Liu Jing, Li Sumeng, Liu Yanan, Zhou Fengqin, Wu Jun, Zheng Xin
Department of Infectious Diseases, Tongji Medical College, Institute of Infection and Immunology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Hepatol Res. 2025 Jul 12. doi: 10.1111/hepr.14238.
Limited research has explored the prognostic significance of the neutrophil-percentage-to-albumin ratio (NPAR), derived neutrophil-to-lymphocyte ratio (dNLR), and systemic immune-inflammation index (SII) in individuals with advanced chronic liver disease (ACLD). This study aimed to examine the association between these inflammatory markers and 90-day transplant-free mortality among patients with ACLD.
We prospectively recruited hospitalized patients with ACLD from the tertiary teaching hospital. Cox regressions were used to determine the associations between NPAR, dNLR, SII, and mortality.
A total of 412 patients with ACLD were included in this study. The 90-day transplant-free mortality increased with higher levels of NPAR, dNLR, and SII. In multivariate analysis, higher NPAR, dNLR, and SII were independently associated with an increased risk of mortality in patients with ACLD after adjustment for confounders. After the adjustment for covariables, the risk of 90-day transplant-free mortality in ACLD patients increased by 66% and 18% for every unit increase in NPAR (OR: 1.66, 95% CI 1.09-2.53) and dNLR (OR: 1.18, 95% CI 1.01-1.38), respectively (p < 0.05). The patients with NPAR < 3.5 (OR: 3.65, 95% CI 1.30-10.27) and dNLR < 3.5 (OR: 2.40, 95% CI 1.19-4.86) had the highest risk. Subgroup analysis revealed that NPAR, dNLR, and SII demonstrated a strong correlation with 90-day transplant-free mortality in both acute decompensation and acute-on-chronic liver failure populations. Subsequent analysis showed a significant association between NPAR, dNLR, SII, and 90-day transplant-free mortality in patients presenting with ascites, infection, and gastrointestinal hemorrhage.
Increased NPAR, dNLR, and SII were independently correlated with a higher risk of mortality in patients with ACLD.
关于中性粒细胞百分比与白蛋白比值（NPAR）、衍生中性粒细胞与淋巴细胞比值（dNLR）以及全身免疫炎症指数（SII）在晚期慢性肝病（ACLD）患者中的预后意义，相关研究有限。本研究旨在探讨这些炎症标志物与ACLD患者90天无移植死亡率之间的关联。
我们前瞻性地招募了来自三级教学医院的住院ACLD患者。采用Cox回归分析来确定NPAR、dNLR、SII与死亡率之间的关联。
本研究共纳入412例ACLD患者。90天无移植死亡率随NPAR、dNLR和SII水平的升高而增加。在多变量分析中，校正混杂因素后，较高的NPAR、dNLR和SII与ACLD患者死亡率增加独立相关。校正协变量后，ACLD患者NPAR每增加一个单位，90天无移植死亡率风险增加66%（OR：1.66，95%CI 1.09 - 2.53），dNLR每增加一个单位，风险增加18%（OR：1.18，95%CI 1.01 - 1.38）（p < 0.05）。NPAR < 3.5（OR：3.65，95%CI 1.30 - 10.27）和dNLR < 3.5（OR：2.40，95%CI 1.19 - 4.86）的患者风险最高。亚组分析显示，NPAR、dNLR和SII在急性失代偿和慢加急性肝衰竭人群中均与90天无移植死亡率密切相关。后续分析表明，在出现腹水、感染和胃肠道出血的患者中，NPAR、dNLR、SII与90天无移植死亡率之间存在显著关联。
ACLD患者中NPAR、dNLR和SII升高与较高的死亡风险独立相关。
