Neutrophil–lymphocyte ratio: a novel predictor for short-term prognosis in acute-on-chronic hepatitis B liver failure

Authors

  • H. Liu,

    1. Beijing Ditan Hospital, Capital Medical University, Beijing, China
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    • Huimin Liu and Heng-Hui Zhang contribute equally to this paper.
  • H. Zhang,

    1. Beijing Ditan Hospital, Capital Medical University, Beijing, China
    2. Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing, China
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    • Huimin Liu and Heng-Hui Zhang contribute equally to this paper.
  • G. Wan,

    1. Beijing Ditan Hospital, Capital Medical University, Beijing, China
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  • Y. Sang,

    1. Beijing Ditan Hospital, Capital Medical University, Beijing, China
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  • Y. Chang,

    1. Beijing Ditan Hospital, Capital Medical University, Beijing, China
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  • X. Wang,

    Corresponding author
    1. Beijing Ditan Hospital, Capital Medical University, Beijing, China
    • Correspondence: Xianbo Wang, MD, Professor, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.

      E-mail: wangxb@ccmu.edu.cn

      and

      Hui Zeng, MD, PhD, Professor, Institute of Infectious diseases, Capital Medical University, Beijing 100015, China.

      E-mail: zenghui@ccmu.edu.cn

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  • H. Zeng

    Corresponding author
    1. Beijing Ditan Hospital, Capital Medical University, Beijing, China
    2. Institute of Infectious Diseases, Capital Medical University, Beijing, China
    3. Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China
    • Correspondence: Xianbo Wang, MD, Professor, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China.

      E-mail: wangxb@ccmu.edu.cn

      and

      Hui Zeng, MD, PhD, Professor, Institute of Infectious diseases, Capital Medical University, Beijing 100015, China.

      E-mail: zenghui@ccmu.edu.cn

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Summary

Acute-on-chronic hepatitis B liver failure (ACHBLF) has a poor prognosis in patients with hepatitis B virus infection. The role of the neutrophil–lymphocyte ratio (NLR), which reflects the inflammatory status of the patient before treatment, has never been studied in this setting. To investigate the predictive value of NLR in patients with ACHBLF, a retrospective cohort with 216 patients and a prospective validation cohort with 73 patients were recruited. Multivariate analyses showed that total bilirubin (TBIL), NLR, age and model for end-stage liver disease (MELD) score had prognostic significance for survival. Both NLR (0.781) and MELD score (0.744) had higher ROC curves, which differed significantly from those for age (0.615) and TBIL (0.691), but not from each other (= 0.94). NLR ≤2.36 predicted lower mortality (with 91.6% sensitivity and 86.0% negative predictive value), and NLR >6.12 was a warning sign for higher mortality risk (with 90.1% specificity and 80.3% positive predictive value). These results demonstrated that pretreatment NLR was associated with the prognosis of patients with ACHBLF, and elevated NLR predicted poor outcome within 8 weeks. We suggest that NLR cut-offs of ≤2.36 and >6.12 are powerful markers for predicting mortality in ACHBLF.

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