Department of Anesthesiology and Critical Care, APHP, Beaujon Hospital, Clichy.
Medical Intensive Care Unit, Rouen University Hospital, Rouen.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e341-e347. doi: 10.1097/MEG.0000000000002063.
Hospital death rates following ICU admission of cirrhotic patients remain high. Identifying patients at high risk of mortality after few days of aggressive management is imperative for providing adequate interventions. Herein, we aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) combined with usual organ failure scores in the outcome prediction of cirrhotic patients hospitalized more than 3 days in ICU.
We conducted a retrospective bicentric study in two cohorts of cirrhotic patients hospitalized more than 3 days in French university hospital ICUs. At admission and day 3, we calculated several clinico-biological scores grading liver disease and organ failure severity and calculated the NLR. The primary outcome was 28-day mortality.
The test cohort included 116 patients. At day 28, 43 (37.1%) patients had died. Variations of MELD score (ΔMELD), SOFA score (ΔSOFA), CLIF-SOFA score (ΔCLIF-SOFA) and NLR (ΔNRL) between admission and day 3 were significantly associated with 28-day mortality in univariate analysis. When included in bivariate analysis ΔNLR remained a significant predictor of 28-day mortality independently of these severity scores. Kaplan-Meier curves and statistics using reclassification methods showed a better 28-day mortality risk prediction using ΔNRL in association with ΔSOFA in comparison to ΔSOFA alone. These results were confirmed in an external validation cohort, including 101 critically ill cirrhotic patients.
ΔNLR is an independent predictor of mortality in the critically ill cirrhotic patients' population who requires intensive care supportive treatment and should be used in association with ΔSOFA as a prognostic biomarker.
肝硬化患者 ICU 入住后死亡率仍然很高。在积极治疗数天后，识别出高死亡率风险的患者对于提供适当的干预措施至关重要。在此，我们旨在评估中性粒细胞与淋巴细胞比值（NLR）与常规器官衰竭评分联合在 ICU 住院超过 3 天的肝硬化患者预后预测中的价值。
我们进行了一项回顾性的、两中心的研究，纳入了在法国大学医院 ICU 住院超过 3 天的两批肝硬化患者。在入院时和第 3 天，我们计算了几种临床生物学评分，以评估肝脏疾病和器官衰竭严重程度，并计算了 NLR。主要结局是 28 天死亡率。
在测试队列中包括 116 名患者。在第 28 天，有 43 名（37.1%）患者死亡。入院时与第 3 天之间的 MELD 评分变化（ΔMELD）、SOFA 评分变化（ΔSOFA）、CLIF-SOFA 评分变化（ΔCLIF-SOFA）和 NLR 变化（ΔNLR）在单变量分析中与 28 天死亡率显著相关。当纳入双变量分析时，ΔNLR 仍然是 28 天死亡率的独立预测因子，独立于这些严重程度评分。Kaplan-Meier 曲线和使用重新分类方法的统计数据显示，与单独使用 ΔSOFA 相比，ΔNLR 与 ΔSOFA 联合使用可更好地预测 28 天死亡率风险。这些结果在包括 101 名重症肝硬化患者的外部验证队列中得到了证实。
ΔNLR 是需要 ICU 支持治疗的重症肝硬化患者死亡率的独立预测因子，应与 ΔSOFA 联合使用，作为一种预后生物标志物。
