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Cirrhosis biomarker predicts 1-year mortality after hospitalization

Neutrophil-to-lymphocyte ratio as a biomarker correlated with 1-year mortality after nonelective hospitalization in patients with cirrhosis, according to published results of a retrospective study.

“The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive, objective, reliable, and widely available biomarker that we and others have shown to be predictive of mortality in patients with cirrhosis,” Jonathan Rice, MD, from the University of Colorado, and colleagues wrote. “NLR is easily calculated from a routinely available complete blood cell count by dividing absolute neutrophil count by absolute lymphocyte count.”

Utilizing the North American Consortium for the Study of End-stage Liver Disease database, the researchers analyzed data on 844 patients with cirrhosis who had a median NLR of 5.1 (range, 3.1-8.8) at the time of hospitalization. At 1-year follow-up, 455 patients survived transplantation-free, 217 patients died, and 172 underwent liver transplantation.

Most of the reported complications were liver-related, including infection (30%), followed by renal/metabolic issues (24%), hepatic encephalopathy (15%) and gastrointestinal bleeding (14%).

On average, patients admitted for liver-related complications had significantly lower NLR compared with those admitted for nonliver infection-related complications (4.5 vs. 7.8; P < .001).

Multivariate analysis showed that NLR per 1-unit increase significantly increased the risk for 1-year mortality (HR = 1.09; 95% CI, 1.03-1.16). By quartile with NLR less than 3 as reference, NLR as a predictive marker of 1-year mortality remained significant in the 3 to 5 value range (HR = 1.79; 95% CI, 1.11-2.89), the more than 5 to 9 range (HR = 1.77; 95% CI, 1.09-2.86), and was highest in those with NLR higher than 9 (HR = 2.3; 95% CI, 1.43-3.7).

Additionally, 90-day mortality increased by 25% per 1-unit increase in NLR up to a value of 8 (OR = 1.24; 95% CI, 1.12-1.39) and increased continuously from second quartile (HR = 1.12; 95% CI, 0.48-2.62), to third (HR = 2.62; 95% CI, 1.23-5.59), to fourth (HR = 3.06; 95% CI, 1.44-6.5), compared with the first quartile.

“Despite recent advances in cirrhosis care in the last decade, both the number and cost of hospitalizations has doubled,” Rice and colleagues wrote. “Now more than ever, clinicians need tools to predict [length of stay], in-hospital mortality and long-term mortality in patients with cirrhosis.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.