Liver and Bile
Eur J Gastroenterol Hepatol. 2022;34(5):529–36
Neutrophil-lymphocyte ratio and the risk of 30-day mortality in patients with overt hepatic encephalopathy
Aim: Patients with overt hepatic encephalopathy (OHE) have an increased risk of adverse outcomes. However, the relationship between neutrophil to lymphocyte ratio (NLR) and the 30-day risk of death in patients with OHE has not been well evaluated.
Methods: The authors retrospectively analyzed 1301 patients with OHE at Beijing Ditan Hospital between August 2008 and December 2018. After adjustment for major risk factors, Cox regression analysis and restricted cubic splines were used to analyze the relation between NLR and 30-day mortality. The 30-day survival was calculated by Kaplan-Meier method.
Results: All patients were divided into 4 subgroups on the basis of the quartiles of the baseline NLR distribution (< 2.5, 2.5–4.3, 4.3–7.5, > 7.5). The 30-day mortality rates were 7.8%, 12.7%, 19.5% and 34.1%, respectively (p < 0.001). Compared with the lowest quartile, the increase in the NLR was associated with an increase risk of 30-day mortality after multivariable adjustment (NLR 2.5–4.3: adjusted hazard ratio [aHR] = 1.17, 95% confidence interval [CI]: 0.70–1.95; NLR 4.3–7.5: aHR = 1.58, 95% CI: 1.01–2.47; NLR > 7.5: aHR = 2.32, 95% CI: 1.50–3.57. A non-linear association between NLR and the adjusted probability of 30-day mortality was observed. Elevated NLR was correlated with increased 30-day mortality in patients with OHE across different subgroups (HR > 1.0).
Conclusion: An elevated neutrophil to lymphocyte ratio is independently associated with a higher risk of 30-day mortality in patients with overt hepatic encephalopathy.