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Prognostic impact of neutrophil-to-lymphocyte ratio in cirrhosis: A propensity score matching analysis with a prespecified cut-point.

Authors
  • Deng, You1, 2
  • Fan, Xiaofei1, 2
  • Ran, Ying1, 2
  • Xu, Xin1, 2
  • Lin, Lin1, 2, 3
  • Cui, Binxin1, 2, 3
  • Hou, Lijun1, 2
  • Zhao, Tianming1, 2
  • Wang, Ya1, 2
  • Su, Zhengyan1, 2
  • Jiang, Xihui1, 2
  • Zhao, Wei1, 2
  • Wang, Bangmao1, 2
  • Sun, Chao1, 2, 3
  • 1 Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China. , (China)
  • 2 Tianjin Institute of Digestive Disease, Tianjin Medical University General Hospital, Tianjin, China. , (China)
  • 3 Department of Internal Medicine, Tianjin Medical University General Hospital Airport Site, Tianjin Airport Economic Area, Tianjin, China. , (China)
Type
Published Article
Journal
Liver international : official journal of the International Association for the Study of the Liver
Publication Date
Nov 01, 2019
Volume
39
Issue
11
Pages
2153–2163
Identifiers
DOI: 10.1111/liv.14211
PMID: 31408916
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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