Neutrophil-lymphocyte ratio is associated with worse outcomes in patients with cirrhosis: insights from the PRO-LIVER Registry.

作者信息

D'Amico Tania, Miglionico Marzia, Cangemi Roberto, Romiti Giulio Francesco, De Fabrizio Benedetta, Fasano Salvatore, Recchia Fabrizio, Stefanini Lucia, Raparelli Valeria, Violi Francesco, Basili Stefania

机构信息

Department of Translational and Precision Medicine, Sapienza-University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.

Department of Translational Medicine, University of Ferrara, Ferrara, Italy.

出版信息

Intern Emerg Med. 2025 May 20. doi: 10.1007/s11739-025-03955-x.

DOI:10.1007/s11739-025-03955-x

PMID:40392481

Abstract

BACKGROUND

Liver cirrhosis (LC) is a leading global cause of morbidity and mortality, with inflammation playing a key role in disease progression and clinical complications of LC. The Neutrophil/Lymphocyte Ratio (NLR), a readily available marker of systemic inflammation, has been linked to short-term adverse outcomes in LC, but data on long-term follow-up are limited. This study aimed to investigate the relationship between NLR and long-term all-cause mortality in an unselected cohort of LC patients.

METHODS

Data were gathered from the Italian multicenter observational study "PRO-LIVER". Patients with available data to calculate NLR at baseline were included. Baseline clinical determinants of NLR and the association of NRL with all-cause mortality at 2-year follow-up were evaluated.

RESULTS

From the overall cohort (n = 753), 506 patients with LC (31% female, mean age 64.8 ± 11.9 years) were included in the analysis. Median value of NLR was 2.42 (Interquartile Range [IQR]: 1.61-3.52). At baseline, patients with NLR ≥ 2.42 were more likely to have Child-Pugh B or C, hepatocellular carcinoma (HCC), or portal vein thrombosis (PVT). After a median follow-up of 21 months, 129 patients died: 44 (17%) with NLR < 2.42 and 85 (34%) with NLR ≥ 2.42 (p < 0.001). At multiple-adjusted Cox regression analysis, NLR ≥ 2.42 was independently associated with all-cause mortality (HR: 1.65; 95% CI: 1.12-2.44; p = 0.012), along with age, Child-Pugh C class, HCC and PVT.