Department of Gastroenterology and Hepatology, Gleneagles Global Health City, Chennai 600, 100, India.
Department of Gastroenterology, Arihant Hospital and Research Centre, Indore, 452 009, India.
Indian J Gastroenterol. 2021 Jun;40(3):265-271. doi: 10.1007/s12664-020-01134-8. Epub 2021 May 11.
Cirrhotic patients are prone to infections due to underlying immune dysfunction in them. We aimed to study the role of inflammatory markers, serum C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), in predicting infection, blood culture positivity, and short-term (1 month) mortality in hospitalized cirrhotic patients.
This prospective study was done over a period of 14 months (October 2017 to November 2018). Patient data included age, gender, etiology of cirrhosis, reason for admission, and comorbidity. Laboratory tests included blood chemistry and blood cell counts, and blood and urine culture. The specific tests included were CRP and NLR. Survival of patients in the following 1 month was noted. Area under receiver operating characteristic curve (AUROC), sensitivity, specificity, predictive values, diagnostic accuracy were calculated and logistic regression analysis performed. A p-value < 0.05 was considered significant.
Two hundred and eight patients formed the study cohort. The median age was 51.5 years and male predominance was noted. Alcohol-related liver disease (49%) was the commonest etiology. The infection rate was 62%, culture positivity was 58.5%, and mortality was 30.8%. NLR and CRP were significantly higher in those with documented infection (culture positive or negative) and among nonsurvivors. Optimal cutoffs for NLR and CRP to predict infection were 5.86 and 33.7, respectively. The risk of having an infection was 7.5 times and about 15 times if NLR and CRP were above the cutoffs. The risk of 1-month mortality was 2-3 times higher if patients had NLR and CRP above the cutoffs. The combination of NLR and CRP (≥ 5.86 and ≥ 33.7, respectively) increased specificity and diagnostic accuracy for infection.
NLR and CRP were independently good predictors of infection and 1-month survival among the patients with cirrhosis of liver included in this study.
肝硬化患者由于潜在的免疫功能障碍而易发生感染。我们旨在研究炎症标志物、血清 C 反应蛋白（CRP）和中性粒细胞与淋巴细胞比值（NLR）在预测感染、血培养阳性和住院肝硬化患者短期（1 个月）死亡率中的作用。
这是一项前瞻性研究，历时 14 个月（2017 年 10 月至 2018 年 11 月）完成。患者数据包括年龄、性别、肝硬化病因、入院原因和合并症。实验室检查包括血液化学和血细胞计数以及血液和尿液培养。具体检查包括 CRP 和 NLR。记录患者在接下来的 1 个月内的生存情况。计算接受者操作特征曲线（AUROC）下面积、灵敏度、特异性、预测值和诊断准确性，并进行逻辑回归分析。p 值<0.05 被认为有统计学意义。
208 例患者形成研究队列。中位年龄为 51.5 岁，男性居多。酒精性肝病（49%）是最常见的病因。感染率为 62%，培养阳性率为 58.5%，死亡率为 30.8%。有记录感染（培养阳性或阴性）和非幸存者的 NLR 和 CRP 显著升高。预测感染的 NLR 和 CRP 的最佳截断值分别为 5.86 和 33.7。如果 NLR 和 CRP 高于截断值，感染的风险分别增加 7.5 倍和 15 倍。如果患者的 NLR 和 CRP 高于截断值，1 个月死亡率的风险增加 2-3 倍。NLR 和 CRP 的组合（分别为≥5.86 和≥33.7）增加了感染的特异性和诊断准确性。
NLR 和 CRP 是本研究中肝硬化患者感染和 1 个月生存率的独立良好预测指标。
