Liu Jing, Li Hai, Xia Jie, Wang Xianbo, Huang Yan, Li Beiling, Meng Zhongji, Gao Yanhang, Qian Zhiping, Liu Feng, Lu Xiaobo, Liu Junping, Deng Guohong, Zheng Yubao, Yan Huadong, Qiao Liang, Xiang Xiaomei, Zhang Qun, Chen Ruochan, Chen Jinjun, Luo Sen, Gao La, Ji Liujuan, Li Jing, Zhou Xinyi, Ren Haotang, Lu Sihong, Li Sumeng, Zhang Weituo, Zheng Xin
Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Chinese Chronic Liver Failure Consortium, Shanghai, China.
Front Med (Lausanne). 2021 Aug 31;8:726950. doi: 10.3389/fmed.2021.726950. eCollection 2021.
Patients with cirrhosis have an increased risk of short-term mortality, however, few studies quantify the association between neutrophil-to-lymphocyte ratio (NLR) and 90-day transplant-free mortality in cirrhotic patients. We prospectively analyzed 3,970 patients with chronic liver diseases from two multicenter cohorts in China (January 2015 to December 2016 and July 2018 to January 2019). Restricted cubic splines (RCS) were used to analyze the relation of NLR and all-causes 90-day transplant-free mortality in cirrhosis. A total of 2,583 cirrhotic patients were enrolled in our study. Restricted cubic splines showed that the odds ratio (OR) of all causes 90-day transplant-free mortality started to increase rapidly until around NLR 6.5, and then was relatively flat ( for non-linearity <0.001). The risk of 90-day transplant-free mortality in cirrhotic patients with NLR < 6.5 increased with an increment of 23% for every unit increase in NLR ( < 0.001). The patients with NLR < 4.5 had the highest risk (OR: 2.34, 95% CI 1.66-3.28). In multivariable-adjusted stratified analyses, the increase in the incidence of 90-day transplant-free mortality with NLR increasing was consistent (OR >1.0) across all major prespecified subgroups, including infection group (OR: 1.04, 95% CI 1.00-1.09) and non-infection (OR: 1.06, 95% CI 1.02-1.11) group. The trends for NLR and numbers of patients with organ failure varied synchronously and were significantly increased with time from day 7 to day 28. We found a non-linear association between baseline NLR and the adjusted probability of 90-day transplant-free mortality. A certain range of NLR is closely associated with poor short-term prognosis in patients with cirrhosis.
肝硬化患者短期死亡风险增加，然而，很少有研究对中性粒细胞与淋巴细胞比值（NLR）和肝硬化患者90天无移植死亡率之间的关联进行量化。我们对来自中国两个多中心队列（2015年1月至2016年12月以及2018年7月至2019年1月）的3970例慢性肝病患者进行了前瞻性分析。使用受限立方样条（RCS）分析NLR与肝硬化患者全因90天无移植死亡率的关系。我们的研究共纳入了2583例肝硬化患者。受限立方样条显示，全因90天无移植死亡率的比值比（OR）在NLR约为6.5之前开始迅速上升，之后相对平稳（非线性检验P<0.001）。NLR<6.5的肝硬化患者，NLR每增加一个单位，90天无移植死亡率风险增加23%（P<0.001）。NLR<4.5的患者风险最高（OR：2.34，95%CI 1.66 - 3.28）。在多变量调整的分层分析中，90天无移植死亡率发生率随NLR升高而增加在所有主要预设亚组中均一致（OR>1.0），包括感染组（OR：1.04，95%CI 1.00 - 1.09）和非感染组（OR：1.06，95%CI 1.02 - 1.11）。NLR与器官衰竭患者数量的趋势同步变化，且从第7天到第28天随时间显著增加。我们发现基线NLR与90天无移植死亡率的校正概率之间存在非线性关联。一定范围的NLR与肝硬化患者不良短期预后密切相关。
