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(3): 477-489 [PMID: 38577540 DOI: 10.4254/wjh.v16.i3.477]
Corresponding Author of This Article
Xin-Hua Li, MD, PhD, Doctor, Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. lixinh8@mail.sysu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2024; 16(3): 477-489 Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.477
Prognostic value of neutrophil-to-lymphocyte ratio in end-stage liver disease: A meta-analysis
Xiang-Hao Cai, Yun-Ming Tang, Shu-Ru Chen, Jia-Hui Pang, Yu-Tian Chong, Hong Cao, Xin-Hua Li
Xiang-Hao Cai, Yun-Ming Tang, Shu-Ru Chen, Jia-Hui Pang, Yu-Tian Chong, Hong Cao, Xin-Hua Li, Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Co-first authors: Xiang-Hao Cai and Yun-Ming Tang.
Co-corresponding authors: Xin-Hua Li and Hong Cao.
Author contributions: Li XH and Cao H contributed to study concept and design; Cai XH and Tang YM contributed to drafting of the manuscript; and Pang JH collected data of including articles; Cai XH and Chen SR performed the analysis of the project; Pang JH compiled the figures and tables. Li XH and Cao H contributed to critical revision of the manuscript for important content; Chong YT, Li XH, and Cao H contributed to obtaining funding. Cai XH and Tang YM are co-first authors due to their significant involvement in drafting the manuscript and collecting data, showcasing their strong understanding of the research findings. Li XH and Cao H are likely the corresponding authors because of their significant contributions to the study's concept, design, and funding acquisition. The pivotal roles of Li XH and Cao H in shaping the study's foundation and ensuring its continued support position them as the lead corresponding authors in this collaborative effort. Chong YT and Li XH contributed to obtained funding. This collaboration between Li XH and Cao H is crucial for the publication of this manuscript. Their combined efforts reflect their shared responsibility for the scholarly work and ensure that their individual contributions are duly recognized and attributed. All authors approved submission.
Supported bythe Science and Technology Planning Project of Guangdong Province, China, No. 2019B020228001; 5010 Project of Sun Yat-sen University, No. 2018024; and Science and Technology Program of Guangzhou, China, No. 202103000060.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Hua Li, MD, PhD, Doctor, Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. lixinh8@mail.sysu.edu.cn
Received: November 12, 2023 Peer-review started: November 12, 2023 First decision: December 7, 2023 Revised: January 3, 2024 Accepted: February 6, 2024 Article in press: February 6, 2024 Published online: March 27, 2024 Processing time: 135 Days and 22.5 Hours
ARTICLE HIGHLIGHTS
Research background
End-stage liver disease (ESLD) carries a high mortality risk. Identifying reliable prognostic factors is important to guide management, but studies on the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in ESLD have reported conflicting results.
Research motivation
To comprehensively evaluate the association between NLR and ESLD prognosis through a systematic review and meta-analysis of existing literature.
Research objectives
To establish whether NLR is a useful prognostic biomarker for predicting mortality in patients with ESLD.
Research methods
A systematic literature search was conducted through multiple databases. Studies evaluating the relationship between NLR and mortality in ESLD patients were selected and their data extracted. Pooled effect sizes were calculated using meta-analysis.
Research results
Higher NLR levels were associated with increased mortality risk in ESLD based on meta-analysis of 27 studies reporting hazard/odds ratios. NLR also distinguished survivors from non-survivors. The prognostic value of NLR was not influenced by patient characteristics but differed regionally.
Research conclusions
NLR is clinically useful for prognostic assessment in ESLD patients, especially Asian populations, but optimal cut-off values require further investigation.
Research perspectives
NLR represents a promising, readily available prognostic tool for risk stratifying ESLD patients. Future research should establish standardized NLR cut-offs and evaluate its utility accounting for potential confounders like severity of neutropenia.
