دورية أكاديمية
أعرض في EDS

Hematological ratios in patients with acute decompensation and acute-on-chronic liver failure: prognostic factors.

التفاصيل البيبلوغرافية
العنوان: Hematological ratios in patients with acute decompensation and acute-on-chronic liver failure: prognostic factors.
المؤلفون: Lashen SA; Departments of Internal Medicine., Salem P; Departments of Internal Medicine., Ibrahim E; Departments of Internal Medicine., Abd Elmoaty D; Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt., Yousif WI; Departments of Internal Medicine.
المصدر: European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2024 Jul 01; Vol. 36 (7), pp. 952-960. Date of Electronic Publication: 2024 May 09.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams And Wilkins Country of Publication: England NLM ID: 9000874 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1473-5687 (Electronic) Linking ISSN: 0954691X NLM ISO Abbreviation: Eur J Gastroenterol Hepatol Subsets: MEDLINE
أسماء مطبوعة: Publication: London : Lippincott Williams And Wilkins
Original Publication: [London, UK ; Philadelphia, PA, USA] : Current Science, c1989-
مواضيع طبية MeSH: Acute-On-Chronic Liver Failure*/blood , Acute-On-Chronic Liver Failure*/mortality , Acute-On-Chronic Liver Failure*/diagnosis , Severity of Illness Index* , C-Reactive Protein*/analysis , Neutrophils* , Predictive Value of Tests*, Humans ; Male ; Female ; Middle Aged ; Prognosis ; Adult ; Case-Control Studies ; Leukocyte Count ; Aged ; Lymphocyte Count ; Monocytes ; Lymphocytes ; Platelet Count ; Liver Cirrhosis/blood ; Liver Cirrhosis/complications ; Liver Cirrhosis/mortality ; Liver Cirrhosis/diagnosis ; Blood Platelets ; Biomarkers/blood ; Time Factors
مستخلص: Background and Aims: 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.
Patients and Methods: 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.
Results: 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.
Conclusions: Cheap, easy, and noninvasive hematological ratios are introduced as a tool for early identification and risk stratification of AD and ACLF patients.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
References: Ye F, Zhai M, Long J, Gong Y, Ren C, Zhang D, et al. The burden of liver cirrhosis in mortality: results from the global burden of disease study. Front Public Health 2022; 10:2522.
Gambino C, Piano S, Angeli P. Acute-on-chronic liver failure in cirrhosis. J Clin Med 2021; 10:4406.
Schierwagen R, Gu W, Brieger A, Brüne B, Ciesek S, Đikić I, et al.; ACLF-I Investigators. Pathogenetic mechanisms and therapeutic approaches of acute-to-chronic liver failure. Am J Physiol Cell Physiol 2023; 325:C129–C140.
Zaccherini G, Baldassarre M, Bartoletti M, Tufoni M, Berardi S, Tamè M, et al. Prediction of nosocomial acute-on-chronic liver failure in patients with cirrhosis admitted to hospital with acute decompensation. JHEP Rep 2019; 1:270–277.
Casulleras M, Zhang IW, López-Vicario C, Clària J. Leukocytes, systemic inflammation, and immunopathology in acute-on-chronic liver failure. Cells 2020; 9:2632.
Trebicka J, Fernandez J, Papp M, Caraceni P, Laleman W, Gambino C, et al.; PREDICT STUDY group of the EASL-CLIF CONSORTIUM. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. J Hepatol 2021; 74:1097–1108.
Gacouin A, Locufier M, Uhel F, Letheulle J, Bouju P, Fillatre P, et al. Liver cirrhosis is independently associated with 90-day mortality in ARDS patients. Shock 2016; 45:16–21.
Mehta G, Mookerjee RP, Sharma V, Jalan R. Systemic inflammation is associated with increased intrahepatic resistance and mortality in alcohol-related acute-on-chronic liver failure. Liver Int 2015; 35:724–734.
Si Y, Liu J, Shan W, Zhang Y, Han C, Wang R, et al. Association of lymphocyte-to-monocyte ratio with total coronary plaque burden in patients with coronary artery disease. Coron Artery Dis 2020; 31:650–655.
Eissa M, Shaarawy S, Abdellateif MS. The role of different inflammatory indices in the diagnosis of COVID-19. Int J Gen Med 2021; 14:7843–7853.
Misiewicz A, Dymicka-Piekarska V. Fashionable, but what is their real clinical usefulness? NLR, LMR, and PLR as a promising indicator in colorectal cancer prognosis: a systematic review. J Inflamm Res 2023; 16:69–81.
Xu Z, Zhang J, Zhong Y, Mai Y, Huang D, Wei W, et al. Predictive value of the monocyte-to-lymphocyte ratio in the diagnosis of prostate cancer. Medicine (Baltim) 2021; 100:e27244.
