Kalra Avash, Wedd Joel P, Bambha Kiran M, Gralla Jane, Golden-Mason Lucy, Collins Christine, Rosen Hugo R, Biggins Scott W
University of Colorado Anschutz Medical Campus, Aurora, CO.
Emory Healthcare, Atlanta, GA.
Liver Transpl. 2017 Feb;23(2):155-165. doi: 10.1002/lt.24702.
The Model for End-Stage Liver Disease (MELD) score has reduced accuracy for liver transplantation (LT) wait-list mortality when MELD ≤ 20. Neutrophil-to-lymphocyte ratio (NLR) is a biomarker associated with systemic inflammation and may predict cirrhotic decompensation and death. We aimed to evaluate the prognostic utility of high NLR (≥4) for liver-related death among low MELD patients listed for LT, controlling for stage of cirrhosis. In a nested case-control study of cirrhotic adults awaiting LT (February 2002 to May 2011), cases were LT candidates with a liver-related death and MELD ≤ 20 within 90 days of death. Controls were similar LT candidates who were alive for ≥90 days after LT listing. NLR and other covariates were assessed at the date of lowest MELD, within 90 days of death for cases and within 90 days after listing for controls. There were 41 cases and 66 controls; MELD scores were similar. NLR 25th, 50th, 75th percentile cutoffs were 1.9, 3.1, and 6.8. NLR was ≥ 4 in 25/41 (61%) cases and in 17/66 (26%) controls. In univariate analysis, NLR (continuous ≥ 1.9, ≥ 4, ≥ 6.8), increasing cirrhosis stage, jaundice, encephalopathy, serum sodium, and albumin and nonselective beta-blocker use were significantly (P < 0.01) associated with liver-related death. In multivariate analysis, NLR of ≥1.9, ≥ 4, ≥ 6.8 were each associated with liver-related death. Furthermore, we found that NLR correlated with the frequency of circulating low-density granulocytes, previously identified as displaying proinflammatory properties, as well as monocytes. In conclusion, elevated NLR is associated with liver-related death, independent of MELD and cirrhosis stage. High NLR may aid in determining risk for cirrhotic decompensation, need for increased monitoring, and urgency for expedited LT in candidates with low MELD. Liver Transplantation 23 155-165 2017 AASLD.
当终末期肝病模型（MELD）评分≤20时，其对肝移植（LT）等待名单上患者死亡率的预测准确性降低。中性粒细胞与淋巴细胞比值（NLR）是一种与全身炎症相关的生物标志物，可能预测肝硬化失代偿和死亡。我们旨在评估高NLR（≥4）对LT等待名单上低MELD患者肝相关死亡的预后价值，并对肝硬化分期进行控制。在一项对等待LT的肝硬化成年患者进行的巢式病例对照研究（2002年2月至2011年5月）中，病例为在死亡90天内发生肝相关死亡且MELD≤20的LT候选者。对照为LT名单登记后存活≥90天的类似LT候选者。在病例死亡90天内及对照名单登记90天内，于MELD最低时评估NLR及其他协变量。有41例病例和66例对照；MELD评分相似。NLR的第25、50、75百分位数分别为1.9、3.1和6.8。25/41（61%）例病例和17/66（26%）例对照的NLR≥4。单因素分析中，NLR（连续变量≥1.9、≥4、≥6.8）、肝硬化分期增加、黄疸、肝性脑病、血清钠、白蛋白以及非选择性β受体阻滞剂的使用与肝相关死亡显著相关（P<0.01）。多因素分析中，NLR≥1.9、≥4、≥6.8均与肝相关死亡相关。此外，我们发现NLR与循环低密度粒细胞（先前已确定具有促炎特性）以及单核细胞的频率相关。总之，NLR升高与肝相关死亡相关，独立于MELD和肝硬化分期。高NLR可能有助于确定肝硬化失代偿风险、增加监测需求以及低MELD候选者加快LT的紧迫性。《肝脏移植》2017年第23卷155 - 165页 美国肝病研究协会
