Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis

Murat Biyik, Ramazan Ucar, Yalcin Solak, Gokhan Gungor, Ilker Polat, Abduzhappar Gaipov, Ozlem O. Cakir, Huseyin Ataseven, Ali Demir, Suleyman Turk, Hakki Polat

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Abstract

OBJECTIVES: Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis. MATERIALS AND METHODS: This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality. RESULTS: There were 86 men and 59 women, mean age 58.9±13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n=73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8±6.8 months, during which 40 patients died. The mean NLRs were 2.08±0.99 and 4.39±3.0 in surviving and nonsurviving patients, respectively (P<0.001). Kaplan-Meier survival analysis was carried out according to the median NLR above and below 2.72. Patients with NLR of at least 2.72 had a significantly lower survival (log rank, P<0.001). NLR was found to be an independent predictor of mortality in all Cox Regression models (odds ratio 1.2; 95% confidence interval 1.2-1.3; P<0.001). Receiver operating characteristic analysis showed that cut-off values of 4.22, 3.07, and 2.96 for NLR predicted 12, 24, and 36-month mortality, respectively (AUC: 0.806, P=0.0029; 0.841, P<0.0001 and 0.783, P<0.0001, respectively). CONCLUSION: NLR is a predictor of mortality independent of CTP and MELD scores in patients with liver cirrhosis. NLR could predict mortality in the subgroup of patients with low MELD scores as well.

Original languageEnglish (US)
Pages (from-to)435-441
Number of pages7
JournalEuropean Journal of Gastroenterology and Hepatology
Volume25
Issue number4
DOIs
StatePublished - Apr 1 2013

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Liver Cirrhosis
Neutrophils
Lymphocytes
Survival
End Stage Liver Disease
Mortality
Child Mortality
Kaplan-Meier Estimate
Survival Analysis
Proportional Hazards Models
ROC Curve
Hepatitis
Area Under Curve
Observational Studies
Comorbidity
Hepatocellular Carcinoma
Cohort Studies
Odds Ratio
Steroids
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis. / Biyik, Murat; Ucar, Ramazan; Solak, Yalcin; Gungor, Gokhan; Polat, Ilker; Gaipov, Abduzhappar; Cakir, Ozlem O.; Ataseven, Huseyin; Demir, Ali; Turk, Suleyman; Polat, Hakki.

In: European Journal of Gastroenterology and Hepatology, Vol. 25, No. 4, 01.04.2013, p. 435-441.

Research output: Contribution to journalArticle

Biyik, M, Ucar, R, Solak, Y, Gungor, G, Polat, I, Gaipov, A, Cakir, OO, Ataseven, H, Demir, A, Turk, S & Polat, H 2013, 'Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis', European Journal of Gastroenterology and Hepatology, vol. 25, no. 4, pp. 435-441. https://doi.org/10.1097/MEG.0b013e32835c2af3
Biyik, Murat ; Ucar, Ramazan ; Solak, Yalcin ; Gungor, Gokhan ; Polat, Ilker ; Gaipov, Abduzhappar ; Cakir, Ozlem O. ; Ataseven, Huseyin ; Demir, Ali ; Turk, Suleyman ; Polat, Hakki. / Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis. In: European Journal of Gastroenterology and Hepatology. 2013 ; Vol. 25, No. 4. pp. 435-441.
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abstract = "OBJECTIVES: Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis. MATERIALS AND METHODS: This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality. RESULTS: There were 86 men and 59 women, mean age 58.9±13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n=73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8±6.8 months, during which 40 patients died. The mean NLRs were 2.08±0.99 and 4.39±3.0 in surviving and nonsurviving patients, respectively (P<0.001). Kaplan-Meier survival analysis was carried out according to the median NLR above and below 2.72. Patients with NLR of at least 2.72 had a significantly lower survival (log rank, P<0.001). NLR was found to be an independent predictor of mortality in all Cox Regression models (odds ratio 1.2; 95{\%} confidence interval 1.2-1.3; P<0.001). Receiver operating characteristic analysis showed that cut-off values of 4.22, 3.07, and 2.96 for NLR predicted 12, 24, and 36-month mortality, respectively (AUC: 0.806, P=0.0029; 0.841, P<0.0001 and 0.783, P<0.0001, respectively). CONCLUSION: NLR is a predictor of mortality independent of CTP and MELD scores in patients with liver cirrhosis. NLR could predict mortality in the subgroup of patients with low MELD scores as well.",
author = "Murat Biyik and Ramazan Ucar and Yalcin Solak and Gokhan Gungor and Ilker Polat and Abduzhappar Gaipov and Cakir, {Ozlem O.} and Huseyin Ataseven and Ali Demir and Suleyman Turk and Hakki Polat",
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T1 - Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis

AU - Biyik, Murat

AU - Ucar, Ramazan

AU - Solak, Yalcin

AU - Gungor, Gokhan

AU - Polat, Ilker

AU - Gaipov, Abduzhappar

AU - Cakir, Ozlem O.

AU - Ataseven, Huseyin

AU - Demir, Ali

AU - Turk, Suleyman

AU - Polat, Hakki

PY - 2013/4/1

Y1 - 2013/4/1

N2 - OBJECTIVES: Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis. MATERIALS AND METHODS: This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality. RESULTS: There were 86 men and 59 women, mean age 58.9±13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n=73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8±6.8 months, during which 40 patients died. The mean NLRs were 2.08±0.99 and 4.39±3.0 in surviving and nonsurviving patients, respectively (P<0.001). Kaplan-Meier survival analysis was carried out according to the median NLR above and below 2.72. Patients with NLR of at least 2.72 had a significantly lower survival (log rank, P<0.001). NLR was found to be an independent predictor of mortality in all Cox Regression models (odds ratio 1.2; 95% confidence interval 1.2-1.3; P<0.001). Receiver operating characteristic analysis showed that cut-off values of 4.22, 3.07, and 2.96 for NLR predicted 12, 24, and 36-month mortality, respectively (AUC: 0.806, P=0.0029; 0.841, P<0.0001 and 0.783, P<0.0001, respectively). CONCLUSION: NLR is a predictor of mortality independent of CTP and MELD scores in patients with liver cirrhosis. NLR could predict mortality in the subgroup of patients with low MELD scores as well.

AB - OBJECTIVES: Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis. MATERIALS AND METHODS: This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality. RESULTS: There were 86 men and 59 women, mean age 58.9±13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n=73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8±6.8 months, during which 40 patients died. The mean NLRs were 2.08±0.99 and 4.39±3.0 in surviving and nonsurviving patients, respectively (P<0.001). Kaplan-Meier survival analysis was carried out according to the median NLR above and below 2.72. Patients with NLR of at least 2.72 had a significantly lower survival (log rank, P<0.001). NLR was found to be an independent predictor of mortality in all Cox Regression models (odds ratio 1.2; 95% confidence interval 1.2-1.3; P<0.001). Receiver operating characteristic analysis showed that cut-off values of 4.22, 3.07, and 2.96 for NLR predicted 12, 24, and 36-month mortality, respectively (AUC: 0.806, P=0.0029; 0.841, P<0.0001 and 0.783, P<0.0001, respectively). CONCLUSION: NLR is a predictor of mortality independent of CTP and MELD scores in patients with liver cirrhosis. NLR could predict mortality in the subgroup of patients with low MELD scores as well.

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