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Yang Y, He X, Tan S, Qu X, Huang W, Cai J, You J, Fu X, He Y, Yang H. The association between immunoinflammatory biomarkers NLR, PLR, LMR and nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Exp Med 2025; 25:39. [PMID: 39812894 PMCID: PMC11735594 DOI: 10.1007/s10238-024-01539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 12/13/2024] [Indexed: 01/16/2025]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disorder closely linked to metabolic syndrome. Identifying novel, easily measurable biomarkers could significantly enhance the diagnosis and management of NAFLD in clinical settings. Recent studies suggest that immunoinflammatory biomarkers-specifically, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-may offer diagnostic value for NAFLD. However, the effectiveness of these biomarkers has not been comprehensively assessed in this patient population. This systematic review and meta-analysis aimed to evaluate the association between these immunoinflammatory biomarkers and NAFLD. As of August 8, 2024, databases including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus were systematically searched to compare NLR, PLR, and LMR levels in NAFLD patients and healthy controls. Study quality was assessed using the Newcastle-Ottawa Scale, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated (PROSPERO registry number: CRD42024580812). A total of 20 studies were included in the meta-analysis. Results indicated that NAFLD patients had significantly higher NLR levels (SMD = 0.43; 95% CI 0.28-0.58; p < 0.001) and lower PLR levels (SMD = - 0.29; 95% CI - 0.41 to - 0.17; p < 0.001) compared to controls. However, no significant difference in LMR was observed between NAFLD patients and controls(SMD = 0.08; 95% CI - 0.00 to 0.17; p = 0.051). These findings suggest that NLR and PLR may hold promise as diagnostic markers for NAFLD, while LMR appears to have limited diagnostic utility. Further research is warranted to explore the potential role of these biomarkers in tracking disease progression.
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Affiliation(s)
- Yunyi Yang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China
| | - Xiaoli He
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China
| | - Shufa Tan
- Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Xiaoxiao Qu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China
| | - Weijin Huang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China
| | - Jiayuan Cai
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China
| | - Jiawen You
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China
| | - Xinyi Fu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China
| | - Yanming He
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China.
| | - Hongjie Yang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110 Ganhe Road, Shanghai, 200437, China.
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Yang W, Tang H, Zhong B, Zhu X, Chen S. A propensity score matching analysis of neutrophil to lymphocyte ratio forecasts the survival of individuals undergoing the transjugular intrahepatic portosystemic shunt. Biotechnol Genet Eng Rev 2024; 40:1791-1805. [PMID: 37010061 DOI: 10.1080/02648725.2023.2196824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) has been shown to predict patient outcomes in various disorders. This study was carried out to evaluate the value of NLR in predicting mortality in decompensated cirrhosis patients having transjugular intrahepatic portosystemic shunt (TIPS). The end-stage liver disease model (MELD) is a scoring system to evaluate the liver function reserve. Retrospective investigation was conducted on the clinical information of 244 decompensated cirrhosis individuals with a MELD score ≤15 who underwent TIPS production at two academic medical centres between January 2017 and August 2021. The main result was 12-month post-TIPS mortality. The area under the receiver operating characteristic curve (AUC) was used to investigate the predictive potential of prognostic markers correlated with 12-month mortality using a logistic regression approach. To minimize the effects of potential factors, a 1:2 propensity score matching (PSM) was carried out. The non-surviving group had 21 (8.6%) patients who passed away within 12mo, while the surviving group included 223 (91.4%) patients who survived for more than 12mo. According to the multivariate analyses, NLR>4.8 was an independent prognostic factor of 12-month mortality after PSM analysis (OR=3.4, 95%CI, 1.052-10.985, P =0.041). In comparison to the non-surviving group, the proportion of NLR-high (>4.8) cells in the surviving group were considerably greater (71.4%vs.38.1%, P =0.017). Whether Unmatched group or the Matched group, NLR exhibited the highest diagnostic performance (AUCs of 0.646 and 0.667, respectively, P <0.05). The NLR is a reasonable and effective indicator of 12-month mortality in decompensated cirrhosis patients with a MELD ≤15 receiving TIPS.
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Affiliation(s)
- Weihao Yang
- Department of Interventional Radiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Haohuan Tang
- Department of Interventional Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Binyan Zhong
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoli Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Sipan Chen
- Department of Interventional Radiology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
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Qi X, Wang C. Prognostic Value of Platelet-to-Monocyte Ratio for Mortality in HBV-Related Acute-on-Chronic Liver Failure. Int J Gen Med 2024; 17:3173-3180. [PMID: 39049831 PMCID: PMC11268747 DOI: 10.2147/ijgm.s464402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/30/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a critical condition associated with unfavorable survival rates. Recent studies have indicated that the platelet-to-monocyte ratio (PMR) is considered an effective prognostic marker in several diseases. However, there has been no study to evaluate the prognostic value of PMR in HBV-ACLF patients. Therefore, this study aimed to investigate the association between PMR and 28-day survival in these patients. Methods In this retrospective study, data, including clinical and laboratory parameters, were collected for 184 HBV-ACLF patients. Disease severity was assessed using the Model for End-Stage Liver Disease (MELD) score. Logistic regression analyses were conducted to identify predictors influencing 28-day survival. Receiver-operating characteristic curve (ROC) analyses were performed to assess the predictive abilities of the identified predictors. Results During the 28-day follow-up period, 56 (30.4%) HBV-ACLF patients died. PMR was significantly lower in non-survivors than in survivors (P <0.001). Logistic regression demonstrated that PMR (Odds ratio, 0.983; 95% Confidence interval, 0.976-0.990; P=0.001) and MELD score (Odds ratio, 1.317; 95% Confidence interval, 1.200-1.446; P <0.001) were independent risk factors for mortality in HBV-ACLF patients. The area under ROC curve for PMR was 0.760 (sensitivity=0.840, specificity=0.620, P=0.001) at a cut-off value of 140.6, and the area under ROC curve for MELD score was 0.819 (sensitivity=0.700, specificity=0.860, P=0.001) at a cut-off value of 23.1. PMR and MELD score exhibited similar predictive performances (Z=1.229; P=0.219). Furthermore, the combined use of PMR and MELD score further increased the area under the ROC curve to 0.858, which more accurate prognosis prediction than use of either factor alone (both P< 0.05). Conclusion The PMR could serve as a reliable tool for predicting mortality in HBV-ACLF patients. Additionally, combining the PMR with the MELD score could improve prognostic accuracy for predicting 28-day mortality in these patients. However, further and larger studies are needed to confirm our findings.
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Affiliation(s)
- Xiaoting Qi
- Department of Clinical Laboratory, The People’s Hospital of Xinjiang Uygur Autonomous Region, Uygur, 830001, People’s Republic of China
| | - Changmin Wang
- Department of Clinical Laboratory, The People’s Hospital of Xinjiang Uygur Autonomous Region, Uygur, 830001, People’s Republic of China
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Quan H, Yu H, Liu XL, Xiong FX, Hou YX, Wang XB, Yang ZY, Jiang YY. Development and validation of a prognostic model for 90-day survival in patients with alcohol-associated cirrhosis and acute decompensation. Hepatol Res 2024; 54:588-599. [PMID: 38241146 DOI: 10.1111/hepr.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND/PURPOSE Patients with alcohol-associated cirrhosis and acute decompensation are considered critically ill and have a higher risk of short-term mortality. This study aimed to establish a nomogram to evaluate their 90-day survival and identify factors that affect disease progression. METHODS We included patients from September 2008 to December 2016 (n = 387 in the derivation group) and from January 2017 to August 2020 (n = 157 in the validation group). LASSO regression and Cox multivariate risk regression were used to analyze the influencing factors of the 90-day mortality risk, and a nomogram was constructed. The performance of a model was analyzed based on the C-index, area under the receiver operating curve, calibration curve, and decision curve analysis. RESULTS Total bilirubin >10 upper limit of normal, high-density lipoprotein cholesterol, lymphocyte and monocyte ratios ≤2.33, white blood cells, and hemoglobin were identified as independent risk factors affecting the 90-day mortality risk of patients and the nomogram was developed. A nomogram demonstrated excellent model predictive accuracy in both the derivation and validation cohorts (C-index: 0.976 and 0.945), which was better than other commonly used liver scoring models (p < 0.05). The nomogram also performed good calibration ability and more clinical net benefit. According to the nomogram score, patients were divided into high- and low-risk groups. Mortality was significantly higher in the high-risk group than in the low-risk group (p < 0.0001). CONCLUSION The nomogram could accurately predict the 90-day mortality risk in patients with alcohol-associated cirrhosis and acute decompensation, helping to identify high-risk patients and personalize treatment at their first admission.
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Affiliation(s)
- Hui Quan
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hao Yu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Li Liu
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fei-Xiang Xiong
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yi-Xin Hou
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xian-Bo Wang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Yun Yang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yu-Yong Jiang
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Kim TH, Yim HJ, Jung YK, Song DS, Yoon EL, Kim HY, Kang SH, Chang Y, Yoo JJ, Jun BG, Lee SW, Park JG, Park JW, Kim SE, Kim TY, Jeong SW, Suk KT, Kim MY, Kim SG, Kim W, Jang JY, Yang JM, Kim DJ. New prognostic model for hospitalized patients with alcoholic cirrhosis and Maddrey's discriminant function <32. Hepatol Int 2024; 18:500-508. [PMID: 37831433 DOI: 10.1007/s12072-023-10582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/09/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND & AIMS Few studies have investigated the prognosis of patients with non-severe alcoholic hepatitis (Non-SAH). The study aimed to develop a new prognostic model for patients with especially Non-SAH. METHODS We extracted 316 hospitalized patients with alcoholic cirrhosis without severe alcoholic hepatitis, defined as Maddrey's discriminant function score lower than 32, from the retrospective Korean Acute-on-Chronic Liver Failure (KACLiF) cohort to develop a new prognostic model (training set), and validated it in 419 patients from the prospective KACLiF cohort (validation set). Prognostic factors for death and liver transplantation were analyzed to construct a prognostic model. RESULTS Twenty-one and 24 patients died within 6 months in both sets, respectively. In the training set, the highest area under the curve (AUC) of conventional prognostic models was 0.765, 0.732, and 0.684 for 1-, 3-, and 6-month mortality, respectively. Refractory ascites, vasopressor use, and hyponatremia were independently associated with mortality of cirrhotic patients with Non-SAH. The new model consisted of four variables: past deterioration, neutrophil proportion > 70%, Na < 128 mmol/L, and vasopressor use. It showed the highest accuracy for short-term mortality in the training and validation sets (0.803 and 0.786; 0.797 and 0.776; and 0.789 and 0.721 for 1-, 3-, and 6-month mortality, respectively). CONCLUSION There is a group of patients with high risk among those classified as Non-SAH. The new model will help stratifying cirrhotic patients with Non-SAH more accurately in terms of prognosis. The patients with high Non-SAH score need to monitor closely and might be considered for preemptive liver transplantation. TRIAL REGESTRATION ClinicalTrials.gov identifier: NCT02650011.
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Affiliation(s)
- Tae Hyung Kim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea.
| | - Young Kul Jung
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea
| | - Do Seon Song
- Department of Internal medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Eileen L Yoon
- Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
| | - Hee Yeon Kim
- Department of Internal medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
- Department of Internal medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Seong Hee Kang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Korea University Ansan Hospital, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea
- Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Young Chang
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Baek Gyu Jun
- Department of Internal Medicine, Ulsan University Gangneung Asan Hospital, Gangneung, Korea
- Department of Internal Medicine, Asan Seoul Internal Medicine Clinic, Seoul, Korea
| | - Sung Won Lee
- Department of Internal medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Jung Gil Park
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Ji Won Park
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung-Eun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Tae Yeob Kim
- Department of Internal Medicine, New Hope Internal Medicine Clinic Seoul, Seoul, Korea
| | - Soung Won Jeong
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ki Tae Suk
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, 24253, Gangwon-do, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Won Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jin Mo Yang
- Department of Internal medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, 24253, Gangwon-do, Korea.
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Cai XH, Tang YM, Chen SR, Pang JH, Chong YT, Cao H, Li XH. Prognostic value of neutrophil-to-lymphocyte ratio in end-stage liver disease: A meta-analysis. World J Hepatol 2024; 16:477-489. [PMID: 38577540 PMCID: PMC10989309 DOI: 10.4254/wjh.v16.i3.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) is commonly utilized as a prognostic indicator in end-stage liver disease (ESLD), encompassing conditions like liver failure and decompensated cirrhosis. Nevertheless, some studies have contested the prognostic value of NLR in ESLD. AIM To investigate the ability of NLR to predict ESLD. METHODS Databases, such as Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Weipu, and Wanfang, were comprehensively searched to identify studies published before October 2022 assessing the prognostic ability of NLR to predict mortality in patients with ESLD. Effect sizes were calculated using comprehensive meta-analysis software and SATAT 15.1. RESULTS A total of thirty studies involving patients with end-stage liver disease (ESLD) were included in the evaluation. Among the pooled results of eight studies, it was observed that the Neutrophil-to-Lymphocyte Ratio (NLR) was significantly higher in non-survivors compared to survivors (random-effects model: standardized mean difference = 1.02, 95% confidence interval = 0.67-1.37). Additionally, twenty-seven studies examined the associations between NLR and mortality in ESLD patients, reporting either hazard ratios (HR) or odds ratios (OR). The combined findings indicated a link between NLR and ESLD mortality (random-effects model; univariate HR = 1.07, 95%CI = 1.05-1.09; multivariate HR = 1.07, 95%CI = 1.07-1.09; univariate OR = 1.29, 95%CI = 1.18-1.39; multivariate OR = 1.29, 95%CI = 1.09-1.49). Furthermore, subgroup and meta-regression analyses revealed regional variations in the impact of NLR on ESLD mortality, with Asian studies demonstrating a more pronounced effect. CONCLUSION Increased NLR in patients with ESLD is associated with a higher risk of mortality, particularly in Asian patients. NLR is a useful prognostic biomarker in patients with ESLD.