Zhou Y, Tian N, Li P, He Y, Tong L, Xie W. The correlation between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with nonalcoholic fatty liver disease: a cross-sectional study. Eur J Gastroenterol Hepatol 2022; 34:1158–1164.
Cakir Guney B, Hayiroglu M, Senocak D, Cicek V, Cinar T, Kaplan M. Evaluation of N/LP ratio as a predictor of disease progression and mortality in COVID-19 patients admitted to the intensive care unit. Medeni Med. J 2021; 3:241–248.
Chen X, Guo W, Diao Z, Huang H, Liu W. Lymphocyte-to-C reactive protein ratio as novel inflammatory marker for predicting outcomes in hemodialysis patients: a multicenter observational study. Front Immunol 2023; 14:1101222.
Dymicka-Piekarska V, Dorf J, Milewska A, Łukaszyk M, Kosidło JW, Kamińska J, et al. Neutrophil/lymphocyte ratio (NLR) and lymphocyte/monocyte ratio (LMR) – risk of death inflammatory biomarkers in patients with COVID-19. J Inflamm Res 2023; 16:2209–2222.
Wang H, Li L, Ma Y. Platelet-to-lymphocyte ratio a potential prognosticator in acute myocardial infarction: a prospective longitudinal study. Clin Cardiol 2023; 46:632–638.
Zhu Z, Jiang H. External validation of chronic liver failure-consortium acute decompensation score in the risk stratification of cirrhotic patients hospitalized with acute variceal bleeding. Eur J Gastroenterol Hepatol 2023; 35:302–312.
Jeong JH, Park IS, Kim DH, Kim SC, Kang C, Lee SH, et al. CLIF–SOFA score and SIRS are independent prognostic factors in patients with hepatic encephalopathy due to alcoholic liver cirrhosis. Medicine (Baltim) 2016; 95:e3935.
Sarkar S, Khanna P, Singh AK. The impact of neutrophil-lymphocyte count ratio in COVID-19: a systematic review and meta-analysis. J Intensive Care Med 2022; 37:857–869.
Janka T, Tornai D, Papp M, Vitális Z. The value of neutrophil-to-lymphocyte ratio to identify bacterial infection and predict short-term mortality in patients with acutely decompensated cirrhosis. Diagnostics (Basel) 2023; 13:2954.
Horvatits T, Drolz A, Trauner M, Fuhrmann V. Liver injury and failure in critical illness. Hepatology 2019; 70:2204–2215.
Sun J, Guo H, Yu X, Zhu H, Zhang X, Yang J, et al. A neutrophil-to-lymphocyte ratio-based prognostic model to predict mortality in patients with HBV-related acute-on-chronic liver failure. BMC Gastroenterol 2021; 21:1–14.
Lin S, Lin Y, Fang Y, Mo Z, Hong X, Ji C, et al. Clinicopathological and prognostic value of preoperative lymphocyte to monocyte ratio for hepatocellular carcinoma following curative resection: a meta-analysis including 4,092 patients. Medicine (Baltim) 2021; 100:e24153.
Lin BY, Zhou L, Geng L, Zheng ZY, Jia JJ, Zhang J, et al. High neutrophil-lymphocyte ratio indicates poor prognosis for acute-on-chronic liver failure after liver transplantation. World J Gastroenterol 2015; 21:3317–3324.
Moreau N, Wittebole X, Fleury Y, Forget P, Laterre PF, Castanares-Zapatero D. Neutrophil-to-lymphocyte ratio predicts death in acute-on-chronic liver failure patients admitted to the intensive care unit: a retrospective cohort study. Shock 2018; 49:385–392.
Sarin S, Pamecha V, Sinha PK, Patil N, Mahapatra N. Neutrophil lymphocyte ratio can preempt development of sepsis after adult living donor liver transplantation. J Clin Exp Hepatol 2022; 12:1142–1149.
Oikonomou T, Goulis I, Kiapidou S, Tagkou N, Akriviadis E, Papatheodoridis G, et al. The significance of C-reactive protein to albumin ratio in patients with decompensated cirrhosis. Ann Gastroenterol 2020; 33:667–674.
Seyedi SA, Nabipoorashrafi SA, Hernandez J, Nguyen A, Lucke-Wold B, Nourigheimasi S, et al. Neutrophil to lymphocyte ratio and spontaneous bacterial peritonitis among cirrhotic patients: a systematic review and meta-analysis. Can J Gastroenterol Hepatol 2022; 2022:8604060.
Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al.; CANONIC Study Investigators of the EASL–CLIF Consortium. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144:1426–37, 1437.e1.
Laleman W, Claria J, Van Der Merwe S, Moreau R, Trebicka J. Systemic inflammation and acute-on-chronic liver failure: too much, not enough. Can J Gastroenterol Hepatol 2018; 2018:1027152.
