Inflammation plays a vital role in liver cirrhosis progression and prognosis.
Dr Zhou and colleagues from China investigated the prognostic significance of inflammatory response markers in decompensated cirrhotic patients without acute-on-chronic liver failure.
Independent predictors were identified using multivariate Cox model and then assembled into a nomogram to predict survival.
Concordance index and time-dependent receiver operating characteristics analysis were adopted to evaluate and compare the performance of nomogram, model for end-stage liver disease (MELD) scores, MELD-Na and Chronic Liver Failure-consortium score for acute decompensated.
The team enrolled a total of 902 decompensated cirrhotic patients with different etiologies, with 6-month, 1-year and 3-year mortality of 19%, 24% and 35%, respectively.
|Neutrophil-to-lymphocyte ratio >5.7 had significantly higher mortality|
|Alimentary Pharmacology & Therapeutics|
The cut-off values for neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio determined by X-tile program were 5.7 and 1.1 respectively.
Patients with neutrophil-to-lymphocyte ratio >5.7 or lymphocyte-to-monocyte ratio ≤1.1 had significantly higher mortality.
The researchers found that independent factors derived from multivariable Cox analysis of development cohort to predict mortality were age, neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio.
The team observed that C-indexes of nomogram were higher than that of MELD score, MELD-Na and Chronic Liver Failure-consortium score for acute decompensated for predicting survival.
The time-dependent receiver operating characteristics and decision curves showed that nomogram was superior to MELD score, MELD-Na and Chronic Liver Failure-consortium score for acute decompensated.
Similar results were observed in validation cohort.
Dr Zhou's team concludes, "The proposed nomogram with neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio resulted in accurate prognostic prediction for decompensated cirrhotic patients without acute-on-chronic liver failure."