Prognostic nomogram incorporating neutrophil-to-lymphocyte ratio for early mortality in decompensated liver cirrhosis

Publication date: March 2018
Source:International Immunopharmacology, Volume 56
Author(s): Lin Lin, Fang Yang, Ya Wang, Shuai Su, Zhengyan Su, Xihui Jiang, Yanmin Zheng, You Deng, Houning Lv, Jingwen Zhao, Rui Lin, Bangmao Wang, Chao Sun
BackgroundNeutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation. However, its predictive utility of 30-day mortality remains elusive in decompensated cirrhotics.AimsWe aimed to combine NLR and other variables associated with early mortality of cirrhotics with acute insults in to a predictive nomogram.MethodsWe 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.ResultsOn 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.ConclusionThe 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.



http://ift.tt/2Es9zlf