Departments of Internal Medicine.
Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Eur J Gastroenterol Hepatol. 2024 Jul 1;36(7):952-960. doi: 10.1097/MEG.0000000000002782. Epub 2024 May 9.
Acute-on-chronic liver failure (ACLF) is the most severe form of acutely decompensated cirrhosis and is characterized by the presence of intense systemic inflammation. Leucocyte quantification can serve as an indirect indicator of systemic inflammation. In our study, we investigated the predictive value of hematological ratios (neutrophils to lymphocytes, monocyte to lymphocytes, platelets to lymphocytes, lymphocytes to C-reactive protein, and neutrophils to lymphocytes and platelets) in acute decompensation (AD) and ACLF patients and their relation to disease severity and early mortality.
We included 60 patients with ACLF and AD, and 30 cirrhotic controls. Clinical data were collected, and survival was followed for 1 and 6 months. Blood samples were analyzed at admission for differential leucocytes and assessed for liver and renal function tests. The leukocyte ratios were calculated and compared, and their correlation with liver function indicators and prognosis was assessed.
All ratios were significantly higher in AD and ACLF patients compared to control (except for lymphocyte to C-reactive protein ratio which was significantly lower), and were positively correlated with Child-Pugh score, model for end-stage liver disease (MELD)-Na, and ACLF severity scores. Multivariate regression revealed that neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and MELD-Na were independent prognostic factors of 1-month and 6-month mortality. A unique prognostic nomogram incorporating MELD-Na, neutrophil to lymphocyte ratio, and monocyte to lymphocyte ratio could be proposed for predicting prognosis in AD and ACLF patients.
Cheap, easy, and noninvasive hematological ratios are introduced as a tool for early identification and risk stratification of AD and ACLF patients.
慢加急性肝衰竭（ACLF）是急性失代偿性肝硬化最严重的形式，其特征是存在强烈的全身炎症。白细胞计数可作为全身炎症的间接指标。在本研究中，我们研究了血液学比值（中性粒细胞与淋巴细胞、单核细胞与淋巴细胞、血小板与淋巴细胞、淋巴细胞与 C 反应蛋白、中性粒细胞与淋巴细胞和血小板）在急性失代偿（AD）和 ACLF 患者中的预测价值及其与疾病严重程度和早期死亡率的关系。
我们纳入了 60 例 ACLF 和 AD 患者和 30 例肝硬化对照患者。收集临床数据，并随访 1 个月和 6 个月的生存情况。入院时采集血液样本进行白细胞分类，并评估肝功能和肾功能试验。计算并比较白细胞比值，并评估其与肝功能指标和预后的相关性。
与对照组相比，AD 和 ACLF 患者的所有比值均显著升高（淋巴细胞与 C 反应蛋白比值除外，其显著降低），且与 Child-Pugh 评分、终末期肝病模型（MELD）-Na 和 ACLF 严重程度评分呈正相关。多变量回归显示，中性粒细胞与淋巴细胞比值、单核细胞与淋巴细胞比值和 MELD-Na 是 1 个月和 6 个月死亡率的独立预后因素。可以提出一个包含 MELD-Na、中性粒细胞与淋巴细胞比值和单核细胞与淋巴细胞比值的独特预后列线图，用于预测 AD 和 ACLF 患者的预后。
廉价、简便、非侵入性的血液学比值可作为早期识别和 AD 和 ACLF 患者风险分层的工具。
