Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran, Iran.
Department of Neurosurgery, University of Florida, Gainesville, USA.
Can J Gastroenterol Hepatol. 2022 Sep 27;2022:8604060. doi: 10.1155/2022/8604060. eCollection 2022.
The goal of this systematic review and meta-analysis was analyzing published studies on the role of neutrophil to lymphocyte ratio (NLR) in infection and spatially spontaneous bacterial peritonitis (SBP) among cirrhotic patients.
PubMed, Web of Science, and Scopus were searched until May 24, 2022. The Newcastle-Ottawa scale was used for quality assessment.
Of 14 studies included in our study, six studies were on infection with 2786 hospitalized cirrhotic patients, of whom 934 developed an infection. Other studies were on SBP with 1573 cirrhotic patients with ascites, of whom 557 developed SBP. The pooled results showed that there was no difference in NLR levels between hospitalized cirrhotic patients who developed infection compared to those who did not (random-effects model: SMD = 0.63, 95% CI = -0.01-1.27, =0.054). However, cirrhotic patients with ascites who developed SBP had elevated levels of NLR compared to those who did not (random-effects model: SMD = 1.05, 95% CI = 0.52-1.57, < 0.001). This difference remained significant in prospective studies (SMD = 0.94, 95% CI = 0.51-1.38, < 0.001) but not in retrospective studies (SMD = 1.37, 95% CI = -0.56-3.29,=0.165), in the subgroup analysis according to the study design. The pooled sensitivity of NLR was 92.07% (95% CI = 74.85%-97.84%) and the pooled specificity was 72.58% (95% CI = 57.72%-83.69%). The pooled positive likelihood ratio, negative likelihood ratio, DOR of NLR were 3.35(95%CI = 2.06-5.46), 0.10 (95%CI = 0.03-0.38), and 30.78 (95%CI = 7.01-135.04), respectively.
Our results support NLR to be a valid biomarker that can be readily integrated into clinical settings to help in the prevention and prediction of SBP among cirrhotic patients.
本系统评价和荟萃分析的目的是分析已发表的关于中性粒细胞与淋巴细胞比值（NLR）在肝硬化患者感染和自发性细菌性腹膜炎（SBP）中的作用的研究。
检索了PubMed、Web of Science 和 Scopus，截至 2022 年 5 月 24 日。使用纽卡斯尔-渥太华量表进行质量评估。
在纳入的 14 项研究中，有 6 项研究是关于感染的，共纳入 2786 例住院肝硬化患者，其中 934 例发生感染。其他研究是关于 SBP 的，共纳入 1573 例有腹水的肝硬化患者，其中 557 例发生 SBP。汇总结果显示，与未发生感染的住院肝硬化患者相比，发生感染的患者的 NLR 水平无差异（随机效应模型：SMD=0.63，95%CI=-0.01-1.27，=0.054）。然而，发生 SBP 的肝硬化腹水患者的 NLR 水平升高（随机效应模型：SMD=1.05，95%CI=0.52-1.57，<0.001）。这种差异在前瞻性研究中仍然显著（SMD=0.94，95%CI=0.51-1.38，<0.001），但在回顾性研究中不显著（SMD=1.37，95%CI=-0.56-3.29，=0.165），这是根据研究设计进行的亚组分析。NLR 的汇总灵敏度为 92.07%（95%CI=74.85%-97.84%），特异性为 72.58%（95%CI=57.72%-83.69%）。NLR 的汇总阳性似然比、阴性似然比、优势比分别为 3.35（95%CI=2.06-5.46）、0.10（95%CI=0.03-0.38）和 30.78（95%CI=7.01-135.04）。
我们的结果支持 NLR 是一种有效的生物标志物，可以很容易地整合到临床环境中，以帮助预防和预测肝硬化患者的 SBP。