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Affiliation(s)
- Xiang-Hao Cai
- Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Yun-Ming Tang
- Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Shu-Ru Chen
- Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Jia-Hui Pang
- Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Yu-Tian Chong
- Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Hong Cao
- Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Xin-Hua Li
- Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
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Ju T, Jiang D, Zhong C, Zhang H, Huang Y, Zhu C, Yang S, Yan D. Characteristics of circulating immune cells in HBV-related acute-on-chronic liver failure following artificial liver treatment. BMC Immunol 2023; 24:47. [PMID: 38007423 PMCID: PMC10676598 DOI: 10.1186/s12865-023-00579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/19/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND AND AIM Liver failure, which is predominantly caused by hepatitis B (HBV) can be improved by an artificial liver support system (ALSS). This study investigated the phenotypic heterogeneity of immunocytes in patients with HBV-related acute-on-chronic liver failure (HBV-ACLF) before and after ALSS therapy. METHODS A total of 22 patients with HBV-ACLF who received ALSS therapy were included in the study. Patients with Grade I according to the ACLF Research Consortium score were considered to have improved. Demographic and laboratory data were collected and analyzed during hospitalization. Immunological features of peripheral blood in the patients before and after ALSS were detected by mass cytometry analyses. RESULTS In total, 12 patients improved and 10 patients did not. According to the immunological features data after ALSS, the proportion of circulating monocytes was significantly higher in non-improved patients, but there were fewer γδT cells compared with those in improved patients. Characterization of 37 cell clusters revealed that the frequency of effector CD8+ T (P = 0.003), CD4+ TCM (P = 0.033), CD4+ TEM (P = 0.039), and inhibitory natural killer (NK) cells (P = 0.029) decreased in HBV-ACLF patients after ALSS therapy. Sub group analyses after treatment showed that the improved patients had higher proportions of CD4+ TCM (P = 0.010), CD4+ TEM (P = 0.021), and γδT cells (P = 0.003) and a lower proportion of monocytes (P = 0.012) compared with the non-improved patients. CONCLUSIONS Changes in effector CD8+ T cells, effector and memory CD4+ T cells, and inhibitory NK cells are associated with ALSS treatment of HBV-ACLF. Moreover, monocytes and γδT cells exhibited the main differences when patients obtained different prognoses. The phenotypic heterogeneity of lymphocytes and monocytes may contribute to the prognosis of ALSS and future immunotherapy strategies.
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Affiliation(s)
- Tao Ju
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Daixi Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Chengli Zhong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Huafen Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Yandi Huang
- Department of Laboratory Medicine, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, China
| | - Chunxia Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Shigui Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
| | - Dong Yan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
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Murakami S, Imamura M, Uchida T, Suehiro Y, Namba M, Fujii Y, Uchikawa S, Teraoka Y, Fujino H, Ono A, Nakahara T, Murakami E, Okamoto W, Yamauchi M, Kawaoka T, Miki D, Hayes NC, Tsuge M, Aikata H, Ohira M, Ohdan H, Oka S. Serum interleukin-6 level predicts the prognosis for patients with alcohol-related acute-on-chronic liver failure. Hepatol Int 2023; 17:1225-1232. [PMID: 37101102 DOI: 10.1007/s12072-023-10532-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/01/2023] [Indexed: 04/28/2023]
Abstract
AIM Heavy alcohol consumption is the most common etiology of acute-on-chronic liver failure (ACLF) in Japan. In some patients, ACLF is associated with a fatal outcome in less than 6 months. We evaluated the prognosis of patients with alcohol-related ACLF in our cohort and explored the prognostic factors. METHODS Forty-six patients with alcoholic liver cirrhosis who fulfilled the Japanese diagnostic criteria for ACLF, including those classified as extended and/or probable, were enrolled in this study. Serum concentrations of inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-10, IL-12p70 and TNFα) were measured. We assessed prognosis and identified factors associated with survival. RESULTS During the median 33-day observation period, 19 patients died, and 3 patients underwent living donor liver transplantation. Cumulative survival rates of patients treated without liver transplantation were 69, 48, 41, and 36% at 1, 3, 6, and 12 months, respectively. Eighteen of the 19 deceased patients died within 6 months after ACLF diagnosis. Serum concentrations of inflammatory cytokines were significantly elevated, and patients who underwent liver transplantation or who died within 6 months after admission had significantly higher serum IL-6 levels than the survival group. Multivariate analysis identified IL-6 > 23.3 pg/mL at admission and model for end-stage liver disease (MELD) score ≥ 25 on day 4 of admission as significant independent factors for mortality within 6 months. CONCLUSION Serum IL-6 level and Day-4 MELD were prognostic factors for alcohol-related ACLF. Early liver transplantation is a potential treatment option for patients whose prognosis is expected to be poor.
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Affiliation(s)
- Serami Murakami
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Michio Imamura
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Takuro Uchida
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yosuke Suehiro
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Maiko Namba
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yasutoshi Fujii
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shinsuke Uchikawa
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yuji Teraoka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Hatsue Fujino
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Atsushi Ono
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takashi Nakahara
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Eisuke Murakami
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Wataru Okamoto
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
- Cancer Treatment Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Masami Yamauchi
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Tomokazu Kawaoka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Daiki Miki
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Nelson C Hayes
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Masataka Tsuge
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
- Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Aikata
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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9
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Zheng J, Li J, Zhang Z, Yu Y, Tan J, Liu Y, Gong J, Wang T, Wu X, Guo Z. Clinical Data based XGBoost Algorithm for infection risk prediction of patients with decompensated cirrhosis: a 10-year (2012-2021) Multicenter Retrospective Case-control study. BMC Gastroenterol 2023; 23:310. [PMID: 37704966 PMCID: PMC10500933 DOI: 10.1186/s12876-023-02949-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVES To appraise effective predictors for infection in patients with decompensated cirrhosis (DC) by using XGBoost algorithm in a retrospective case-control study. METHODS Clinical data were retrospectively collected from 6,648 patients with DC admitted to five tertiary hospitals. Indicators with significant differences were determined by univariate analysis and least absolute contraction and selection operator (LASSO) regression. Further multi-tree extreme gradient boosting (XGBoost) machine learning-based model was used to rank importance of features selected from LASSO and subsequently constructed infection risk prediction model with simple-tree XGBoost model. Finally, the simple-tree XGBoost model is compared with the traditional logical regression (LR) model. Performances of models were evaluated by area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. RESULTS Six features, including total bilirubin, blood sodium, albumin, prothrombin activity, white blood cell count, and neutrophils to lymphocytes ratio were selected as predictors for infection in patients with DC. Simple-tree XGBoost model conducted by these features can predict infection risk accurately with an AUROC of 0.971, sensitivity of 0.915, and specificity of 0.900 in training set. The performance of simple-tree XGBoost model is better than that of traditional LR model in training set, internal verification set, and external feature set (P < 0.001). CONCLUSIONS The simple-tree XGBoost predictive model developed based on a minimal amount of clinical data available to DC patients with restricted medical resources could help primary healthcare practitioners promptly identify potential infection.
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Affiliation(s)
- Jing Zheng
- Operation Management Office, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, 401320, China
| | - Jianjun Li
- Department of Cardiothoracic Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, 401320, China
| | - Zhengyu Zhang
- Medical Records Department, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yue Yu
- Senior Bioinformatician Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, 55905, US
| | - Juntao Tan
- Operation Management Office, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, 401320, China
| | - Yunyu Liu
- Medical Records Department, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Jun Gong
- Department of Information Center, the University Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Tingting Wang
- College of Medical Informatics, Chongqing Medical University, Chongqing, 400016, China
| | - Xiaoxin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qing Chun Road, Hangzhou, 310003, Zhejiang, China.
| | - Zihao Guo
- Department of Gastroenterology, Chongqing Banan Cancer Hospital, Chongqing, 400054, China.
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10
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Goyes D, Trivedi HD, Curry MP. Prognostic Models in Acute-on-Chronic Liver Failure. Clin Liver Dis 2023; 27:681-690. [PMID: 37380291 DOI: 10.1016/j.cld.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by severe hepatic dysfunction leading to multiorgan failure in patients with end-stage liver disease. ACLF is a challenging clinical syndrome with a rapid clinical course and high short-term mortality. There is no single uniform definition of ACLF or consensus in predicting ACLF-related outcomes, which makes comparing studies difficult and standardizing management protocols challenging. This review aims to provide insights into the common prognostic models that define and grade ACLF.
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Affiliation(s)
- Daniela Goyes
- Department of Medicine, Loyola Medicine - MacNeal Hospital, Berwyn, IL, USA
| | - Hirsh D Trivedi
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael P Curry
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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11
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Zhou J, Li X, Wang M, Gu C, Liu J. Platelet-to-Monocyte Ratio as a Novel Promising Agent for the Prognosis of Hepatitis B Virus-Associated Decompensated Cirrhosis. Can J Gastroenterol Hepatol 2023; 2023:6646156. [PMID: 37485072 PMCID: PMC10361825 DOI: 10.1155/2023/6646156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023] Open
Abstract
Aim The present study aimed at investigating associations of the platelet-to-monocyte ratio (PMR), a novel hematological indicator of inflammatory responses with 30-day outcomes in patients with HBV-associated decompensated cirrhosis (HBV-DeCi). Methods We recruited 329 patients with HBV-DeCi for this retrospective study and extracted baseline clinical data and laboratory characteristics from medical records. Univariate and multivariate analyses were performed to determine major factors influencing 30-day mortality. Receiver operating characteristic curve analysis was performed to compare the predictive values of prognostic markers. Results During the 30-day follow-up period, 21 (6.4%) patients died. The PMR was significantly different between nonsurvivors and survivors. Lower PMR was found to be associated with an increased risk of 30-day mortality, and PMR (odds ratio: 1.011; 95% CI: 1.003-1.019; P=0.005) was found to be an independent predictor of 30-day mortality in patients with HBV-DeCi with a significant predictive value (AUC = 0.826, 95% CI: 0.781-0.865). The combination of PMR and MELD score could improve prognostic accuracy in these patients (AUC = 0.911, 95% CI: 0.876-0.940). Conclusions Our results demonstrate that low PMR may be an independent predictor of 30-day mortality in patients with HBV-DeCi, and combined with the MELD score, it may be useful to complement other conventional measures to enable effective management of these patients.
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Affiliation(s)
- Jun Zhou
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China
| | - Xin Li
- Department of Laboratory Medicine, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, Jiangsu, China
| | - Min Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China
| | - Chunrong Gu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China
| | - Jingping Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China
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12
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Zhang Y, Chen P, Zhu X. Lymphocyte-to-white blood cell ratio is associated with outcome in patients with hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol 2023; 29:3678-3687. [PMID: 37398886 PMCID: PMC10311607 DOI: 10.3748/wjg.v29.i23.3678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The lymphocyte-to-white blood cell ratio (LWR) is a blood marker of the systemic inflammatory response. The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) remains unclear.
AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.
METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital. Patients were divided into survivor and non-survivor groups according to their 28-d prognosis. The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses. Patients were divided into low- and high-LWR groups according to the cutoff values. Kaplan-Meier analysis was performed according to the level of LWR.
RESULTS During the 28-d follow-up time, 135 patients died, and the mortality rate was 40.90%. The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients. A lower LWR level was an independent risk factor for poor 28-d outcomes (hazard ratio = 0.052, 95% confidence interval: 0.005-0.535). The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh, model for end-stage liver disease, and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores. In addition, the 28-d mortality was higher for patients with LWR < 0.11 than for those with LWR ≥ 0.11.
CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBV-ACLF patients.
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Affiliation(s)
- Yue Zhang
- Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Peng Chen
- Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Xuan Zhu
- Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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13
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Zhang Q, Mao W, He X, Yuan M. High red cell distribution width-to-platelet ratio indicates adverse outcomes for hepatitis B virus-associated decompensated cirrhosis. Biomark Med 2023; 17:189-196. [PMID: 37158064 DOI: 10.2217/bmm-2023-0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Background: This work was designed to determine the association between red cell distribution width-to-platelet ratio (RPR) and 30-day prognosis in hepatitis B virus-associated decompensated cirrhosis (HBV-DC) patients. Methods: A total of 168 HBV-DC patients were included. Independent risk factors for poor prognosis were determined by logistic regression analyses. Results: A total of 21 (12.5%) patients died within 30 days. RPR was higher in nonsurvivors than in survivors. Multivariate analysis identified RPR and Model for End-Stage Liver Disease (MELD) score as independent prognostic predictors, and the predictive value of RPR was similar to that of the MELD score. Moreover, combining RPR with the MELD score further improved the predictive value for mortality. Conclusion: RPR has potential as a reliable tool for the prediction of poor prognosis in HBV-DC patients.
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Affiliation(s)
- Qiu Zhang
- Department of Clinical Laboratory, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou, 312400, China
| | - WeiLin Mao
- Department of Clinical Laboratory, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Xia He
- Department of Clinical Laboratory, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou, 312400, China
| | - ManChun Yuan
- Department of Clinical Laboratory, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou, 312400, China
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14
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Yang W, Guo G, Mao L, Hui Y, Wang X, Yu Z, Sun M, Li Y, Fan X, Cui B, Jiang K, Sun C. Comparison of the GLIM criteria with specific screening tool for diagnosing malnutrition in hospitalized patients with cirrhosis: A descriptive cross-sectional study. JPEN J Parenter Enteral Nutr 2023; 47:310-321. [PMID: 36128998 DOI: 10.1002/jpen.2452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/04/2022] [Accepted: 09/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) has been built to diagnose malnutrition; however, its validity among patients with cirrhosis remains enigmatic. We aimed to investigate the prevalence of malnutrition according to GLIM criteria and compare the differences by using a specific screening tool. METHODS We conducted a descriptive cross-sectional study analyzing hospitalized patients. The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) was chosen as the screening tool. Estimated prevalence was shown with and without the initial screening process. Diverse combinations of phenotypic and etiologic criteria and distinct body mass index (BMI) cutoffs were applied to detect frequency of malnourished patients with cirrhosis. RESULTS Overall, 363 patients were recruited (median age, 64 years; 51.2% female). The prevalence of malnutrition according to GLIM criteria with and without RFH-NPT screening was 33.3% and 36.4%, respectively. Low BMI and inflammation represented the most prevalent combination resulting in a malnutrition diagnosis (42.4%), followed by low BMI and reduced food intake (39.4%). By contrast, the least prevalence was found when combining reduced muscle mass with inflammation to diagnose malnutrition. Furthermore, the frequency of malnourished and well-nourished participants was not statistically different when using divergent BMI reference values across the study population. CONCLUSIONS GLIM criteria may serve a specific proxy to diagnose malnutrition, along with RFH-NPT screening. Relevant investigation is required to report on the applied combination of phenotypic/etiologic criteria, taking into consideration the marked impact of different models. More attempts are warranted to delineate the prognostic role of GLIM criteria in the context of cirrhosis.
