Prognostic nomogram incorporating neutrophil-to-lymphocyte ratio for early mortality in decompensated liver cirrhosis
Prognostic nomogram incorporating neutrophil-to-lymphocyte ratio for early mortality in decompensated liver cirrhosis
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结合中性粒细胞与淋巴细胞比率的失代偿性肝硬化早期死亡率的预后列线图
DOI：
10.1016/j.intimp.2018.01.007
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发表时间：
2018-03-01
影响因子：
5.6
通讯作者：
Sun, Chao
中科院分区：
文献类型：
--
作者：
Lin, Lin;Yang, Fang;Sun, Chao
背景：中性粒细胞/淋巴细胞比率(NLR)是全身炎症反应的标志。然而，它对失代偿期肝硬化症患者30天死亡率的预测作用仍然难以捉摸。目的：我们的目标是将NLR和其他与肝硬变早期死亡率相关的变量与急性损伤合并到预测性诺模图中。方法：对352例失代偿期肝硬变患者进行回顾性分析。以30天的死亡率作为主要结局。进行了多变量Cox分析，建立了基于NLR的诺模图。诺模图的性能取决于它的校准、辨别力和临床实用性。用Milliplex细胞因子测定法测定血清细胞因子水平。结果：经多因素分析，影响早期死亡的独立因素为白蛋白、MELD和NLR，均进入标准图。诺模图表现出较好的区分性，和谐指数为0.88。诺模图的校正预测的生存与实际结果最接近。决策曲线分析表明，我们的诺模图在临床实践中是有用的。在我们研究的循环细胞因子中，与健康受试者相比，肝硬变患者的IL-6和IL-8显著升高。高NLR与IL-6、IL-8的表达呈正相关。结论：结合NLR的诺模图为失代偿期肝硬化症患者的30天死亡率提供了个体化的预测工具。NLR值的升高可能意味着过度的炎症反应。
Background: Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation. However, its pre-dictive utility of 30-day mortality remains elusive in decompensated cirrhotics. Aims: We aimed to combine NLR and other variables associated with early mortality of cirrhotics with acute insults in to a predictive nomogram. Methods: We retrospectively analyzed 352 decompensated cirrhotics. The 30-day mortality was regarded as primary outcome. Multivariate Cox analysis was performed, and a NLR-based nomogram was developed. The performance of nomogram was determined in terms of its calibration, discrimination and clinical usefulness. Serum cytokines were evaluated by Milliplex cytokine assay. Results: On multiple analysis, independent factors for early mortality were albumin, MELD and NLR, which were all selected into the nomogram. The nomogram showed good discrimination, with a concordance index of 0.88. Calibration of the nomogram predicted survival corresponding optimally with the actual outcomes. Decision curve analysis indicated our nomogram was useful in clinical practice. Among circulating cytokines we investigated , IL-6 and IL-8 were substantially elevated in cirrhotics compared to healthy subjects. High NLR was positively correlated with the expression of IL-6 and IL-8. Conclusion: The proposed nomogram incorporating NLR offered an individualized predictive tool for 30-day mortality in decompensated cirrhotics. The escalating value of NLR likely implicated excessive inflammatory response.