OUP accepted manuscript

Predictive value of neutrophil-to-lymphocyte ratio and MELD score for short-term survival of patients with HBV-DeCi

OBJECTIVE

The prognostic value of neutrophil-to-lymphocyte ratio (NLR) combined with Model for End-Stage Liver Disease (MELD) score was evaluated for hepatitis B virus-associated decompensated cirrhosis (HBV-DeCi).

METHODS

The 30-day mortality of 166 hBV-DeCi patients was examined. Receiver operating characteristic curve analysis and multivariate regression analysis were used to assess the performance of NLR for prediction of poor outcomes.

RESULTS

The 30-day mortality rate was 10.2% (17/166). NLR was significantly lower in survivors than in non-survivors, and could be used for prognosis prediction in HBV-DeCi patients. Area under the curve was higher for NLR combined with MELD score than for each factor alone. (MELD score, AUC:0.864、NLR, AUC:0.781, Combined, AUC:0.920) The Odds ratio of MELD score is lower than NLR.(MELD score:1.447&NLR:1.745).

CONCLUSIONS

The findings demonstrate that NLR combined with MELD score has a high prognostic value for HBV-DeCi patients.

Role of the Lymphocyte Count-to-C-Reactive Protein Ratio in the Risk Stratification for High EASE Scores After Living Donor Liver Transplantation: A Retrospective Observational Cohort Study

Background: Early allograft failure (EAF) significantly contributes to mortality, necessitating re-transplantation following liver transplantation. The EAF simplified estimation (EASE) score has been recently developed to predict EAF. We aimed to assess the predictive capacity of high EASE scores for EAF and postoperative outcomes and to evaluate the association between the lymphocyte count-to-C-reactive protein ratio (LCR) and high EASE scores after living donor liver transplantation (LDLT). Methods: We retrospectively analyzed the data of 808 patients who underwent LDLT. After excluding 16 patients with incomplete laboratory data, the final cohort included 792 patients. Patients with EASE scores ≥-0.74 were categorized into the high EASE group. Multivariate logistic regression was used to examine the association between the LCR and high EASE scores. Results: High EASE scores demonstrated superior predictive accuracy for EAF development relative to that of the early allograft dysfunction (EAD) model (p = 0.018) and were more closely associated with overall mortality (p = 0.033). A preoperative LCR < 12.7 significantly increased the odds (odds ratio, 3.3; confidence interval, 1.997-5.493) of exhibiting high EASE scores post-LDLT, alongside preoperative hematocrit levels, operative duration, intraoperative continuous renal replacement therapy, administered calcium dose, mean heart rate, and donor age. Conclusions: The EASE score could offer enhanced utility for predicting EAF and overall mortality following LDLT relative to that of EAD. Identifying and managing risk factors, including low LCR values, for elevated EASE scores is essential for improving patient prognoses.

Inflammatory indexes predict mortality in non-malignant patients in palliative care

BACKGROUND

The literature on the use of inflammatory indexes for palliative care patients without malignancy is scarce.

AIMS

To determine which inflammatory indexes are associated with the mortality risks of non-malignant patients hospitalised and receiving palliative care.

METHODS

Discharged or deceased patients in a palliative care unit of a secondary care hospital were included. The laboratory values were obtained during the first 48 hours of hospitalisation.

FINDINGS

As a result of univariate Cox regression analysis, 14-day mortality rate was affected by lymphocyte ratio, neutrophil-to-albumin ratio (NAR), C-reactive protein/albumin ratio (CAR), multi-inflammatory indexes (MII-1) and MII-2 (p<0.001, p=0.001, p=0.002, p=0.009 and p=0.003, respectively); NLR, CLR, NAR, CAR, MII-1 and MII-2 (respectively p=0.005, p<0.001, p<0.001, p<0.001, p=0.001 and p<0.001) affected 28-day mortality rate. Indexes that statistically significantly increased both 14-day and 28-day mortality rates independently of other variables were CLR, NAR, CAR, MII-1 and MII-2.

CONCLUSION

High values in inflammatory indexes, including C-reactive protein and albumin increase the risk of 14-day and 28-day mortality rates in palliative care non-malignant patients.

Evaluation of five lymphocyte-based scores for prediction of mortality in hepatitis B virus-associated decompensated cirrhosis

Background

Lymphocytes are generally accepted to be a key component of the immune response, and an inadequate immune response is closely associated with disease severity and adverse outcomes in hepatitis B virus (HBV)-infected patients. The present study aimed to determine and compare the prognostic values of five lymphocyte-based scores (monocyte-to-lymphocyte ratio [MLR], mean platelet volume-to-lymphocyte ratio [MPVLR], neutrophil-to-lymphocyte ratio [NLR], red cell distribution width-to-lymphocyte ratio [RLR], and C-reactive protein-to-lymphocyte ratio [CLR]) for HBV-associated decompensated cirrhosis (HBV-DC).

Methods

Data were extracted from an institutional database. The outcome was 30-day mortality. Receiver operating characteristic curve analyses were conducted, and the resulting area under the curve (AUC) values were used to evaluate the predictive capabilities of the five lymphocyte-based scores for mortality in HBC-DC relative to Model for End-Stage Liver Disease (MELD) score.

Results

The study included 273 patients, and the 30-day mortality was 20.9%. Lymphocyte counts were slightly lower in non-survivors than in survivors. The prognostic values of CLR, NLR, MLR, MPVLR, and RLR for mortality in HBV-DC were different. The predictive powers of NLR and MLR were superior to those of the other three scores and similar to that of MELD score. Multivariate analyses identified NLR, MLR, and MELD score as independent prognostic predictors.

Conclusion

High NLR and MLR are easily accessible and reliable indicators for predicting 30-day mortality in HBV-DC and have superior prognostic ability compared with other lymphocyte-based scores.