0.0001), with limited predictive value for medium-term mortality. The NLR accuracy was better than that of the GBS and Rockall score, similar to that of the AIMS65 and Child scores, but inferior to that of MELD. The value for all scores in predicting rebleeding was poor, with the highest AUC for the NLR. (4) Conclusions: The NLR exhibited reasonable accuracy in predicting short-term mortality in AVB. Our model (including NLR, age, creatinine, bilirubin, albumin, INR, platelet count, HCC, and etiology) demonstrated 80.72% accuracy in predicting 6-week mortality.

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中性粒细胞与淋巴细胞比值对急性静脉曲张出血的再出血和死亡风险预测有作用吗?一项5年回顾性比较研究。
(1)背景:急性静脉曲张出血(AVB)是上消化道出血(UGIB)的重要原因。几种预后评分可能对评估死亡率和再出血风险有用,格拉斯哥-布拉奇福德评分(GBS)和罗克尔评分是最常用的非静脉曲张出血。评估肝功能衰竭的评分(MELD和Child)不能反映出血的严重程度。中性粒细胞与淋巴细胞比值(NLR)在UGIB中增加,可以预测生存和再出血。(2)方法:分析2017 - 2021年住院AVB患者NLR、GBS、Rockall、AIMS65、Child和MELD对死亡率(48 h、5天、住院和6周)和再出血的预测作用。进行ROC分析,并采用logistic回归的多因素分析构建简化模型。(3)结果:共收治415例患者。NLR对48小时死亡率具有相当的准确性(AUC 0.718, 95% CI 0.597-0.839, p < 0.0001),对中期死亡率的预测价值有限。NLR的准确性优于GBS和Rockall评分,与AIMS65和Child评分相近,但低于MELD评分。所有评分预测再出血的价值都很差,NLR的AUC最高。(4)结论:NLR预测AVB短期死亡率具有合理的准确性。我们的模型(包括NLR、年龄、肌酐、胆红素、白蛋白、INR、血小板计数、HCC和病因)预测6周死亡率的准确率为80.72%。
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