Weiss E, de la Grange P, Defaye M, Lozano JJ, Aguilar F, Hegde P, et al. Characterization of blood immune cells in patients with decompensated cirrhosis including ACLF. Front Immunol 2021; 11:619039.
Engelmann C, Zhang IW, Clària J. Mechanisms of immunity in acutely decompensated cirrhosis and acute-on-chronic liver failure. Liver Int 2023. doi: 10.1111/liv.15644. (PMID: 10.1111/liv.15644)
Ni P, Yu M, Zhang R, Cheng C, He M, Wang H, et al. Dose-response association between C-reactive protein and risk of all-cause and cause-specific mortality: a systematic review and meta-analysis of cohort studies. Ann Epidemiol 2020; 51:20–27.e11.
Kuo NR, Hou MC, Chu WC, Yang YY, Huang CC, Li TH, et al. Low lymphocyte-to-monocyte ratio, calcitriol level, and CD206 level predict the development of acute-on-chronic liver failure in patients’ cirrhosis with acute decompensation. J Chinese Med Assoc 2023; 86:265–273.
Yao J, Liu T, Zhao Q, Ji Y, Bai J, Wang H, et al. Genetic landscape, and immune mechanism of monocytes associated with the progression of acute-on-chronic liver failure. Hepatol Int 2023; 17:676–688.
Cakir Guney B, Hayiroglu M, Senocak D, Cicek V, Cinar T, Kaplan M. Evaluation of N/LP ratio as a predictor of disease progression and mortality in COVID-19 patients admitted to the intensive care unit. Medeni Med J 2021; 36:241–248.
Xiao W, Lu Z, Liu Y, Hua T, Zhang J, Hu J, et al. Influence of the initial neutrophils to lymphocytes and platelets ratio on the incidence and severity of sepsis-associated acute kidney injury: a double robust estimation based on a large public database. Front Immunol 2022; 13:925494.
Santoshi RK, Patel R, Patel NS, Bansro V, Chhabra G. A comprehensive review of thrombocytopenia with a spotlight on intensive care patients. Cureus 2022; 14:e27718.
Scharf RE. Thrombocytopenia and hemostatic changes in acute and chronic liver disease: pathophysiology, clinical and laboratory features, and management. J Clin Med 2021; 10:1530.
Scherlinger M, Richez C, Tsokos GC, Boilard E, Blanco P. The role of platelets in immune-mediated inflammatory diseases. Nat Rev Immunol 2023; 23:495–510.
Xu X, Li C, Chen J, Liu X, Su H, Tong J, et al. Relationship between platelet to white blood cell ratio and 30-day prognosis of patients with acute-on-chronic liver failure. Hepat Mon 2021; 21:e118640.
Chae YJ, Lee J, Park JH, Han DG, Ha E, Yi IK. Late mortality prediction of neutrophil-to-lymphocyte and platelet ratio in patients with trauma who underwent emergency surgery: a retrospective study. J Surg Res 2021; 267:755–761.
Cai J, Wang K, Han T, Jiang H. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Med (United States) 2018; 97:e13324.
Li JN, Sun MY, Li H, Tang SH. Value of the monocyte-to-lymphocyte ratio in the prognostic evaluation of hepatitis B-related acute-on-chronic liver failure. chinese J Hepatol 2022; 30:644–648.
Okugawa Y, Toiyama Y, Yamamoto A, Shigemori T, Ide S, Kitajima T, et al. Lymphocyte-C-reactive protein ratio as promising new marker for predicting surgical and oncological outcomes in colorectal cancer. Ann Surg 2020; 272:342–351.
State N. CRP and the prognosis of patients with cirrhosis. Maedica 2021; 16:353–361.
Chirapongsathorn S, Bunraksa W, Chaiprasert A, Punpanich D, Supasyndh O, Kamath PS. Adding C-reactive protein and procalcitonin to the model of end-stage liver disease score improves mortality prediction in patients with complications of cirrhosis. J Gastroenterol Hepatol 2018; 33:726–732.
Starlinger P, Ahn JC, Mullan A, Gyoeri GP, Pereyra D, Alva-Ruiz R, et al. The addition of C-reactive protein and von willebrand factor to model for end-stage liver disease-sodium improves prediction of waitlist mortality. Hepatology 2021; 74:1533–1545.
المشرفين على المادة: 9007-41-4 (C-Reactive Protein)
0 (Biomarkers)
تواريخ الأحداث: Date Created: 20240603 Date Completed: 20240603 Latest Revision: 20240603
رمز التحديث: 20240604
DOI: 10.1097/MEG.0000000000002782
PMID: 38829945
قاعدة البيانات: MEDLINE
الوصف
تدمد:1473-5687
DOI:10.1097/MEG.0000000000002782