A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure

Abstract Background Although the Asian Pacific Association for the Study of the Liver acute-on-chronic liver failure (ACLF) research consortium (AARC) ACLF score is easy to use in patients with hepatitis b virus-related ACLF (HBV-ACLF), serum lactate is not routinely tested in primary hospitals, and...

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Autores principales:	Jian Sun, Hongying Guo, Xueping Yu, Haoxiang Zhu, Xueyun Zhang, Jianghua Yang, Jiefei Wang, Zhiping Qian, Zhongliang Shen, Richeng Mao, Jiming Zhang
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Acute-on-chronic liver failure Asian Pacific Society for the Study of the Liver ACLF Research Consortium Prognosis Bacterial infection Neutrophil-to-lymphocyte ratio Lactate Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/ed4916d0fa534fdeab8b394a0b000950
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spelling	oai:doaj.org-article:ed4916d0fa534fdeab8b394a0b0009502021-11-14T12:16:48ZA neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure10.1186/s12876-021-02007-w1471-230Xhttps://doaj.org/article/ed4916d0fa534fdeab8b394a0b0009502021-11-01T00:00:00Zhttps://doi.org/10.1186/s12876-021-02007-whttps://doaj.org/toc/1471-230XAbstract Background Although the Asian Pacific Association for the Study of the Liver acute-on-chronic liver failure (ACLF) research consortium (AARC) ACLF score is easy to use in patients with hepatitis b virus-related ACLF (HBV-ACLF), serum lactate is not routinely tested in primary hospitals, and its value may be affected by some interference factors. Neutrophil-to-lymphocyte ratio (NLR) is used to assess the status of bacterial infection (BI) or outcomes in patients with various diseases. We developed an NLR-based AARC ACLF score and compared it with the existing model. Methods A total of 494 HBV-ACLF patients, enrolled in four tertiary academic hospitals in China with 90-day follow-up, were analysed. Prognostic performance of baseline NLR and lactate were compared between cirrhotic and non-cirrhotic subgroups via the receiver operating curve and Kaplan–Meier analyses. A modified AARC ACLF (mAARC ACLF) score using NLR as a replacement for lactate was developed (n = 290) and validated (n = 204). Results There were significantly higher baseline values of NLR in non-survivors, patients with admission BI, and those with higher grades of ACLF compared with the control groups. Compared with lactate, NLR better reflected BI status in the cirrhotic subgroup, and was more significantly correlated with CTP, MELD, MELD-Na, and the AARC score. NLR was an independent predictor of 90-day mortality, and was categorized into three risk grades (< 3.10, 3.10–4.78, and > 4.78) with 90-day cumulative mortalities of 8%, 21.2%, and 77.5% in the derivation cohort, respectively. The mAARC ACLF score, using the three grades of NLR instead of corresponding levels of lactate, was superior to the other four scores in predicting 90-day mortality in the derivation (AUROC 0.906, 95% CI 0.872–0.940, average P < 0.001) and validation cohorts (AUROC 0.913, 95% CI 0.876–0.950, average P < 0.01), with a considerable performance in predicting 28-day mortality in the two cohorts. Conclusions The prognostic value of NLR is superior to that of lactate in predicting short-term mortality risk in cirrhotic and non-cirrhotic patients with HBV-ACLF. NLR can be incorporated into the AARC ACLF scoring system for improving its prognostic accuracy and facilitating the management guidance in patients with HBV-ACLF in primary hospitals.Jian SunHongying GuoXueping YuHaoxiang ZhuXueyun ZhangJianghua YangJiefei WangZhiping QianZhongliang ShenRicheng MaoJiming ZhangBMCarticleAcute-on-chronic liver failureAsian Pacific Society for the Study of the Liver ACLF Research ConsortiumPrognosisBacterial infectionNeutrophil-to-lymphocyte ratioLactateDiseases of the digestive system. GastroenterologyRC799-869ENBMC Gastroenterology, Vol 21, Iss 1, Pp 1-14 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Acute-on-chronic liver failure Asian Pacific Society for the Study of the Liver ACLF Research Consortium Prognosis Bacterial infection Neutrophil-to-lymphocyte ratio Lactate Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Acute-on-chronic liver failure Asian Pacific Society for the Study of the Liver ACLF Research Consortium Prognosis Bacterial infection Neutrophil-to-lymphocyte ratio Lactate Diseases of the digestive system. Gastroenterology RC799-869 Jian Sun Hongying Guo Xueping Yu Haoxiang Zhu Xueyun Zhang Jianghua Yang Jiefei Wang Zhiping Qian Zhongliang Shen Richeng Mao Jiming Zhang A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure
description	Abstract Background Although the Asian Pacific Association for the Study of the Liver acute-on-chronic liver failure (ACLF) research consortium (AARC) ACLF score is easy to use in patients with hepatitis b virus-related ACLF (HBV-ACLF), serum lactate is not routinely tested in primary hospitals, and its value may be affected by some interference factors. Neutrophil-to-lymphocyte ratio (NLR) is used to assess the status of bacterial infection (BI) or outcomes in patients with various diseases. We developed an NLR-based AARC ACLF score and compared it with the existing model. Methods A total of 494 HBV-ACLF patients, enrolled in four tertiary academic hospitals in China with 90-day follow-up, were analysed. Prognostic performance of baseline NLR and lactate were compared between cirrhotic and non-cirrhotic subgroups via the receiver operating curve and Kaplan–Meier analyses. A modified AARC ACLF (mAARC ACLF) score using NLR as a replacement for lactate was developed (n = 290) and validated (n = 204). Results There were significantly higher baseline values of NLR in non-survivors, patients with admission BI, and those with higher grades of ACLF compared with the control groups. Compared with lactate, NLR better reflected BI status in the cirrhotic subgroup, and was more significantly correlated with CTP, MELD, MELD-Na, and the AARC score. NLR was an independent predictor of 90-day mortality, and was categorized into three risk grades (< 3.10, 3.10–4.78, and > 4.78) with 90-day cumulative mortalities of 8%, 21.2%, and 77.5% in the derivation cohort, respectively. The mAARC ACLF score, using the three grades of NLR instead of corresponding levels of lactate, was superior to the other four scores in predicting 90-day mortality in the derivation (AUROC 0.906, 95% CI 0.872–0.940, average P < 0.001) and validation cohorts (AUROC 0.913, 95% CI 0.876–0.950, average P < 0.01), with a considerable performance in predicting 28-day mortality in the two cohorts. Conclusions The prognostic value of NLR is superior to that of lactate in predicting short-term mortality risk in cirrhotic and non-cirrhotic patients with HBV-ACLF. NLR can be incorporated into the AARC ACLF scoring system for improving its prognostic accuracy and facilitating the management guidance in patients with HBV-ACLF in primary hospitals.
format	article
author	Jian Sun Hongying Guo Xueping Yu Haoxiang Zhu Xueyun Zhang Jianghua Yang Jiefei Wang Zhiping Qian Zhongliang Shen Richeng Mao Jiming Zhang
author_facet	Jian Sun Hongying Guo Xueping Yu Haoxiang Zhu Xueyun Zhang Jianghua Yang Jiefei Wang Zhiping Qian Zhongliang Shen Richeng Mao Jiming Zhang
author_sort	Jian Sun
title	A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure
title_short	A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure
title_full	A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure
title_fullStr	A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure
title_full_unstemmed	A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure
title_sort	neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with hbv-related acute-on-chronic liver failure
publisher	BMC
publishDate	2021
url	https://doaj.org/article/ed4916d0fa534fdeab8b394a0b000950
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A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure

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