title: Prognostic value of the neutrophil-to-lymphocyte ratio in patients with acute-on-chronic liver failure.
abstract: OBJECTIVE
  The 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 3-month mortality in patients with acute-on-chronic liver failure (AoCLF).
  
  
  METHODS
  One hundred and twenty-seven patients, including 46 patients with chronic hepatitis B (CHB), 81 with AoCLF and 58 healthy controls (HCs), were enrolled in the study. All patients were followed up for 4 months. The primary end-point was in-hospital mortality at the end of 90 days. A blood sample was collected for all subjects at admission to examine liver function, renal function, international normalised ratio, C-reactive protein and neutrophil and lymphocyte counts, and NLRs were calculated. A total of six clinical chemistry and biochemical variables were analysed for potential associations with outcomes using Cox proportional hazards and multiple regression models.
  
  
  RESULTS
  Acute-on-chronic liver failure patients had significantly higher NLRs on admission compared with HCs and CHB patients (all p = 0.001). Patients with elevated NLRs were associated with increased severity of liver disease and 3-month mortality rates. According to multivariate analysis, only NLR was an independent predictor for mortality (p = 0.025).
  
  
  CONCLUSIONS
  The NLR measured at admission can serve as an independent predictor for 3-month mortality rate in AoCLF patients.
authors.affiliation: Department of Colorectal Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Zhejiang, China.
authors.forename: L
authors.initials: L
authors.lastname: Chen
authors.forename: Y
authors.initials: Y
authors.lastname: Lou
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.forename: J
authors.initials: J
authors.lastname: Yang
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000401:mortality*; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications; D008214:Lymphocytes / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000382:microbiology*; D011379:Prognosis