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Affiliation(s)
- Wanting Yang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Gaoyue Guo
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Lihong Mao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoyu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Zihan Yu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingyu Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Yifan Li
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Binxin Cui
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
| | - Kui Jiang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China.,Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, China
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15
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Zou J, Li H, Deng G, Wang X, Zheng X, Chen J, Meng Z, Zheng Y, Gao Y, Qian Z, Liu F, Lu X, Shi Y, Shang J, Huang Y, Chen R. A novel prognostic nomogram for older patients with acute-on-chronic liver diseases (AoCLD): a nationwide, multicentre, prospective cohort study. Age Ageing 2023; 52:afac313. [PMID: 36626326 PMCID: PMC9831261 DOI: 10.1093/ageing/afac313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/03/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND the incidence of acute-on-chronic liver disease (AoCLD) is increasing. OBJECTIVE to investigate the clinical features and risk factors of AoCLD and construct an effective prognostic nomogram model for older patients with AoCLD. METHODS data from 3,970 patients included in the CATCH-LIFE study were used, including 2,600 and 1,370 patients in the training and validation sets, respectively. Multivariate Cox regression analyses were performed to identify predictive risk factors in older individuals, and an easy-to-use nomogram was established. Performance was assessed using area under the curve, calibration plots and decision curve analysis (DCA). RESULTS of the 3,949 patients with AoCLD, 809 were older with a higher proportion of autoimmune-related abnormalities, hepatitis C viral infection and schistosomiasis. In the older patient group, the incidence of cirrhosis, hepatic encephalopathy (HE), infection, ascites and gastrointestinal bleeding; neutrophil-to-lymphocyte ratio (NLR), aspartate-to-alanine transaminase ratio (AST/ALT), creatinine and blood urea nitrogen levels were higher, whereas incidence of acute-on-chronic liver failure, white blood cell, platelet and haemoglobin levels; albumin, total bilirubin (TB), AST and ALT levels; international normalised ratio (INR), estimated glomerular filtration rate and blood potassium levels were lower than in the younger group. The final nomogram was developed based on the multivariate Cox analysis in training cohort using six risk factors: ascites, HE grades, NLR, TB, INR and AST/ALT. Liver transplantation-free mortality predictions were comparable between the training and validation sets. DCA showed higher net benefit for the nomograph than the treat-all or treat-none strategies, with wider threshold probabilities ranges. CONCLUSIONS our analysis will assist clinical predictions and prognoses in older patients with AoCLD.
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Affiliation(s)
- Ju Zou
- Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China
| | - Hai Li
- Department of Gastroenterology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
| | - Guohong Deng
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xianbo Wang
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xin Zheng
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Department of Infectious Diseases, Institute of Infection and Immunology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jinjun Chen
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhongji Meng
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yubao Zheng
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanhang Gao
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Department of Hepatology, The First Hospital of Jilin University, Changchun, China
| | - Zhiping Qian
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China
| | - Feng Liu
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
| | - Xiaobo Lu
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yu Shi
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia Shang
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
- Department of Infectious Diseases, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Yan Huang
- Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China
| | - Ruochan Chen
- Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China
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16
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Abstract
OBJECTIVE This study aimed to explore the prognostic value of the lymphocyte (LYM)-to-white blood cell (WBC) ratio (LWR) in patients with decompensated liver cirrhosis (DLC). METHODS This study was conducted by recruiting 214 patients with DLC with different aetiologies (development cohort). Receiver operating characteristic (ROC) curve analyses were used to assess the predictive accuracy of the LWR, and Youden's index was used to determine the optimal cut-off values of the LWR based on the ROC curve. Next, patients were divided into high- and low-LWR groups according to the cut-off values. Multivariate logistic analyses were performed to determine the independent predictors for the 1-, 3- and 6-month mortality. Restricted cubic spline (RCS) was used to determine and visualize the association between LWR and the risk of death. We verified the predictive ability of LWR in the validation cohort of 139 patients. RESULTS In the development cohort, there were 16 (7.5%), 22 (10.3%) and 30 patients (14.0%) who died at 1, 3 and 6 months, respectively. The LWR was significantly lower in non-survivors than in survivors and was an independent predictor of poor outcomes. The ROC analyses with the Delong test showed that the LWR had comparable predictive power with the Model for End-Stage Liver Disease (MELD) score, neutrophil-to-LYM ratio (NLR) and Chronic Liver Failure consortium score for acute decompensated (CLIF-C ADs). RCS showed a non-linear relationship between the LWR and the risk of death at 1 and 3 months, whereas a linear relationship was observed between the LWR and the risk of death at 6 months. We verified that the decreased LWR was an independent predictor of adverse outcomes at 3-, and 6-month follow-up endpoints in the validation cohort. CONCLUSIONS Our findings indicate that a lower LWR is an independent factor for unfavourable outcomes and may serve as a potential novel prognostic predictor in patients with DLC.KEY MESSAGESThis study is the first report on the prognostic value of the lymphocyte (LYM)-to-white blood cell (WBC) ratio (LWR) in patients with decompensated liver cirrhosis (DLC).Decreased LWR is an independent factor for adverse outcomes in patients with DLC.
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Affiliation(s)
- Yanan Xie
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, PR China
| | - Chiyi He
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, PR China
| | - Wei Wang
- Department of Gastroenterology, Yijishan Hospital of Wannan Medical College, Wuhu, PR China
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Wu Y, Zhang M, Ni T, Zhang X, Wang R, Zhu L, Du J, Zhu Y, Zhao Y, Yang Y. Prognosis of systemic inflammation at an early stage of cirrhosis using the monocyte-to-lymphocyte ratio during malnutrition risk screening: a prospective cohort study. Postgrad Med 2022; 134:801-809. [PMID: 35929972 DOI: 10.1080/00325481.2022.2110600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine whether the monocyte-to-lymphocyte ratio (MLR), as a systemic inflammation index, predicts malnutrition risk during the early stages of cirrhosis. METHODS We conducted a single-center prospective cohort study, enrolling patients from June 2016 to September 2020. The patients underwent malnutrition risk assessments upon admission. The patients were classified into five clinical stages according to portal hypertension. The malnutrition risk was scored using the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) and validated by the Nutritional Risk Screening 2002 (NRS-2002) or Liver Disease Undernutrition Screening Tool (LDUST). Routine clinical laboratory measurements were performed to calculate the MLR, Child-Turcotte-Pugh (CTP) class, and model for end-stage liver disease (MELD) score. The patients were followed up for 2 years. RESULTS Among the 154 patients with cirrhosis, 60 had compensated cirrhosis and 94 had decompensated cirrhosis. The optimal cutoff value of the MLR, >0.4, was effective in predicting malnutrition related to death or liver transplantation. Those with a high malnutrition risk defined by the NRS-2002 or RFH-NPT had a higher MLR than those with a low malnutrition risk. For patients with class A CTP cirrhosis or a MELD score of <10, an MLR cutoff of <0.4 significantly distinguished more patients with a low malnutrition risk than those with a high malnutrition risk. Both the RFH-NPT score and MLR increased significantly across the decompensated cirrhosis substages. Interestingly, the MLR exhibited a positive correlation with the RFH-NPT score until varices appeared, but the correlation was the highest at the substage of a history of variceal bleeding (r = 0.714, P = 0.009). Multivariable analysis demonstrated that an MLR of >0.4 was an independent factor for malnutrition risk by screening with the RFH-NPT, and this was confirmed using the LDUST and NRS-2002. CONCLUSION Immune-related inflammatory dysfunction predicts malnutrition risk during the early stages of cirrhosis.
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Affiliation(s)
- Yuchao Wu
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengmeng Zhang
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tianzhi Ni
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoli Zhang
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruojing Wang
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Li Zhu
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Juan Du
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yage Zhu
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yingren Zhao
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuan Yang
- Department of Infectious Diseases and Hepatopathy, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Ballester MP, Sittner R, Jalan R. Alcohol and Acute-on-Chronic Liver Failure. J Clin Exp Hepatol 2022; 12:1360-1370. [PMID: 36157143 PMCID: PMC9499845 DOI: 10.1016/j.jceh.2021.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022] Open
Abstract
Acute-on-chronic liver failure (ACLF) is a clinical syndrome that occurs in patients with cirrhosis and is characterised by acute deterioration, organ failure and high short-term mortality. Alcohol is one of the leading causes of ACLF and the most frequently reported aetiology of underlying chronic liver disease. Among patients with alcoholic hepatitis (AH), ACLF is a frequent and severe complication. It is characterised by both immune dysfunction associated to an increased risk of infection and high-grade systemic inflammation that ultimately induce organ failure. Diagnosis and severity of ACLF determine AH prognosis, and therefore, ACLF prognostic scores should be used in severe AH with organ failure. Corticosteroids remain the first-line treatment for severe AH but they seem insufficient when ACLF is associated. Novel therapeutic targets to contain the excessive inflammatory response and reduce infection have been identified and are under investigation. With liver transplantation remaining one of the most effective therapies for severe AH and ACLF, adequate organ allocation represents a growing challenge. Hence, a clear understanding of the pathophysiology, clinical implications and management strategies of ACLF in AH is essential for hepatologists, which is narrated briefly in this review.
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Key Words
- ACLF, Acute-on-chronic liver failure
- AH, alcoholic hepatitis
- ALT, alanine aminotransferase
- APASL, Asian Pacific Association for the Study of the Liver
- AST, aspartate aminotransferase
- DAMPs, damage-associated molecular patterns
- EASL-CLIF, European Association for the Study of the Liver – Chronic Liver Failure Consortium
- GAHS, Glasgow alcoholic hepatitis score
- IL, interleukin
- INR, international normalised ratio
- MELD, model for end-stage liver disease
- NAC, N-acetylcysteine
- NACSELD, North American Consortium for the Study of End-Stage Liver Disease
- PAMPs, pathogen-associated molecular patterns
- TNF, tumour necrosis factor
- WGO, World Gastroenterology Organization
- acute-on-chronic liver failure
- alcoholic hepatitis
- cirrhosis
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Affiliation(s)
- Maria Pilar Ballester
- Digestive Disease Department, University Clinic Hospital of Valencia, Blasco Ibañez Av, 17, Valencia, 46010, Spain
- INCLIVA Biomedical Research Institute, Menéndez y Pelayo St., 4, Valencia, 46010, Spain
| | - Richard Sittner
- Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum, Charitéplatz 1 Berlin, 10117, Germany
| | - Rajiv Jalan
- Liver Failure Group, Institute for Liver and Disease Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, United Kingdom
- European Foundation for the Study of Chronic Liver Failure (EF Clif) and the European Association for the Study of the Liver–Chronic Liver Failure (EASL-CLIF) Consortium, Travessera de Gràcia St., 11, Barcelona, 08021, Spain
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Neutrophil-lymphocyte ratio and the risk of 30-day mortality in patients with overt hepatic encephalopathy. Eur J Gastroenterol Hepatol 2022; 34:529-536. [PMID: 35352702 DOI: 10.1097/meg.0000000000002368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
AIM Patients with overt hepatic encephalopathy (OHE) have an increased risk of adverse outcomes. However, the relationship between neutrophil to lymphocyte ratio (NLR) and the 30-day risk of death in patients with OHE has not been well evaluated. METHODS We retrospectively analyzed 1301 patients with OHE at Beijing Ditan Hospital between August 2008 and December 2018. After adjustment for major risk factors, Cox regression analysis and restricted cubic splines were used to analyze the relation between NLR and 30-day mortality. The 30-day survival was calculated by Kaplan-Meier method. RESULTS All patients were divided into four subgroups on the basis of the quartiles of the baseline NLR distribution (< 2.5, 2.5-4.3, 4.3-7.5, >7.5). The 30-day mortality rates were 7.8%, 12.7%, 19.5% and 34.1%, respectively (P < 0.001). Compared with the lowest quartile, the increase in the NLR was associated with an increase risk of 30-day mortality after multivariable adjustment (NLR 2.5-4.3: adjusted hazard ratio [AHR], 1.17 (95% confidence interval [CI], 0.70-1.95); NLR 4.3-7.5: AHR, 1.58 (95% CI, 1.01-2.47); NLR > 7.5: AHR, 2.32 (95% CI, 1.50-3.57). A nonlinear association between NLR and the adjusted probability of 30-day mortality was observed. Elevated NLR was correlated with increased 30-day mortality in patients with OHE across different subgroups (HR >1.0). CONCLUSION An elevated NLR is independently associated with a higher risk of 30-day mortality in patients with OHE.
