The prognostic value of the neutrophil-to-lymphocyte ratio in critically ill cirrhotic patients

Background Hospital death rates following ICU admission of cirrhotic patients remain high. Identifying patients at high risk of mortality after few days of aggressive management is imperative for providing adequate interventions. Herein, we aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) combined with usual organ failure scores in the outcome prediction of cirrhotic patients hospitalized more than 3 days in ICU. Methods We conducted a retrospective bicentric study in two cohorts of cirrhotic patients hospitalized more than 3 days in French university hospital ICUs. At admission and day 3, we calculated several clinico-biological scores grading liver disease and organ failure severity and calculated the NLR. The primary outcome was 28-day mortality. Results The test cohort included 116 patients. At day 28, 43 (37.1%) patients had died. Variations of MELD score (Delta MELD), SOFA score (Delta SOFA), CLIF-SOFA score (Delta CLIF-SOFA) and NLR (Delta NRL) between admission and day 3 were significantly associated with 28-day mortality in univariate analysis. When included in bivariate analysis Delta NLR remained a significant predictor of 28-day mortality independently of these severity scores. Kaplan-Meier curves and statistics using reclassification methods showed a better 28-day mortality risk prediction using Delta NRL in association with Delta SOFA in comparison to Delta SOFA alone. These results were confirmed in an external validation cohort, including 101 critically ill cirrhotic patients. Conclusions Delta NLR is an independent predictor of mortality in the critically ill cirrhotic patients' population who requires intensive care supportive treatment and should be used in association with Delta SOFA as a prognostic biomarker. Copyright (C) 2021 Wolters Kluwer Health, Inc. All rights reserved.