中性粒细胞与淋巴细胞比值可预测肝硬化急性失代偿住院患者的短期死亡率。

NEUTROPHIL-LYMPHOCYTE RATIO PREDICTS SHORT-TERM MORTALITY IN PATIENTS HOSPITALIZED FOR ACUTE DECOMPENSATION OF CIRRHOSIS.

机构信息

Universidade Federal de Santa Catarina, Departamento de Medicina Interna, Divisão de Gastroenterologia, Florianópolis, SC, Brasil.

出版信息

Arq Gastroenterol. 2021 Apr-Jun;58(2):131-138. doi: 10.1590/S0004-2803.202100000-23.

DOI:10.1590/S0004-2803.202100000-23

PMID:34287528

Abstract

BACKGROUND

Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis.

OBJECTIVE

Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17).

METHODS

In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients.

RESULTS

In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour.

CONCLUSION

NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.

摘要

背景

肝硬化患者存在慢性系统性炎症和免疫功能障碍，这会影响肝脏疾病的进展。中性粒细胞与淋巴细胞比值（NLR）被提出作为肝硬化患者全身炎症反应和生存的标志物。

目的

评估 NLR 在肝硬化患者中的预后作用及其与炎症细胞因子（IL-6、IL-10 和 IL-17）的关系。

方法

本前瞻性研究纳入两组患者：1）门诊随访的稳定肝硬化患者（n=193）；2）因急性失代偿至少住院 48 小时的住院肝硬化患者（n=334），入院时和 48 小时检测评估。可获得 130 例住院患者的循环炎症细胞因子。

结果

在稳定的肝硬化门诊患者中，NLR 与 MELD 评分和其他与疾病严重程度相关的变量相关。然而，中位随访 32 个月后，NLR 与死亡率无关（HR 1.058，95%CI 0.900-1.243；P=0.495）。在住院患者中，入院后 48 小时的 NLR 与 90 天生存率独立相关（HR 1.061，95%CI 1.020-1.103；P=0.003），这是在多变量 Cox 回归分析中得出的。入院后 48 小时 NLR<3.6 的患者 90 天 Kaplan-Meier 生存率为 87%，而 NLR≥3.6 的患者为 62%（P<0.001）。入院后前 48 小时 NLR 的升高也与死亡率独立相关（HR 2.038，95%CI 1295-3207；P=0.002）。入院后 NLR 未升高的患者 90 天 Kaplan-Meier 生存率为 83%，而 NLR 升高的患者为 62%（P<0.001）。入院时的 IL-6、IL-10 和 IL-17 与入院时和 48 小时 NLR 均呈正相关。基线时 IL-10 水平较低与入院后前 48 小时 NLR 的升高有关。