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20
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Kim JH, Kim SE, Song DS, Kim HY, Yoon EL, Kim TH, Jung YK, Suk KT, Jun BG, Yim HJ, Kwon JH, Lee SW, Kang SH, Kim MY, Jeong SW, Jang JY, Yoo JJ, Kim SG, Jin YJ, Cheon GJ, Kim BS, Seo YS, Kim HS, Sinn DH, Chung WJ, Kim HY, Lee HA, Nam SW, Kim IH, Suh JI, Kim JH, Chae HB, Sohn JH, Cho JY, Kim YJ, Yang JM, Park JG, Kim W, Cho HC, Kim DJ. Platelet-to-White Blood Cell Ratio Is Associated with Adverse Outcomes in Cirrhotic Patients with Acute Deterioration. J Clin Med 2022; 11:2463. [PMID: 35566588 PMCID: PMC9103428 DOI: 10.3390/jcm11092463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The platelet-to-white blood cell ratio (PWR) is a hematologic marker of the systemic inflammatory response. Recently, the PWR was revealed to have a role as an independent prognostic factor for mortality in patients with hepatitis B virus (HBV)-related acute-on-chronic failure (ACLF) and HBV-related liver cirrhosis (LC) with acute decompensation (AD). However, the prognostic role of the PWR still needs to be investigated in LC patients with AD. In this study, we analyzed whether the PWR could stratify the risk of adverse outcomes (death or liver transplantation (LT)) in these patients. Methods: A prospective cohort of 1670 patients with AD of liver cirrhosis ((age: 55.2 ± 7.8, male = 1226 (73.4%)) was enrolled and evaluated for 28-day and overall adverse outcomes. Results: During a median follow-up of 8.0 months (range, 1.9−15.5 months), 424 (25.4%) patients had adverse outcomes (death = 377, LT = 47). The most common etiology of LC was alcohol use (69.7%). The adverse outcome rate was higher for patients with a PWR ≤ 12.1 than for those with a PWR > 12.1. A lower PWR level was a prognostic factor for 28-day adverse outcomes (PWR: hazard ratio 1.707, p = 0.034) when adjusted for the etiology of cirrhosis, infection, ACLF, and the MELD score. In the subgroup analysis, the PWR level stratified the risk of 28-day adverse outcomes regardless of the presence of ACLF or the main form of AD but not for those with bacterial infection. Conclusions: A lower PWR level was associated with 28-day adverse outcomes, indicating that the PWR level can be a useful and simple tool for stratifying the risk of 28-day adverse outcomes in LC patients with AD.
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Affiliation(s)
- Jung-Hee Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (J.-H.K.); (K.-T.S.); (H.-S.K.); (D.-J.K.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Sung-Eun Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (J.-H.K.); (K.-T.S.); (H.-S.K.); (D.-J.K.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Do-Seon Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-S.S.); (H.-Y.K.); (J.-H.K.); (S.-W.L.); (J.-M.Y.)
| | - Hee-Yeon Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-S.S.); (H.-Y.K.); (J.-H.K.); (S.-W.L.); (J.-M.Y.)
| | - Eileen L. Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (E.L.Y.); (J.-H.S.)
| | - Tae-Hyung Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea; (T.-H.K.); (Y.-K.J.); (H.-J.Y.); (Y.-S.S.); (J.-H.K.)
| | - Young-Kul Jung
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea; (T.-H.K.); (Y.-K.J.); (H.-J.Y.); (Y.-S.S.); (J.-H.K.)
| | - Ki-Tae Suk
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (J.-H.K.); (K.-T.S.); (H.-S.K.); (D.-J.K.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Baek-Gyu Jun
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul 01757, Korea; (B.-G.J.); (S.-H.K.)
| | - Hyung-Joon Yim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea; (T.-H.K.); (Y.-K.J.); (H.-J.Y.); (Y.-S.S.); (J.-H.K.)
| | - Jung-Hyun Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-S.S.); (H.-Y.K.); (J.-H.K.); (S.-W.L.); (J.-M.Y.)
| | - Sung-Won Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-S.S.); (H.-Y.K.); (J.-H.K.); (S.-W.L.); (J.-M.Y.)
| | - Seong-Hee Kang
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul 01757, Korea; (B.-G.J.); (S.-H.K.)
| | - Moon-Young Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Soung-Won Jeong
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (S.-W.J.); (J.-Y.J.)
| | - Jae-Young Jang
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul 04401, Korea; (S.-W.J.); (J.-Y.J.)
| | - Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (J.-J.Y.); (S.-G.K.)
| | - Sang-Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (J.-J.Y.); (S.-G.K.)
| | - Young-Joo Jin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon 22212, Korea;
| | - Gab-Jin Cheon
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung 25440, Korea;
| | - Byung-Seok Kim
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu 42472, Korea;
| | - Yeon-Seok Seo
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea; (T.-H.K.); (Y.-K.J.); (H.-J.Y.); (Y.-S.S.); (J.-H.K.)
| | - Hyung-Su Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (J.-H.K.); (K.-T.S.); (H.-S.K.); (D.-J.K.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
| | - Dong-Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea;
| | - Woo-Jin Chung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Hwi-Young Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Korea; (H.-Y.K.); (H.-A.L.)
| | - Han-Ah Lee
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07804, Korea; (H.-Y.K.); (H.-A.L.)
| | - Seung-Woo Nam
- Department of Internal Medicine, National Medical Center, Seoul 04564, Korea;
| | - In-Hee Kim
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju 54896, Korea;
| | - Jung-Il Suh
- Department of Gastroenterology, Dongguk University College of Medicine, Kyongju 38067, Korea;
| | - Ji-Hoon Kim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, Korea; (T.-H.K.); (Y.-K.J.); (H.-J.Y.); (Y.-S.S.); (J.-H.K.)
| | - Hee-Bok Chae
- Department of Internal Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju 28644, Korea;
| | - Joo-Hyun Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea; (E.L.Y.); (J.-H.S.)
| | - Ju-Yeon Cho
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju 61452, Korea;
| | - Yoon-Jun Kim
- Department of Internal Medicine, Liver Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Jin-Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (D.-S.S.); (H.-Y.K.); (J.-H.K.); (S.-W.L.); (J.-M.Y.)
| | - Jung-Gil Park
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, Korea;
| | - Won Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, Korea;
| | - Hyun-Chin Cho
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, Korea;
| | - Dong-Joon Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 24252, Korea; (J.-H.K.); (K.-T.S.); (H.-S.K.); (D.-J.K.)
- Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea
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Prognostic value of neutrophil-to-lymphocyte ratio in cirrhosis patients undergoing transjugular intrahepatic portosystemic shunt. Eur J Gastroenterol Hepatol 2022; 34:435-442. [PMID: 34750323 DOI: 10.1097/meg.0000000000002295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS The neutrophil-to-lymphocyte-ratio (NLR) is used as an inflammatory index and has proven to be an accurate prognostic indicator for decompensated cirrhotics; however, its role in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) has not been evaluated. We examined whether NLR is associated with mortality in decompensated cirrhosis patients undergoing TIPS. METHODS We performed a retrospective review of 268 decompensated cirrhotics who underwent TIPS from January 2011 to December 2015 at an academic medical center. NLR, patient demographics, manifestations of cirrhosis, TIPS indications and mortality were recorded. Univariate and multivariate Cox regression analyses for prognostic factors associated with 30-day and 90-day post TIPS mortality were performed. RESULTS A total of 129 (48%) patients received TIPS for refractory ascites with 79 (29%) for variceal bleeding, 14 (5%) for hepatic hydrothorax, and 46 (17%) for other indications. Cirrhosis etiology included hepatitis C (36%), alcohol (28%), nonalcoholic steatohepatitis (20%), or other (15%). Median NLR was 4.42 (IQR 2.75-7.19). Univariate and multivariate analysis showed NLR as an independent predictive factor of 30-day and 90-day mortality. Furthermore, in patients with a Model of End-Stage Liver Disease (MELD) ≤ 15, NLR is superior to MELD/MELD-Na score in predicting 30-day and 90-day mortality. In patients with MELD > 15, MELD/MELD-Na score is superior to NLR. CONCLUSION Our data indicate that elevated NLR independently predicts 30-day and 90-day mortality. In patients with a MELD ≤ 15, NLR is a better prognostic factor than MELD or MELD-Na in predicting short-term mortality.
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Carranza C, Carreto-Binaghi LE, Guzmán-Beltrán S, Muñoz-Torrico M, Torres M, González Y, Juárez E. Sex-Dependent Differential Expression of Lipidic Mediators Associated with Inflammation Resolution in Patients with Pulmonary Tuberculosis. Biomolecules 2022; 12:biom12040490. [PMID: 35454079 PMCID: PMC9025322 DOI: 10.3390/biom12040490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
There is a sex bias in tuberculosis’s severity, prevalence, and pathogenesis, and the rates are higher in men. Immunological and physiological factors are fundamental contributors to the development of the disease, and sex-related factors could play an essential role in making women more resistant to severe forms of the disease. In this study, we evaluated sex-dependent differences in inflammatory markers. Serum samples were collected from 34 patients diagnosed with pulmonary TB (19 male and 15 female) and 27 healthy controls (18 male and 9 female). Cytokines IL2, IL4, IL6, IL8, IL10, IFNγ, TNFα, and GM-CSF, and eicosanoids PGE2, LTB4, RvD1, and Mar1 were measured using commercially available immunoassays. The MDA, a product of lipidic peroxidation, was measured by detecting thiobarbituric-acid-reactive substances (TBARS). Differential inflammation patterns between men and women were observed. Men had higher levels of IL6, IL8, and TNFα than women. PGE2 and LTB4 levels were higher in patients than healthy controls, but there were no differences for RvD1 and Mar1. Women had higher RvD1/PGE2 and RvD1/LTB4 ratios among patients. RvD1 plays a vital role in resolving the inflammatory process of TB in women. Men are the major contributors to the typical pro-inflammatory profile observed in the serum of tuberculosis patients.
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Affiliation(s)
- Claudia Carranza
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Laura Elena Carreto-Binaghi
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Silvia Guzmán-Beltrán
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
| | - Marcela Muñoz-Torrico
- Servicio Clínico de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico;
| | - Martha Torres
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Yolanda González
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
| | - Esmeralda Juárez
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
- Correspondence:
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Low Hemoglobin-to-Red Cell Distribution Width Ratio Is Associated with Mortality in Patients with HBV-Related Decompensated Cirrhosis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5754790. [PMID: 35198637 PMCID: PMC8860564 DOI: 10.1155/2022/5754790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/15/2022]
Abstract
Background The prognostic role of hemoglobin-to-red blood cell distribution width ratio (HRR) in HBV-related decompensated cirrhosis (HBV-DeCi) has not been established. The present study is aimed at determining the potential of HRR as a predictive factor for the prognosis of HBV-DeCi patients. Methods The study included 177 HBV-DeCi patients. The clinical outcome was death at 30 days. Multivariate regression analysis and receiver operating characteristic curve analysis were applied to assess the predictive value of HRR for poor outcomes. Results A total of 26 patients (14.7%) had died by 30 days. Patients with unfavorable outcomes had lower HRR than patients with favorable outcomes. Multivariate analysis revealed that HRR and Model for End-Stage Liver Disease (MELD) score were independently associated with poor outcomes. Combination of HRR and MELD score may improve prognostic accuracy in HBV-DeCi. Conclusions The present findings indicate that low HRR may be a promising predictor for mortality in HBV-DeCi patients.
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Wu J, Shi C, Sheng X, Xu Y, Zhang J, Zhao X, Yu J, Shi X, Li G, Cao H, Li L. Prognostic Nomogram for Patients with Hepatitis E Virus-related Acute Liver Failure: A Multicenter Study in China. J Clin Transl Hepatol 2021; 9:828-837. [PMID: 34966646 PMCID: PMC8666371 DOI: 10.14218/jcth.2020.00117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/14/2021] [Accepted: 04/16/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIMS Timely and effective assessment scoring systems for predicting the mortality of patients with hepatitis E virus-related acute liver failure (HEV-ALF) are urgently needed. The present study aimed to establish an effective nomogram for predicting the mortality of HEV-ALF patients. METHODS The nomogram was based on a cross-sectional set of 404 HEV-ALF patients who were identified and enrolled from a cohort of 650 patients with liver failure. To compare the performance with that of the model for end-stage liver disease (MELD) scoring and CLIF-Consortium-acute-on-chronic liver failure score (CLIF-C-ACLFs) models, we assessed the predictive accuracy of the nomogram using the concordance index (C-index), and its discriminative ability using time-dependent receiver operating characteristics (td-ROC) analysis, respectively. RESULTS Multivariate logistic regression analysis of the development set carried out to predict mortality revealed that γ-glutamyl transpeptidase, albumin, total bilirubin, urea nitrogen, creatinine, international normalized ratio, and neutrophil-to-lymphocyte ratio were independent factors, all of which were incorporated into the new nomogram to predict the mortality of HEV-ALF patients. The area under the curve of this nomogram for mortality prediction was 0.671 (95% confidence interval: 0.602-0.740), which was higher than that of the MELD and CLIF-C-ACLFs models. Moreover, the td-ROC and decision curves analysis showed that both discriminative ability and threshold probabilities of the nomogram were superior to those of the MELD and CLIF-C-ACLFs models. A similar trend was observed in the validation set. CONCLUSIONS The novel nomogram is an accurate and efficient mortality prediction method for HEV-ALF patients.
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Affiliation(s)
- Jian Wu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Laboratory Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cuifen Shi
- Department of Infectious Disease, The Second People’s Hospital of Yancheng City, Yancheng, Jiangsu, China
| | - Xinyu Sheng
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanping Xu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinrong Zhang
- Department of Laboratory Medicine, The People’s Hospital of Dafeng City, Yancheng, Jiangsu, China
| | - Xinguo Zhao
- Department of Respiration, The Fifth People’s Hospital of Wuxi, Wuxi, Jiangsu, China
| | - Jiong Yu
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinhui Shi
- Department of Laboratory Medicine, The First People’s Hospital of Yancheng City, Yancheng, Jiangsu, China
| | - Gongqi Li
- Department of Clinical Laboratory, Linyi Traditional Hospital, Linyi, Shandong, China
| | - Hongcui Cao
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, Hangzhou, Zhejiang, China
| | - Lanjuan Li
- State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Xia M, Chen H, Chen T, Xue P, Dong X, Lin Y, Ma D, Zhou W, Shi W, Li H. Transcriptional Networks Identify BRPF1 as a Potential Drug Target Based on Inflammatory Signature in Primary Lower-Grade Gliomas. Front Oncol 2021; 11:766656. [PMID: 34926268 PMCID: PMC8674185 DOI: 10.3389/fonc.2021.766656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/15/2021] [Indexed: 12/26/2022] Open
Abstract
Gliomas are the most common tumors of the central nervous system and are classified into grades I-IV based on their histological characteristics. Lower-grade gliomas (LGG) can be divided into grade II diffuse low-grade gliomas and grade III moderate gliomas and have a relatively good prognosis. However, LGG often develops into high-grade glioma within a few years. This study aimed to construct and identify the prognostic value of an inflammatory signature and discover potential drug targets for primary LGG. We first screened differentially expressed genes in primary LGG (TCGA) compared with normal brain tissue (GTEx) that overlapped with inflammation-related genes from MSigDB. After survival analysis, nine genes were selected to construct an inflammatory signature. LGG patients with a high inflammatory signature score had a poor prognosis, and the inflammatory signature was a strong independent prognostic factor in both the training cohort (TCGA) and validation cohort (CGGA). Compared with the low-inflammatory signature group, differentially expressed genes in the high-inflammatory signature group were mainly enriched in immune-related signaling pathways, which is consistent with the distribution of immune cells in the high- and low-inflammatory signature groups. Integrating driver genes, upregulated genes and drug targets data, bromodomain and PHD finger-containing protein 1 (BRPF1) was selected as a potential drug target. Inhibition of BRPF1 function or knockdown of BRPF1 expression attenuated glioma cell proliferation and colony formation.
