title: Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis.
abstract: OBJECTIVE
  Neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. We aimed to evaluate the role of NLR in the prediction of long-term mortality in patients with stable liver cirrhosis.
  
  
  METHODS
  This is a retrospective observational cohort study in which 145 stable cirrhotic patients without infection, hepatocellular carcinoma, and ongoing steroid therapy were enrolled between January 2009 and December 2011. The primary end point was survival during follow-up. NLR along with Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD) scores, and Charlson comorbidity index were assessed for the prediction of mortality.
  
  
  RESULTS
  There were 86 men and 59 women, mean age 58.9±13.4 years. The etiologies of liver cirrhosis included viral hepatitis (n=73), cryptogenic (50), alcoholic (12), and other (10). The mean follow-up duration was 27.8±6.8 months, during which 40 patients died. The mean NLRs were 2.08±0.99 and 4.39±3.0 in surviving and nonsurviving patients, respectively (P<0.001). Kaplan-Meier survival analysis was carried out according to the median NLR above and below 2.72. Patients with NLR of at least 2.72 had a significantly lower survival (log rank, P<0.001). NLR was found to be an independent predictor of mortality in all Cox Regression models (odds ratio 1.2; 95% confidence interval 1.2-1.3; P<0.001). Receiver operating characteristic analysis showed that cut-off values of 4.22, 3.07, and 2.96 for NLR predicted 12, 24, and 36-month mortality, respectively (AUC: 0.806, P=0.0029; 0.841, P<0.0001 and 0.783, P<0.0001, respectively).
  
  
  CONCLUSIONS
  NLR is a predictor of mortality independent of CTP and MELD scores in patients with liver cirrhosis. NLR could predict mortality in the subgroup of patients with low MELD scores as well.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Meram School of Medicine, Selcuk University, 42090 Meram, Konya, Turkey. drmuratbiyik@gmail.com
authors.forename: Murat
authors.initials: M
authors.lastname: Biyik
authors.forename: Ramazan
authors.initials: R
authors.lastname: Ucar
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Solak
authors.forename: Gokhan
authors.initials: G
authors.lastname: Gungor
authors.forename: Ilker
authors.initials: I
authors.lastname: Polat
authors.forename: Abduzhappar
authors.initials: A
authors.lastname: Gaipov
authors.forename: Ozlem O
authors.initials: OO
authors.lastname: Cakir
authors.forename: Huseyin
authors.initials: H
authors.lastname: Ataseven
authors.forename: Ali
authors.initials: A
authors.lastname: Demir
authors.forename: Suleyman
authors.initials: S
authors.lastname: Turk
authors.forename: Hakki
authors.initials: H
authors.lastname: Polat
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index