Value of neutrophil-lymphocyte ratio in predicting the prognosis of patients with decompensated cirrhosis

Objective To investigate the value of neutrophil-lymphocyte ratio ( NLR) in predicting the prognosis of patients with decompensated cirrhosis. Methods A retrospective analysis was performed for the clinical data of 173 patients who were diagnosed with decompensated cirrhosis in The Third Affiliated Hospital of Anhui Medical University from January 2013 to December 2016, including sex, age, etiology, medical history, and first laboratory examination after admission. With death as the outcome event, these patients were divided into survival group and death group according to the outcome of the disease at 1-year follow-up. The influencing factors for prognosis were analyzed, and the value of NLR in predicting the prognosis of patients with decompensated cirrhosis were evaluated. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was performed to investigate the correlation between two variables. A univariate Cox analysis was performed for related variables, and the multivariate Cox proportional hazards model was used to identify independent influencing factors.The receiver operating characteristic ( ROC) curve was plotted and the area under the ROC curve ( AUC) was calculated; the optimal cut-off value was determined according to the optimal Youden index. The Kaplan-Meier survival analysis was performed to compare the 1-year survival rate of patients with different NLR values, and the log-rank test was used for comparison. Results Of all 173 patients, 50 died and 123 survived within the 1-year follow-up. The death group had significantly higher NLR, Child-Turcotte-Pugh ( CTP) score, and Model for End-Stage Liver Disease ( MELD) score than the survival group ( U = 4660. 0, 4994. 5, and t =-9. 209, all P < 0. 001) .NLR was positively correlated with CTP score and MELD score ( r = 0. 363 and 0. 410, both P < 0. 001) . The optimal cut-off values of NLR and MELD score in predicting 1-year prognosis were 3. 52 and 14. 26, respectively, with AUCs of 0. 758 and 0. 854, respectively;the combination of NLR and MELD score had an increased AUC of 0. 863. The survival analysis showed that the high-NLR group ( NLR≥3. 52) had a significantly lower survival rate than the low-NLR group ( NLR < 3. 52) ( χ2= 36. 602, P < 0. 001) . The multivariate Cox regression analysis showed that NLR≥3. 52 was an independent risk factor for death within 1 year. Conclusion NLR has a good value in predicting the 1-year prognosis of patients with decompensated cirrhosis.