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Affiliation(s)
- Mingyang Xia
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Huiyao Chen
- Center for Molecular Medicine, Children's Hospital of Fudan University, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Tong Chen
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Ping Xue
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai, China
| | - Xinran Dong
- Center for Molecular Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Yifeng Lin
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Duan Ma
- Key Laboratory of Neonatal Diseases, Division of Neonatology, Children's Hospital of Fudan University, Ministry of Health, Shanghai, China
| | - Wenhao Zhou
- Center for Molecular Medicine, Children's Hospital of Fudan University, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,Center for Molecular Medicine, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences and Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Shi
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai, China
| | - Hao Li
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai, China
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26
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Neutrophil-lymphocyte ratio and the risk of hepatocellular carcinoma in patients with hepatitis B-caused cirrhosis. Eur J Gastroenterol Hepatol 2021; 33:e686-e692. [PMID: 34074986 DOI: 10.1097/meg.0000000000002217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM The neutrophil-to-lymphocyte ratio (NLR) has been reported as a prognostic marker of hepatocellular carcinoma (HCC); however, the relationship between NLR and risk of HCC occurrence has yet to be systematically elucidated. We aimed to investigate the association between NLR and HCC risk in patients with hepatitis B-caused cirrhosis (HBC) undergoing antiviral therapy. METHODS A total of 1599 patients with HBC receiving entecavir or tenofovir at three tertiary hospitals between June 2014 and November 2017 were included. Cox proportional hazards regression was used to identify the association between NLR and risk of HCC occurrence by adjusting for potential risk factors. The cumulative incidence of HCC was evaluated using Kaplan-Meier analysis. RESULTS At study enrollment, the median NLR was 2.0 (interquartile range, 1.4-3.0). The 3-year cumulative probabilities of HCC were 4.8, 8.4, 13.2, and 18.0% across the NLR quartiles, respectively (P < 0.001). Compared with the lowest quartile, higher NLR correlated with an increased HCC occurrence [NLR 1.4-2.0: adjusted hazard ratio (aHR), 1.18 (95% confidence interval (CI), 1.11-1.25); NLR 2.0-3.0: aHR, 2.09 (95% CI, 1.19-3.66); NLR > 3.0: aHR, 2.80 (95% CI, 1.59-4.95); P for trend = 0.001] in the fully adjusted models. In the subgroup analysis, elevated NLR was associated with increased HCC risk, regardless of stratification criteria. CONCLUSION Elevated NLR is an independent risk factor for HCC occurrence in patients with HBC undergoing antiviral therapy.
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Rui F, Yang H, Guo Z, Ge Z, Hu X, Zhang L, Xue Q, Chen H, Xu Y, Tan M, Qin C, He Z, Li J. Derivation and validation of prognostic models for predicting survival outcomes in Acute-on-chronic liver failure patients. J Viral Hepat 2021; 28:1719-1728. [PMID: 34496100 DOI: 10.1111/jvh.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 12/09/2022]
Abstract
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associated with high bacterial infection (BI) and short-term mortality. However, many ACLF prognostic predictive modelsare complicated. The aim of this study is to develop prognostic models for ACLF patients to predict BI and mortality. We retrospective recruited 263 patients with ACLF from Shandong Provincial Hospital and Taizhou Enze Medical Center (Group) Enze Hospital. ACLF was defined according to the Asian Pacific Association for the Study of the Liver (APASL) criteria. Multivariable logistic regression was used to derive prediction models for occurring BI and 28-day mortality in ACLF patients. Ninety seven of 263 patients (37%) occurred BI and 41 of 155 (26%) died within 28 days of admission. C-reactive protein (CRP), glucose, and albumin were the independent predictors for occurring BI during the hospital stay. We also found that hepatic encephalopathy (HE), prothrombin time, activated partial thromboplastin time (APRI), and glucose were the independent predictors of 28-day mortality of ACLF patients. Using logistic regression model, we generated a new modified MELD model (M-MELD) by incorporating HE, APRI, and glucose. AUC of M-MELD model was 0.871, which were significantly higher than MELD score (AUC:0.734), MELD-Na score (AUC:0.742), and integrated MELD score (iMELD) (AUC:0.761). HE, MELD score, APRI, and blood glucose were independent risk factors for 28-day mortality of ACLF patients. The modified MELD model (M-MELD) by incorporating HE, APRI, and glucose has better discriminative performances compared with MELD in predicting 28-day mortality.
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Affiliation(s)
- Fajuan Rui
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong Frist Medical University, Ji'nan, China
| | - Hongli Yang
- Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Zhaoyang Guo
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong Frist Medical University, Ji'nan, China
| | - Zhengming Ge
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Xinyu Hu
- Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Lulu Zhang
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Qi Xue
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong Frist Medical University, Ji'nan, China
| | - Haiping Chen
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Yayun Xu
- Department of Infectious Disease, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, China
| | - Meng Tan
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China
| | - Chengyong Qin
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong Frist Medical University, Ji'nan, China
| | - Zebao He
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China.,Department of Infectious Diseases, Taizhou Enze Medical Center (Group), Enze Hospital, Taizhou, China
| | - Jie Li
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, China
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28
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Han JB, Shu QH, Zhang YF, Yi YX. Predictive Value of Inflammation Biomarkers in Patients with Portal Vein Thrombosis. J Clin Transl Hepatol 2021; 9:384-391. [PMID: 34221924 PMCID: PMC8237143 DOI: 10.14218/jcth.2020.00159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/09/2021] [Accepted: 02/26/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS To investigate the usefulness of inflammation biomarkers to serve as a predictors of portal vein thrombosis (PVT) postoperatively (post) in patients with portal hypertension after splenectomy and periesophagogastric devascularization. METHODS A total of 177 liver cirrhosis patients were recruited from January 2013 to December 2017. They were divided into a PVT group (n=71) and a non-PVT group (n=106), according to ultrasound examination findings at 7-day post. Inflammation biomarkers involving platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), red blood cell distribution width-to-platelet ratio(RPR), mean platelet volume-to-platelet ratio (MPR) preoperatively (pre) and at 1, 3, 7-days post were recorded. RESULTS The univariate logistic regression analysis indicated that PLR (pre) (odds ratio (OR)=3.963, 95% confidence interval (CI)=2.070-7.587, p<0.000), MLR (pre) (OR=2.760, 95% CI=1.386-5.497, p=0.004), PLR (post-day 7) (OR=3.345, 95% CI=1.767-6.332, p=0.000) were significantly associated with the presence of PVT. The multivariate logistic regression analysis results indicated that PLR (pre) (OR=3.037, 95% CI=1.463-6.305, p=0.003), MLR (pre) (OR=2.188, 95% CI=1.003-4.772, p=0.049), PLR(post-day 7) (OR=2.166, 95% CI=1.053-4.454, p=0.036) were independent factors for predicting PVT. CONCLUSIONS The PLR (pre), MLR (pre), and PLR (post-day 7) are predictors of portal vein thrombosis post in patients with portal hypertension after splenectomy and periesophagogastric devascularization.
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Affiliation(s)
| | | | - Yu-Feng Zhang
- Correspondence to: Yu-Feng Zhang and Yong-Xiang Yi, Department of Hepatopancreatobiliary Surgery, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No. 1 Zhongfu Road, Nanjing, Jiangsu 210003, China. Tel/Fax: +86-25-83626570, E-mail: (YFZ) and (YXY)
| | - Yong-Xiang Yi
- Correspondence to: Yu-Feng Zhang and Yong-Xiang Yi, Department of Hepatopancreatobiliary Surgery, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No. 1 Zhongfu Road, Nanjing, Jiangsu 210003, China. Tel/Fax: +86-25-83626570, E-mail: (YFZ) and (YXY)
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Xu X, Wang H, Zhao W, Wang Y, Wang J, Qin B. Recompensation factors for patients with decompensated cirrhosis: a multicentre retrospective case-control study. BMJ Open 2021; 11:e043083. [PMID: 34162632 PMCID: PMC8230976 DOI: 10.1136/bmjopen-2020-043083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES We aimed to evaluate recompensation factors among patients with decompensated cirrhosis. DESIGN A multicentre retrospective case-control study was conducted. Data were collected from and compared between groups of patients with recompensated and acute decompensated cirrhosis. Univariable and multivariable logistic regressions were used to select indicators associated with recompensation among patients with decompensated cirrhosis with different complications. A decision tree with 10-fold cross-validation was used to develop the model to identify patients with recompensation. We followed the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guideline for development and reporting of the new model. SETTING The study was conducted in six tertiary public hospitals in Chongqing, China. PARTICIPANTS This study included 3953 patients with decompensated cirrhosis. RESULTS In the total sample of included patients, there were 553 patients with recompensation and 3400 patients with acute decompensation, including 1158 patients with gastrointestinal bleeding, 1715 patients with a bacterial infection, 104 patients with hepatic encephalopathy and 423 patients with ascites. The most relevant indicator of recompensation selected by the decision tree model was albumin, with a threshold of 40 g/L. Total protein, haemoglobin, basophil percentage, alanine aminotransferase, neutrophil-to-lymphocyte ratio and diabetes were also selected to subsequently distinguish patients. The terminal nodes with a probability of recompensation was 0.89. The overall accuracy rate of the model was 0.92 (0.91-0.93), and it exhibited high specificity (86.9%) and sensitivity (92.6%). CONCLUSIONS The occurrence of recompensated cirrhosis could be identified by albumin, total protein, haemoglobin, basophil percentage, alanine aminotransferase, neutrophil-to-lymphocyte ratio and diabetes. These simple variables may help clinicians develop a treatment plan to encourage patients with decompensated cirrhosis to recompensate.
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Affiliation(s)
- Xiaomei Xu
- Department of Infectious Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haolin Wang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Wenlong Zhao
- College of Medical Informatics, Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Yong Wang
- Department of Infectious Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayue Wang
- Department of Infectious Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Qin
- Department of Infectious Diseases, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tapadia A, Jain M, Reddy MS, Mahadevan B, Varghese J, Venkataraman J. Serum C-reactive protein and neutrophil-to-lymphocyte ratio as predictors of survival in cirrhotic patients with systemic inflammatory response syndrome and bacterial infection. Indian J Gastroenterol 2021; 40:265-271. [PMID: 33974227 DOI: 10.1007/s12664-020-01134-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cirrhotic patients are prone to infections due to underlying immune dysfunction in them. We aimed to study the role of inflammatory markers, serum C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), in predicting infection, blood culture positivity, and short-term (1 month) mortality in hospitalized cirrhotic patients. METHODS This prospective study was done over a period of 14 months (October 2017 to November 2018). Patient data included age, gender, etiology of cirrhosis, reason for admission, and comorbidity. Laboratory tests included blood chemistry and blood cell counts, and blood and urine culture. The specific tests included were CRP and NLR. Survival of patients in the following 1 month was noted. Area under receiver operating characteristic curve (AUROC), sensitivity, specificity, predictive values, diagnostic accuracy were calculated and logistic regression analysis performed. A p-value < 0.05 was considered significant. RESULTS Two hundred and eight patients formed the study cohort. The median age was 51.5 years and male predominance was noted. Alcohol-related liver disease (49%) was the commonest etiology. The infection rate was 62%, culture positivity was 58.5%, and mortality was 30.8%. NLR and CRP were significantly higher in those with documented infection (culture positive or negative) and among nonsurvivors. Optimal cutoffs for NLR and CRP to predict infection were 5.86 and 33.7, respectively. The risk of having an infection was 7.5 times and about 15 times if NLR and CRP were above the cutoffs. The risk of 1-month mortality was 2-3 times higher if patients had NLR and CRP above the cutoffs. The combination of NLR and CRP (≥ 5.86 and ≥ 33.7, respectively) increased specificity and diagnostic accuracy for infection. CONCLUSION NLR and CRP were independently good predictors of infection and 1-month survival among the patients with cirrhosis of liver included in this study.
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Affiliation(s)
- Ashishkumar Tapadia
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India
| | - Mayank Jain
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India.
