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Leucocyte ratios are biomarkers of mortality in patients with acute decompensation of cirrhosis and acute‐on‐chronic liver failure
Author(s) -
Bernsmeier Christine,
Cavazza Anna,
Fatourou Evangelia M.,
Theocharidou Eleni,
Akintimehin Abisoye,
Baumgartner Benjamin,
Dhar Ameet,
Auzinger Georg,
Thursz Mark,
Bernal William,
Wendon Julia A.,
Karvellas Constantine J.,
Antoniades Charalambos G.,
McPhail Mark J. W.
Publication year - 2020
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.15932
Subject(s) - medicine , cirrhosis , decompensation , sepsis , gastroenterology , chronic liver disease , liver disease , immunology
Summary Background In patients with cirrhosis, progression to acute decompensation (AD) and acute‐on‐chronic liver failure (ACLF) has been associated with poor prognosis. Differential leucocyte ratios might predict mortality in systemic inflammatory conditions. Aim To evaluate differential leucocyte ratios as prognostic biomarkers in patients with cirrhosis. Methods Patients with AD and ACLF were recruited from four centres in three countries. Peripheral blood differential leucocytes were measured (three centres using flow cytometry) on hospital admission and at 48 hours. Ratios were correlated to model for end‐stage liver disease (MELD), chronic liver failure‐sequential organ failure (CLIF‐SOFA), suspected/culture‐positive bacterial infection and survival. Results Nine hundred twenty‐six patients (562 (61%) male, median age 55 (25‐94) years) were studied. Overall, 350 (37%) did not survive to hospital discharge. Neutrophil‐lymphocyte ratio (NLR) and monocyte‐lymphocyte ratio (MLR) were elevated in patients with AD and ACLF who died during their hospital stay. On multivariate analysis NLR retained statistical significance independently of CLIF‐SOFA or MELD. NLR >30 was associated with an 80% 90‐day mortality in patients with ACLF but not AD. On sensitivity analysis for subgroups (alcohol‐related liver disease and suspected sepsis), NLR and MLR retained statistically robust accuracy for the prediction of mortality. Significant predictive accuracy was only observed in centres using flow cytometry. Conclusion Leucocyte ratios are simple and robust biomarkers of outcome in ACLF, which are comparable to CLIF‐SOFA score but dependent on leucocyte quantification method. NLR and MLR may be used as screening tools for mortality prediction in patients with acutely deteriorating cirrhosis.