Neutrophil-to-lymphocyte ratio correlates with proinflammatory neutrophils and predicts death in low model for end-stage liver disease patients with cirrhosis.
Neutrophil-to-lymphocyte ratio correlates with proinflammatory neutrophils and predicts death in low model for end-stage liver disease patients with cirrhosis.
复制标题
DOI：
10.1002/lt.24702
复制
发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Biggins SW
中科院分区：
文献类型：
--
作者：
Kalra A;Wedd JP;Bambha KM;Gralla J;Golden-Mason L;Collins C;Rosen HR;Biggins SW
终末期肝病模型（MELD）评分降低了MELD≤20时肝移植（LT）等待名单死亡率的准确性。中性粒细胞与淋巴细胞比率（NLR）是与全身性炎症相关的生物标志物，可以预测肝硬化失代偿和死亡。我们的目的是在控制肝硬化分期的情况下，评估高NLR（≥4）对低MELD患者肝相关死亡的预后效用。在一项针对等待肝移植的肝硬化成人的巢式病例对照研究（2002年2月至2011年5月）中，肝移植候选者中有肝脏相关死亡，且在死亡后90天内MELD≤20。对照组为肝移植后存活≥90天的类似肝移植候选者。NLR和其他协变量在最低MELD之日、病例死亡后90天内和列入对照后90天内进行评估。41例病例和66例对照；MELD评分相似。NLR第25、50、75百分位截止点分别为1.9、3.1和6.8。25/41（61%）病例NLR≥4,17/66（26%）对照组NLR≥4。在单因素分析中，NLR（连续≥1.9、≥4、≥6.8）、肝硬化分期增加、黄疸、脑病、血清钠、白蛋白和非选择性β受体阻滞剂的使用与肝脏相关死亡显著相关（P < 0.01）。在多变量分析中，NLR≥1.9、≥4、≥6.8与肝脏相关死亡相关。此外，我们发现NLR与循环低密度粒细胞的频率相关，低密度粒细胞以前被认为具有促炎特性，以及单核细胞。总之，NLR升高与肝脏相关死亡相关，与MELD和肝硬化分期无关。高NLR可能有助于确定肝硬化失代偿的风险，是否需要加强监测，以及低MELD候选人是否迫切需要加速肝移植。
The Model for End-Stage Liver Disease (MELD) score has reduced accuracy for liver transplantation (LT) wait-list mortality when MELD ≤20. Neutrophil-to-lymphocyte ratio (NLR) is a biomarker associated with systemic inflammation and may predict cirrhotic decompensation and death. We aimed to evaluate the prognostic utility of high NLR (≥4) for liver-related death among low MELD patients listed for LT, controlling for stage of cirrhosis. In a nested case-control study of cirrhotic adults awaiting LT (February 2002 to May 2011), cases were LT candidates with a liver-related death and MELD ≤20 within 90 days of death. Controls were similar LT candidates who were alive for ≥90 days after LT listing. NLR and other covariates were assessed at the date of lowest MELD, within 90 days of death for cases and within 90 days after listing for controls. There were 41 cases and 66 controls; MELD scores were similar. NLR 25th, 50th, 75th percentile cutoffs were 1.9, 3.1, and 6.8. NLR was ≥4 in 25/41 (61%) cases and in 17/66 (26%) controls. In univariate analysis, NLR (continuous ≥1.9, ≥4, ≥6.8), increasing cirrhosis stage, jaundice, encephalopathy, serum sodium, and albumin and nonselective beta-blocker use were significantly (P < 0.01) associated with liver-related death. In multivariate analysis, NLR of ≥1.9, ≥4, ≥6.8 were each associated with liver-related death. Furthermore, we found that NLR correlated with the frequency of circulating low-density granulocytes, previously identified as displaying proinflammatory properties, as well as monocytes. In conclusion, elevated NLR is associated with liver-related death, independent of MELD and cirrhosis stage. High NLR may aid in determining risk for cirrhotic decompensation, need for increased monitoring, and urgency for expedited LT in candidates with low MELD.
登录
查看更多内容
影响因子：
25.7
作者：
Cazzaniga, Massimo;Dionigi, Elena;Salerno, Francesco
通讯作者：
Salerno, Francesco
DOI：
10.1152/ajpendo.00468.2003
发表时间：
2004-05-01
影响因子：
5.1
作者：
Krogh-Madsen, R;Moller, K;Pedersen, BK
通讯作者：
Pedersen, BK
影响因子：
6.7
作者：
Huo, TI;Lin, HC;Lee, SD
通讯作者：
Lee, SD
影响因子：
4.6
作者：
Kwong, Allison J.;Lai, Jennifer C.;Roberts, John P.
通讯作者：
Roberts, John P.
DOI：
10.4049/jimmunol.1201719
发表时间：
2012-09-15
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
--
作者：
Kaplan MJ;Radic M
通讯作者：
Radic M