- Department of Gastroenterology, Arihant Hospital and Research Centre, Indore, 452 009, India.
| | - Mettu Srinivas Reddy
- Institute of Liver Disease and Transplantation, Dr. Rela's Institute of Medical Sciences, Chennai 600 044, India
| | - B Mahadevan
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India
| | - Joy Varghese
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India
- Department of Hepatology, Sri Ramachandra Medical College, Porur, Chennai 600 116, India
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Xu X, Tan J, Wang H, Zhao W, Qin B. Risk Stratification Score to Predict Readmission of Patients With Acute Decompensated Cirrhosis Within 90 Days. Front Med (Lausanne) 2021; 8:646875. [PMID: 34136498 PMCID: PMC8200567 DOI: 10.3389/fmed.2021.646875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Patients with acute decompensated (AD) cirrhosis are frequently readmitted to the hospital. An accurate predictive model for identifying high-risk patients may facilitate the development of effective interventions to reduce readmission rates. Methods: This cohort study of patients with AD cirrhosis was conducted at six tertiary hospitals in China between September 2012 and December 2016 (with 705 patients in the derivation cohort) and between January 2017 and April 2020 (with 251 patients in the temporal validation cohort). Least absolute shrinkage and selection operator Cox regression was used to identify the prognostic factors and construct a nomogram. The discriminative ability, calibration, and clinical net benefit were evaluated based on the C-index, area under the curve, calibration curve, and decision curve analysis. Kaplan–Meier curves were constructed for stratified risk groups, and log-rank tests were used to determine significant differences between the curves. Results: Among 956 patients, readmission rates were 24.58, 42.99, and 51.78%, at 30, 60, and 90 days, respectively. Bacterial infection was the main reason for index hospitalization and readmission. Independent factors in the nomogram included gastrointestinal bleeding [hazard rate (HR): 2.787; 95% confidence interval (CI): 2.221–3.499], serum sodium (HR: 0.955; 95% CI: 0.933–0.978), total bilirubin (HR: 1.004; 95% CI: 1.003–1.005), and international normalized ratio (HR: 1.398; 95% CI: 1.126–1.734). For the convenience of clinicians, we provided a web-based calculator tool (https://cqykdx1111.shinyapps.io/dynnomapp/). The nomogram exhibited good discrimination ability, both in the derivation and validation cohorts. The predicted and observed readmission probabilities were calibrated with reliable agreement. The nomogram demonstrated superior net benefits over other score models. The high-risk group (nomogram score >56.8) was significantly likely to have higher rates of readmission than the low-risk group (nomogram score ≤ 56.8; p < 0.0001). Conclusions: The nomogram is useful for assessing the probability of short-term readmission in patients with AD cirrhosis and to guide clinicians to develop individualized treatments based on risk stratification.
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Affiliation(s)
- Xiaomei Xu
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Gastroenterology, The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Juntao Tan
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Haolin Wang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Wenlong Zhao
- College of Medical Informatics, Chongqing Medical University, Chongqing, China.,Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Bo Qin
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Abstract
Liver cirrhosis is a major healthcare problem. Acute decompensation, and in particular its interplay with dysfunction of other organs, is responsible for the majority of deaths in patients with cirrhosis. Acute decompensation has different courses, from stable decompensated cirrhosis over unstable decompensated cirrhosis to pre-acute-on-chronic liver failure and finally acute-on-chronic liver failure, a syndrome with high short-term mortality. This review focuses on the recent developments in the field of acute decompensation and acute-on-chronic liver failure.
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Affiliation(s)
- Philip Ferstl
- Department for Internal Medicine I, University Hospital, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Jonel Trebicka
- Department for Internal Medicine I, University Hospital, Goethe University, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany; European Foundation for the Study of Chronic Liver Failure, Travesera de Gracia 11, 08021 Barcelona, Spain.
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Chen L, Zhang J, Lu T, Cai J, Zheng J, Yao J, Yi S, Li H, Chen G, Zhao H, Zhang Y, Yang Y. A nomogram to predict survival in patients with acute-on-chronic hepatitis B liver failure after liver transplantation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:555. [PMID: 33987253 PMCID: PMC8105851 DOI: 10.21037/atm-20-6180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Individualized prediction of survival after liver transplantation (LT) for patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) has not been well investigated. This study aimed to develop a prognostic nomogram for patients with HBV-ACLF undergoing LT. METHODS The nomogram was derived from a retrospective study of 290 patients who underwent LT for HBV-ACLF at the Third Affiliated Hospital of Sun Yat-sen University between January 2012 and December 2017. Concordance index and determiner calibration curve was used to ascertain the predictive accuracy and discriminative ability of the nomogram. The predictive performance of the nomogram was compared with that of Child-Pugh score, model for end-stage liver disease (MELD), MELD-Na, chronic liver failure Consortium Organ Failure score (CLIF-C OFs), and CLIF-C ACLF. RESULTS The 1-year mortality rate was 23.1% (67/290). The Cox multivariate analysis showed that risk factors for 1-year survival rate included white blood cell count, alanine aminotransferase/aspartate aminotransferase ratio, and the organ failure numbers. The determiner calibration curve showed good agreement between prediction of the nomogram and actual observation. The concordance index of the nomogram for predicting 1-year survival was 0.707, which was significantly higher than that of other prognostic models: Child-Pugh score (0.626), MELD (0.627), MELD-Na (0.583), CLIF-C OF (0.674), and comparable to that of CLIF-C ACLF (0.684). CONCLUSIONS Our study developed a novel nomogram that could accurately predict individualized post-transplantation survival in patients with HBV-ACLF. The nomogram might be a useful tool for identifying HBV-ACLF patients who would benefit from LT.
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Affiliation(s)
- Liang Chen
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiebin Zhang
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Tongyu Lu
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianye Cai
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jun Zheng
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jia Yao
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shuhong Yi
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hua Li
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guihua Chen
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hui Zhao
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yingcai Zhang
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang Yang
- Department of Hepatic Surgery and Liver Transplantation Center, Organ Transplantation Institute, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Wang X, Feng H, Hui Y, Yu Z, Zhao T, Mao L, Lin L, Wang B, Fan X, Yu Q, Sun C. Neutrophil-to-lymphocyte ratio is associated with malnutrition risk estimated by the Royal Free Hospital-Nutritional Prioritizing Tool in hospitalized cirrhosis. JPEN J Parenter Enteral Nutr 2021; 46:123-129. [PMID: 33720443 DOI: 10.1002/jpen.2097] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/16/2021] [Accepted: 02/28/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver cirrhosis is characterized by immune dysfunction, contributing to malnutrition. We previously revealed neutrophil-to-lymphocyte ratio (NLR) as an indicator of disordered immune system. Herein we aimed to (1) determine the optimal NLR cutoff that best predicts malnutrition risk and (2) clarify the association between NLR and nutrition status. METHODS A total of 135 hospitalized patients with cirrhosis were included. Immune dysfunction was evaluated by levels of serum C-reactive protein (CRP), NLR, and other parameters. Malnutrition was screened by a risk score referring to the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). Receiver operating characteristic (ROC) curve was implemented to determine the best NLR cutoff that predicts malnutrition risk. Correlation between NLR and indicators of hepatic and physical function (handgrip strength) were also examined. Multivariable logistic regression was used to assess the association between NLR and malnutrition risk. RESULTS ROC curve revealed that the optimum cutoff to predict malnutrition risk was NLR > 4.2, with a sensitivity of 47.2%, specificity of 81.0%, negative predictive value of 58.0%, and positive predictive value of 74.5%, respectively. Patients with NLR > 4.2 exhibited a higher RFH-NPT score, serum platelet-to-lymphocyte ratio, and CRP. A positive correlation was found between NLR values and Child-Turcotte-Pugh (r = 0.22; P = .010), model for end-stage liver disease (r = 0.36; P < .001), and RFH-NPT scores (r = 0.31; P < .001). NLR was a risk factor for malnutrition independently of alcoholic liver disease and presence of ascites. CONCLUSIONS Immune dysfunction measured by NLR was associated with malnutrition risk estimated by RFH-NPT in cirrhosis.
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Affiliation(s)
- Xiaoyu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongjuan Feng
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Nutriology, Tianjin Third Central Hospital, Tianjin, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Zihan Yu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Tianming Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Lihong Mao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin Lin
- Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin Airport Economic Area, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingxiang Yu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China.,Department of Gastroenterology, Tianjin Medical University General Hospital Airport Hospital, Tianjin Airport Economic Area, Tianjin, China
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Neutrophil-to-Lymphocyte Ratio and Albumin: New Serum Biomarkers to Predict the Prognosis of Male Alcoholic Cirrhosis Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2020:7268459. [PMID: 33415154 PMCID: PMC7769654 DOI: 10.1155/2020/7268459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/28/2022]
Abstract
Background and Aims Alcohol-associated liver disease is exhibiting an increasing disease burden. In terms of pathogenesis, inflammation is closely related to alcohol-induced liver injury. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker. Here, we aim to evaluate the role of the NLR and other biomarkers in predicting short-term mortality in alcoholic cirrhotic patients. Methods This was a retrospective study that included 459 male alcoholic cirrhosis patients. Among them, 345 patients completed follow-up. Based on their 30-day mortality information, patients were separated into surviving and nonsurviving groups. Demographic, clinical, and biochemical features were collected for further analysis. Logistic regression was used to identify factors associated with short-term mortality, and receiver operating characteristic (ROC) curve analysis was used to establish the predictive value of these factors. Results The prognostic scores were significantly higher in the nonsurviving group than in the surviving group: NLR: 5.5 vs. 3.2 (P < 0.001), model for end-stage liver disease (MELD): 15.4 vs. 7.9 (P < 0.001), Maddrey's discriminant function (MDF): 39.8 vs. 12.7 (P < 0.001), and the integrated MELD (i-MELD): 37.9 vs. 28.4 (P < 0.001). Logistic regression demonstrated that albumin (ALB), NLR, and i-MELD values were significantly correlated with patient death in 30 days. On ROC analysis, the diagnostic accuracy for 30-day mortality of the NLR (area under the ROC curve (AUROC) of 0.72, P < 0.001) was similar to that of the MELD or i-MELD (AUROCs of 0.71 and 0.74, respectively, P < 0.001). The new biomarker, NLA, calculated as 100 × NLR/ALB, had the best prognostic value. The cutoff values of the NLR and NLA for predicting 30-day mortality were 4.2 and 19.6, respectively. Conclusions The NLR and its related biomarker NLA are simple and robust predictors of 30-day mortality in alcoholic cirrhosis patients.
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Michalak A, Cichoż-Lach H, Guz M, Kozicka J, Cybulski M, Jeleniewicz W, Stepulak A. Towards an evaluation of alcoholic liver cirrhosis and nonalcoholic fatty liver disease patients with hematological scales. World J Gastroenterol 2020; 26:7538-7549. [PMID: 33384553 PMCID: PMC7754555 DOI: 10.3748/wjg.v26.i47.7538] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/12/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Seeking potentially novel blood markers of liver fibrosis and steatosis is constantly of crucial importance. Despite a growing number of studies in this field of hepatology, a certain role of hematological indices in the course of liver disorders has not been fully elucidated, yet. AIM To evaluate a diagnostic accuracy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume-to-platelet-ratio (MPR) in the course of alcoholic liver cirrhosis (ALC) and nonalcoholic fatty liver disease (NAFLD). METHODS One hundred forty-two patients with ALC, 92 with NAFLD and 68 persons in control group were enrolled in the study. Hematological indices (NLR, PLR and MPR), indirect and direct markers of liver fibrosis (aspartate transaminase to alkaline transaminase ratio, aspartate transaminase to platelet ratio index, fibrosis-4, gamma-glutamyl transpeptidase to platelet ratio, procollagen I carboxyterminal propeptide, procollagen III aminoterminal propeptide, transforming growth factor-α, platelet-derived growth factor AB, laminin) were measured in each person. Model for end-stage liver disease (MELD) score in ALC group and NAFLD fibrosis score together with BARD score were calculated in NAFLD patients. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were applied to assess the sensitivity and specificity of examined markers and to evaluate proposed cut-offs of measured indices in the course of ALC and NAFLD. RESULTS MPR and NLR values in ALC patients were significantly higher in comparison to control group; PLR level was significantly lower. MPR and PLR correlated with assessed indirect and direct markers of liver fibrosis. MPR, NLR and PLR correlated with MELD score. NLR level in NAFLD patients was significantly higher in comparison to controls. MPR correlated with indirect markers of liver fibrosis and NAFLD fibrosis score. AUC values and proposed cut-offs for NLR, PLR and MPR in ALC patients were: 0.821 (> 2.227), 0.675 (< 70.445) and 0.929 (> 0.048), respectively. AUC values and proposed cut-offs for NLR, PLR and MPR in NAFLD group were: 0.725 (> 2.034), 0.528 (> 97.101) and 0.547 (> 0.038), respectively. CONCLUSION Hematological markers are inseparably connected with serological indices of liver fibrosis in ALC and NAFLD patients. MPR and NLR turned out to be the most powerful parameters in ALC patients.
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Affiliation(s)
- Agata Michalak
- Department of Gastroenterology, Medical University of Lublin, Lublin 20-954, Jaczewskiego 8, Poland
| | - Halina Cichoż-Lach
- Department of Gastroenterology, Medical University of Lublin, Lublin 20-954, Jaczewskiego 8, Poland
| | - Małgorzata Guz
- Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin 20-093, Chodźki 3, Poland
| | - Joanna Kozicka
- Department of Gastroenterology, Medical University of Lublin, Lublin 20-954, Jaczewskiego 8, Poland
| | - Marek Cybulski
- Department of Biochemistry and Molecular Biology, Medical Univeristy of Lublin, Lublin 20-093, Chodźki 3, Poland
| | - Witold Jeleniewicz
- Department of Biochemistry and Molecular Biology, Medical Univeristy of Lublin, Lublin 20-093, Chodźki 3, Poland
| | - Andrzej Stepulak
- Department of Biochemistry and Molecular Biology, Medical Univeristy of Lublin, Lublin 20-093, Chodźki 3, Poland
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Zhang J, Qiu Y, He X, Mao W, Han Z. Platelet-to-white blood cell ratio: A novel and promising prognostic marker for HBV-associated decompensated cirrhosis. J Clin Lab Anal 2020; 34:e23556. [PMID: 32893950 PMCID: PMC7755811 DOI: 10.1002/jcla.23556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022] Open
Abstract
Aim The present study aimed to investigate associations of the platelet‐to‐white blood cell ratio (PWR)—a novel hematological indicator of inflammatory responses—with 30‐day outcomes in patients with HBV‐associated decompensated cirrhosis (HBV‐DeCi). Methods We recruited 131 patients with HBV‐DeCi for this retrospective study and extracted baseline clinical data and laboratory characteristics from medical records. Univariate and multivariate analyses were performed to determine major factors influencing 30‐day mortality. Area under the receiver operating characteristic curve analyses was performed to compare the predictive values of prognostic markers. Results During the 30‐day follow‐up period, 15 patients died. The PWR was significantly different between nonsurvivors and survivors. Lower PWR was found to be associated with an increased risk of mortality, and PWR was found to be an independent predictor of mortality in patients with HBV‐DeCi. Conclusions Our results demonstrate that low PWR may be a predictor of poor prognosis in patients with HBV‐DeCi, and this factor may be a useful supplement to standard approaches to enable effective management of these patients.
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Affiliation(s)
- JinFei Zhang
- Department of Clinical Laboratory, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou, China
| | - YingPo Qiu
- Department of Clinical Laboratory, The Second Hospital of Yinzhou District, Ningbo, China
| | - Xia He
- Department of Clinical Laboratory, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou, China
| | - WeiLin Mao
- Department of Clinical Laboratory, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou, China.,Department of Clinical Laboratory, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Zhong Han
- Department of Clinical Laboratory, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou, China
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Prediction Model of HBsAg Seroclearance in Patients with Chronic HBV Infection. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6820179. [PMID: 32855968 PMCID: PMC7443222 DOI: 10.1155/2020/6820179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
Abstract
Background Prediction of HBsAg seroclearance, defined as the loss of circulating HBsAg with or without development of antibodies for HBsAg in patients with chronic hepatitis B (CHB), is highly difficult and challenging due to its low incidence. This study is aimed at developing and validating a nomogram for prediction of HBsAg loss in CHB patients. Methods We analyzed a total of 1398 patients with CHB. Two-thirds of the patients were randomly assigned to the training set (n = 918), and one-third were assigned to the validation set (n = 480). Univariate and multivariate analysis by Cox regression analysis was performed using the training set, and the nomogram was constructed. Discrimination and calibration were performed using the training set and validation set. Results On multivariate analysis of the training set, independent factors for HBsAg loss including BMI, HBeAg status, HBsAg titer (quantitative HBsAg), and baseline hepatitis B virus (HBV) DNA level were incorporated into the nomogram. The HBsAg seroclearance calibration curve showed an optimal agreement between predictions by the nomogram and actual observation. The concordance index (C-index) of nomogram was 0.913, with confirmation in the validation set where the C-index was 0.886. Conclusions We established and validated a novel nomogram that can individually predict HBsAg seroclearance and non-seroclearance for CHB patients, which is clinically unprecedented. This practical prognostic model may help clinicians in decision-making and design of clinical studies.
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Li X, Wu J, Mao W. Evaluation of the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and red cell distribution width for the prediction of prognosis of patients with hepatitis B virus-related decompensated cirrhosis. J Clin Lab Anal 2020; 34:e23478. [PMID: 32666632 PMCID: PMC7676184 DOI: 10.1002/jcla.23478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background The development and progression of hepatitis B virus‐related decompensated cirrhosis (DeCi) is associated with inflammatory responses. The monocyte‐to‐lymphocyte ratio (MLR), neutrophil‐to‐lymphocyte ratio (NLR), and red cell distribution width (RDW) are well‐known inflammation markers. We aimed to assess the utility of these parameters for predicating the prognosis of patients with HBV‐DeCi. Methods We retrospectively recruited 174 patients diagnosed with HBV‐DeCi. Univariate and multivariate regression models were used to determine risk factors for mortality. Areas under the receiver operating characteristic curves were calculated to estimate and compare the predictive values of the three parameters. Hepatic function was evaluated using the Model for End‐Stage Liver Disease (MELD) score. Results The NLR, RDW, and MLR were found to be significantly higher in patients who did not survive compared with surviving patients. Moreover, these variables were all able to predict early poor outcomes in patients with HBV‐DeCi, with NLR exhibiting the highest accuracy. Furthermore, a combination of the NLR and MELD score was a more accurate prognostic marker for predicting mortality than either marker alone in such patients. Conclusions Hematological parameters can provide prognostic information for patients with HBV‐DeCi. Routine assessment of these parameters at admission may provide valuable data to complement other conventional measures for assessing disease condition in patients with HBV‐DeCi.
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Affiliation(s)
- XinKe Li
- Department of Radiation Oncology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - JianPing Wu
- Department of Clinical Laboratory, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - WeiLin Mao
- Department of Clinical Laboratory, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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Cong R, Kong F, Ma J, Li Q, Wu Q, Ma X. Combination of preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and monocyte-lymphocyte ratio: a superior prognostic factor of endometrial cancer. BMC Cancer 2020; 20:464. [PMID: 32448185 PMCID: PMC7245911 DOI: 10.1186/s12885-020-06953-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/12/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The preoperative peripheral blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-lymphocyte ratio (MLR) have been reported to be associated with the prognosis of various cancers but are always discussed separately. The aim of this study is to bring the combination of NLR, PLR and MLR into the prognostic assessment system of endometrial cancer (EC) and establish a nomogram to provide an objective prediction model for clinical decisions. METHODS A total of 1111 patients with EC who had accepted surgical treatment during 2013-2017 were involved in the analysis. Their NLR, PLR, and MLR levels were obtained from a routine blood examination within 2 weeks before operation. Receiver operating characteristic curve (ROC) analysis was performed to determine optimal cutoffs. Chi-square tests analysed the associations of the ratios with other clinicopathological variables. The prognostic value was indicated by overall survival (OS) via Cox proportional hazards models and Kaplan-Meier analysis. R software was used to establish the nomogram based on the combination of NLR, PLR, MLR and other clinicopathological factors. RESULTS The median follow-up period was 40 months, and the median age was 56. The enrolled patients were stratified by cutoffs of 2.14 for NLR, 131.82 for PLR and 0.22 for MLR. Multivariate analyses demonstrated that high NLR over 2.14 (HR = 2.71, 95%CI = 1.83-4.02, P<0.001), high PLR over 131.82 (HR = 2.75, 95%CI = 1.90-3.97, P<0.001), and high MLR over 0.22 (HR = 1.72, 95%CI = 1.20-2.45, P = 0.003) were significantly associated with worse OS. The combined indicator, high NLR + high PLR + high MLR (HR = 4.34, 95%CI = 2.54-7.42, P<0.001), showed the highest prognostic value. The Harrell's concordance index of the nomogram was 0.847 (95% CI = 0.804-0.890), showing good discrimination and calibration of this model. CONCLUSION The combination of NLR, PLR, and MLR is a superior prognostic factor of EC. The nomogram involving the combination of NLR, PLR, MLR and other clinicopathological factors is recommended to predict OS for EC patients clinically.
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Affiliation(s)
- Rong Cong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China
| | - Fanfei Kong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China
| | - Jian Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China
| | - Qing Li
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China
| | - Qijun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaoxin Ma
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Sanhao Street, 110004, Shenyang, People's Republic of China.
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Piotrowski D, Sączewska-Piotrowska A, Jaroszewicz J, Boroń-Kaczmarska A. Lymphocyte-To-Monocyte Ratio as the Best Simple Predictor of Bacterial Infection in Patients with Liver Cirrhosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051727. [PMID: 32155772 PMCID: PMC7084714 DOI: 10.3390/ijerph17051727] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022]
Abstract
Background and aim: The aim of this study was to assess the diagnostic performance of new morphology-related indices and Child–Turcotte–Pugh (CTP) and Model for End-Stage Liver Disease (MELD) scores during hospitalization in predicting the onset of bacterial infection in patients with liver cirrhosis. Material and methods: A total of 171 patients (56.9% males; median age 59 years; total number of hospitalizations 209) with liver cirrhosis were included in this observational study. The diagnosis of cirrhosis was made on the basis of clinical, biochemical, ultrasonic, histological, and endoscopic findings. The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), modified aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), Fibrosis-4 index (FIB-4), platelet-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR), and CTP and MELD scores were calculated for the cases of patients with cirrhosis. Results: Bacterial infection was diagnosed in 60 of the 209 (28.7%) hospitalizations of patients with cirrhosis. The most common infections were urinary tract infection (UTI), followed by pneumonia and sepsis. The more severe the liver failure, the greater the bacterial infection prevalence and mortality. Patients with decompensated liver cirrhosis were infected more often than subjects with compensated cirrhosis (50.0% vs. 12.9%, p = 0.003). The calculated MELD score, CTP, NLR, LMR, AAR, monocyte count, and C-reactive protein (CRP) concentration were also related to the bacterial infection prevalence, and mortality areas under the curve (AUC) were 0.629, 0.687, 0.606, 0.715, 0.610, 0.648, and 0.685, respectively. The combined model with two variables (LMR and CTP) had the best AUC of 0.757. The most common bacteria isolated from patients with UTI were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumonia. Gram-negative bacteria were also responsible for spontaneous bacterial peritonitis (SBP), and together with gram-positive streptococci and staphylococci, these microorganisms were isolated from blood cultures of patients with sepsis. Significant differences were found between CTP classification, MELD score, NLR, LMR, AAR, CRP, and PLR in patients with cirrhosis with, or without, bacterial infection. Conclusions: Bacterial infection prevalence is relatively high in patients with liver cirrhosis. Although all analyzed scores, including the LMR, NLR, aspartate aminotransferase (AST)/alanine aminotransferase (ALT), CRP, CTP, and MELD, allowed the prediction of bacterial occurrence, the LMR had the highest clinical utility, according to the area under the curve (AUC) and odds ratio (OR).
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Affiliation(s)
- Damian Piotrowski
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland;
- Correspondence: ; Tel.: +48-501-492-461
| | - Anna Sączewska-Piotrowska
- Department of Labour Market Research and Forecasting, University of Economics, 40-287 Katowice, Poland;
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Anna Boroń-Kaczmarska
- Department of Infectious Diseases, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland;
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Deng Y, Fan X, Ran Y, Xu X, Lin L, Cui B, Hou L, Zhao T, Wang Y, Su Z, Jiang X, Zhao W, Wang B, Sun C. Prognostic impact of neutrophil-to-lymphocyte ratio in cirrhosis: A propensity score matching analysis with a prespecified cut-point. Liver Int 2019; 39:2153-2163. [PMID: 31408916 DOI: 10.1111/liv.14211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS An elevated neutrophil-to-lymphocyte ratio (NLR) has received attention as a prognostic surrogate across chronic liver diseases. However, an exact threshold has not been fully elucidated. METHODS A total number of 589 patients with cirrhosis (LC) were included. The value of NLR was calculated and its optimal cut-off was initially determined by X-tile program. Independent predictors of 90-day mortality were identified with Cox regression model. The Kaplan-Meier method was used to generate survival curves. To reduce influences of selection bias and possible confounders, a 1:2 propensity score matching (PSM) was performed. RESULTS The X-tile indicated that the difference in survival was most significant for NLR more than 8.9. Serum NLR > 8.9 was an independent indicator in the entire cohort and PSM subset (HR 4.268, 95% CI 2.211-8.238, P < .001; HR 4.209, 95% CI 1.448-12.238, P = .008 respectively). Subgroup analysis showed that NLR > 8.9 was an independent risk factor of 90-day mortality regardless of age, gender, CTP or MELD score. CONCLUSIONS The value of NLR more than 8.9 is a feasible cut-off across clinical settings among applicable population. The adding of NLR to other conventional predictive systems has the potential to provide incremental value without extra economic cost.
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Affiliation(s)
- You Deng
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaofei Fan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Ran
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Xu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin Lin
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
- Department of Internal Medicine, Tianjin Medical University General Hospital Airport Site, Tianjin Airport Economic Area, Tianjin, China
| | - Binxin Cui
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
- Department of Internal Medicine, Tianjin Medical University General Hospital Airport Site, Tianjin Airport Economic Area, Tianjin, China
| | - Lijun Hou
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Tianming Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Ya Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhengyan Su
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Xihui Jiang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Sun
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China
- Department of Internal Medicine, Tianjin Medical University General Hospital Airport Site, Tianjin Airport Economic Area, Tianjin, China
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Mao W, Wu J. Haematologic indices in hepatitis B virus-related liver disease. Clin Chim Acta 2019; 500:135-142. [PMID: 31654630 DOI: 10.1016/j.cca.2019.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 02/07/2023]
Abstract
Several markers and prognostic scores have been identified for predicting the development and progression of liver disease; among them, haematological parameters (the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), RDW to platelet ratio (RPR), mean platelet volume (MPV), and mean corpuscular volume (MCV)) have recently gained significant interest. Compared with traditional prognostic factors, haematological indices are easy to obtain and relatively inexpensive. There is growing evidence that these haematological indices play a key role in HBV-related liver diseases and has been proposed as a predictive marker of adverse outcomes in these patients. This article focuses on discussing the diagnostic and prognostic value of the haematological indices in patients with HBV-related liver diseases.
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Affiliation(s)
- WeiLin Mao
- Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, PR China
| | - JianPing Wu
- Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, PR China.
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Forrest EH, Storey N, Sinha R, Atkinson SR, Vergis N, Richardson P, Masson S, Ryder S, Thursz MR, Allison M, Fraser A, Austin A, McCune A, Dhanda A, Katarey D, Potts J, Verma S, Parker R, Hayes PC. Baseline neutrophil-to-lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis. Aliment Pharmacol Ther 2019; 50:442-453. [PMID: 31313853 DOI: 10.1111/apt.15335] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/13/2019] [Accepted: 05/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Treating severe alcoholic hepatitis involves the exposure of patients to corticosteroids for 7 days to assess "response". AIM To assess the prognostic and therapeutic implications of baseline neutrophil-to-lymphocyte ratio (NLR) in patients with severe alcoholic hepatitis. METHODS Patients recruited to the STOPAH trial and an independent validation group were analysed retrospectively. Area under the receiver operating curve (AUC) analysis was performed. Kaplan-Meier analysis was used to assess survival. Log-rank test and odds ratio (OR) were used for comparative analysis. RESULTS Baseline NLR was available for 789 STOPAH patients. The AUC for NLR was modest for 90-day outcome (0.660), but was associated with infection, acute kidney injury (AKI) and severity of alcoholic hepatitis. Ninety-day survival was not affected by prednisolone treatment if NLR < 5 or > 8 but mortality was reduced with prednisolone treatment when the NLR was 5-8 (21.0% cf. 34.5%; P = 0.012). Prednisolone treatment increased the chance of Lille response if the NLR was ≥ 5 (56.5% cf. 41.1%: P = 0.01; OR 1.86) but increased the risk of day 7 infection (17.3% cf. 7.4%: P = 0.006; OR 2.60) and AKI (20.8% cf. 7.0%: P = 0.008; OR 3.46) if the NLR was > 8. Incorporation of NLR into a modified Glasgow alcoholic hepatitis score (mGAHS) improved the AUC to 0.783 and 0.739 for 28-day and 90-day outcome, respectively. CONCLUSION The NLR is associated with AKI and infection in severe alcoholic hepatitis. The NLR identifies those most likely to benefit from corticosteroids at baseline (NLR 5-8). The mGAHS has a good predictive value for 28- and 90-day outcomes.
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Gao B, Xiao J, Zhang M, Zhang F, Zhang W, Yang J, He J, Liu Y, Zou X, Xu P, Zhuge Y. High-density lipoprotein cholesterol for the prediction of mortality in cirrhosis with portal vein thrombosis: a retrospective study. Lipids Health Dis 2019; 18:79. [PMID: 30927926 PMCID: PMC6441144 DOI: 10.1186/s12944-019-1005-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/05/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lipid profiles disorders frequently occur in patients with chronic liver diseases, and the mortality of cirrhosis complicated with portal vein thrombosis (PVT) remains high. Research identifying simple and objective prognosis indicators for cirrhotic PVT has been limited. The aim of the present study was to investigate the association between lipid profiles and liver function, which may help predict the 1-year mortality in non-malignant cirrhosis with PVT. METHODS A retrospective cohort of 117 subjects with non-malignant cirrhotic PVT was conducted. The primary indicators of lipid profiles included triglyceride, cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol. Correlations of lipid profiles with liver function tests, the Child-Turcotte-Pugh (CTP) score and the model for end-stage liver disease (MELD) score were investigated. The relationship between lipid profiles and 1-year mortality was assessed using the area under the receiver operating characteristic curves (AUROC). Logistic regression models were established to confirm the association between HDL-C and mortality. RESULTS The level of HDL-C was significantly decreased in non-survivors (p < 0.01) and patients with more severe liver damage stages (CTP p < 0.001; MELD p < 0.001). There was no significant difference in the HDL-C level among patients with different severities of PVT (p = 0.498). The level of HDL-C was positively correlated with albumin (p < 0.001, R = 0.438) and platelet (p = 0.022, R = 0.212) levels. The level of HDL-C was negatively correlated with bilirubin (p < 0.001, R = - 0.319), C-reactive protein (p < 0.001, R = - 0.342), the aspartate aminotransferase to alanine aminotransferase ratio (p < 0.0.1, R = - 0.237), the CTP score (p < 0.001, R = - 0.397) and the MELD score (p < 0.001, R = - 0.406). The 1-year mortality rate was 12.8%. The AUROC of HDL-C for the prediction of 1-year mortality in this population was 0.744 (p < 0.01, 95%CI 0.609-0.879). The level of HDL-C was independently associated with mortality by multivariate logistic regression models. CONCLUSIONS The HDL-C level significantly decreases with the deterioration of liver function, which may serve as a potential indicator for the prognosis of non-malignant cirrhotic patients with PVT.
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Affiliation(s)
- Bo Gao
- Department of Gastroenterology and Clinical Nutrition, Nanjing Medical University Drum Tower Clinical Medical School, 321zhongshan road, Gulou District, Nanjing, 210008, China
| | - Jiangqiang Xiao
- Department of Gastroenterology, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ming Zhang
- Department of Gastroenterology, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Feng Zhang
- Department of Gastroenterology, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Wei Zhang
- Department of Gastroenterology, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jian Yang
- Department of Ultrasonography, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Jian He
- Department of Radiology, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yu Liu
- Department of Gynecology and Obstetrics, The affiliated Obstetrics and Gynecology Hospital with Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Xiaoping Zou
- Department of Gastroenterology, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ping Xu
- Department of Gastroenterology and Clinical Nutrition, Nanjing Medical University Drum Tower Clinical Medical School, 321zhongshan road, Gulou District, Nanjing, 210008, China.
| | - Yuzheng Zhuge
- Department of Gastroenterology and Clinical Nutrition, Nanjing Medical University Drum Tower Clinical Medical School, 321zhongshan road, Gulou District, Nanjing, 210008, China.
- Department of Gastroenterology, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China.
- Department of Gastroenterology and Hepatology, Nanjing Medical University Drum Tower Clinical Medical School, 321zhongshan road, Gulou District, Nanjing, 210008, China.
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Yoo JJ, Cho EJ, Lee B, Kim SG, Kim YS, Lee YB, Lee JH, Yu SJ, Kim YJ, Yoon JH. Prognostic Value of Biochemical Response Models for Primary Biliary Cholangitis and the Additional Role of the Neutrophil-to-Lymphocyte Ratio. Gut Liver 2019; 12:714-721. [PMID: 30400732 PMCID: PMC6254625 DOI: 10.5009/gnl18271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/21/2018] [Accepted: 07/27/2018] [Indexed: 12/11/2022] Open
Abstract
Background/Aims Recently reported prognostic models for primary biliary cholangitis (PBC) have been shown to be effective in Western populations but have not been well-validated in Asian patients. This study aimed to compare the performance of prognostic models in Korean patients and to investigate whether inflammation-based scores can further help in prognosis prediction. Methods This study included 271 consecutive patients diagnosed with PBC in Korea. The following prognostic models were evaluated: the Barcelona model, the Paris-I/II model, the Rotterdam criteria, the GLOBE score and the UK-PBC score. The neutrophil-to-lymphocyte ratio (NLR) was analyzed with reference to its association with prognosis. Results For predicting liver transplant or death at the 5-year and 10-year follow-up examinations, the UK-PBC score (areas under the receiver operating characteristic curve [AUCs], 0.88 and 0.82) and GLOBE score (AUCs, 0.85 and 0.83) were significantly more accurate in predicting prognosis than the other scoring systems (all p＜0.05). There was no significant difference between the performance of the UK-PBC and GLOBE scores. In addition to the prognostic models, a high NLR (＞2.46) at baseline was an independent predictor of reduced transplant-free survival in the multivariate analysis (adjusted hazard ratio, 3.74; p＜0.01). When the NLR was applied to the prognostic models, it significantly differentiated the prognosis of patients. Conclusions The UK-PBC and GLOBE scores showed good prognostic performance in Korean patients with PBC. In addition, a high NLR was associated with a poorer prognosis. Including the NLR in prognostic models may further help to stratify patients with PBC.
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Affiliation(s)
- Jeong-Ju Yoo
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Bora Lee
- Department of Statistics, Graduate School, Chung-Ang University, Seoul, Korea
| | - Sang Gyune Kim
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Young Seok Kim
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Yun Bin Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Gustot T, Jalan R. Acute-on-chronic liver failure in patients with alcohol-related liver disease. J Hepatol 2019; 70:319-327. [PMID: 30658733 DOI: 10.1016/j.jhep.2018.12.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022]
Abstract
The spectrum of alcohol-related liver diseases (ALD) includes steatosis, steatohepatitis, progressive liver fibrosis, and cirrhosis. Acute-on-chronic liver failure (ACLF) is a recently defined entity that occurs in patients with chronic liver diseases and is characterised by acute decompensation, organ failures and a high risk of short-term mortality. Active alcohol consumption, alcoholic hepatitis and bacterial infections are the most frequent events precipitating the development of ACLF in the context of ALD (ALD-ACLF). The specific management of this entity remains unknown and the place of salvage liver transplantation controversial. This overview details the current knowledge on specific aspects of epidemiology, pathophysiology, prognosis and management of ALD-ACLF.
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Affiliation(s)
- Thierry Gustot
- Dept. Gastroenterology and Hepato-Pancreatology, C.U.B. Erasme Hospital, Brussels, Belgium; Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium; Inserm Unité 1149, Centre de Recherche sur l'inflammation (CRI), Paris, France; UMR S_1149, Université Paris Diderot, Paris, France; The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain.
| | - Rajiv Jalan
- The EASL-CLIF Consortium, European Foundation-CLIF, Barcelona, Spain; Liver Failure Group, Insitute for Liver and Digestive Health, University College London, London, UK
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Cai J, Wang K, Han T, Jiang H. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Medicine (Baltimore) 2018; 97:e13324. [PMID: 30431619 PMCID: PMC6257482 DOI: 10.1097/md.0000000000013324] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Systemic inflammatory responses are associated with the development and progression of liver failure. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), red cell distribution width (RDW), RDW-to platelet ratio (RPR), mean platelet volume (MPV), and MPV-to platelet ratio (MPR) are markers of systemic inflammation. This study aimed to evaluate the prognostic values of these inflammatory markers in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).203 HBV-ACLF patients, 79 cirrhosis patients (LC), 63 chronic hepatitis B (CHB), and 81 healthy subjects (HS) participated in this cohort study. Complete blood counts and biochemical examinations were obtained after overnight fasting. Multivariate analyses of 90-day outcome predictors were analyzed by Cox regression models. Survival probability curves were calculated by the Kaplan-Meier method.The levels of NLR, MLR, RDW, MPV, RPR, and MPR were significantly higher and PNI was lower in patients with liver failure at presentation compared to those in LC, CHB, and HS (P <.001). In acute-on-chronic liver failure (ACLF) patients, NLR and MLR were higher in nonsurvivors than in survivors (P <.001), while other inflammatory markers showed no difference. ROC curve analyses showed that NLR combined with MLR had the highest AUC for identified poor outcome, followed by NLR, chronic liver failure-sequential organ failure assessment (CLIF-SOFA), MLR, model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP) and TBIL. Multivariate analyses showed that TBIL, NLR, CTP, MELD, and CLIF-SOFA were independent predictors for 90-day mortality.Combination of NLR and MLR are more accurate prognostic markers for predicting poor outcome than either marker alone in ACLF patients. And this combination is superior to the CLIF-SOFA, MELD, CTP score, and TBIL in terms of prognostic ability.
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Affiliation(s)
- Junjun Cai
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Shijiazhuang
| | - Kai Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Sunsimiao Hospital, Beijing University of Chinese Medicine, Tongchuan
| | - Tao Han
- Department of Hepatology, Tianjin Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key laboratory of Artificial Cell, Tianjin, China
| | - Huiqing Jiang
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Shijiazhuang
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Jamil Z, Durrani AA. Assessing the outcome of patients with liver cirrhosis during hospital stay: A comparison of lymphocyte/monocyte ratio with MELD and Child-Pugh scores. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:308-315. [PMID: 29755015 DOI: 10.5152/tjg.2018.17631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Developing an easy and reliable score for evaluating the prognosis of patients with liver cirrhosis has always been challenging for hepatologists. This study aimed to assess the lymphocyte-to-monocyte ratio (LMR) in comparison with the Model for End-Stage Liver Disease (MELD) and Child-Pugh (CP) scores for determining the outcomes in these patients during hospital stay. MATERIALS AND METHODS Receiver operator characteristic (ROC) curve was used to assess the efficacy of three parameters (LMR and MELD and CP scores) in determining the outcomes in 182 patients with cirrhosis. The cutoff values were calculated using Youden index, and the area under the curves (AUCs) was also compared. The associations of these scores between the survived and nonsurvived group was studied. The predictors of patient survival were determined using logistic regression analysis. RESULTS The mean values for LMR and MELD and CP scores were 6.23, 11.62, and 9.32, respectively. MELD and CP were positively correlated with each other. LMR was negatively correlated to both MELD and CP scores (p=0.04). Pairwise comparison showed that the difference between the AUCs of MELD and LMR was not statistically significant (0.958 vs. 0.807; p > 0.05). With the LMR cutoff value of > 3.31 (sensitivity, 80%; specificity, 74.83%), patients were segregated into low and high LMR groups. MELD and CP scores were significantly higher in the low LMR group than in the high LMR group (p=0.000). Patients in the low LMR group showed decreased survival than those in the high LMR group (p=0.000). The nonsurvived group had lower LMR and higher MELD and CP scores than those of the survived group (p=0.000). Logistic regression model showed MELD (p=0.000), CP score (p=0.010), 1/LMR (p=0.004), alanine aminotransferase (ALT) level (p=0.010), and international normalized ratio (INR; p=0.043) as predictors of outcome of these patients. CONCLUSION LMR can be used to determine the outcome of patients during hospital stay, because it is easy to calculate and can be interpreted with efficacy nearly equal to those of MELD and CP scores.
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Affiliation(s)
- Zubia Jamil
- Department of Medicine, Foundation University Medical College, Islamabad, Pakistan
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qSOFA score not predictive of in-hospital mortality in emergency patients with decompensated liver cirrhosis. Med Klin Intensivmed Notfmed 2018; 114:724-732. [PMID: 30132026 DOI: 10.1007/s00063-018-0477-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/27/2018] [Accepted: 07/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Quick sequential organ failure assessement (qSOFA) has been validated for patients with presumed sepsis and the general emergency department (ED) population. However, it has not been validated in specific subgroups of ED patients with a high mortality. We aimed to investigate the prognostic performance of qSOFA with respect to in-hospital mortality, intensive care unit (ICU) admission, and length of hospitalisation in patients with decompensated liver cirrhosis. Furthermore, we compared qSOFA to systemic inflammatory response syndrome (SIRS), model of end stage liver disease score (MELD), and Child-Pugh criteria and evaluated whether addition of sodium (Na+) levels to qSOFA increases its prognostic performance. METHODS This observational study included patients admitted with the diagnosis of decompensated liver cirrhosis. All patients with a complete set of vital parameters were included in this study. RESULTS A total of 186 patients were included. A positive qSOFA score was not associated with in-hospital mortality, ICU admission, or length of hospitalisation (all p > 0.15). MELD scores reliably predicted need for ICU admission and in-hospital mortality (both p < 0.01), but not the length of hospitalisation. qSOFA-Na+ only moderately increased the diagnostic performance of qSOFA with regard to need for ICU admission (AUCICU[qSOFA] = 0.504 vs. AUCICU[qSOFA-Na+] = 0.609, p = 0.03), but not for in-hospital mortality (AUCdeath[qSOFA] = 0.513 vs. AUCdeath[qSOFA-Na+] = 0.592, p = 0.054). CONCLUSION qSOFA does not predict in-hospital mortality, ICU admission or length of hospitalisation in patients with decompensated liver cirrhosis. Extension of qSOFA with a disease-specific component, the qSOFA-Na+, moderately increased the diagnostic ability of qSOFA.
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