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. 2017 Apr 20;12(4):e0175332.
doi: 10.1371/journal.pone.0175332. eCollection 2017.

Neutrophil-lymphocyte ratio predicts short term mortality in patients with hepatitis B virus-related acute-on-chronic liver failure treated with an artificial liver support system

Zeng Fan  1   2 , Chen EnQiang  1 , Du Ling Yao  1 , Yan LiBo  1 , Li Hong  1 , Bai Lang  1 , Feng Ping  1 , Tang Hong  1
Affiliations

Neutrophil-lymphocyte ratio predicts short term mortality in patients with hepatitis B virus-related acute-on-chronic liver failure treated with an artificial liver support system

Zeng Fan et al. PLoS One. .

Abstract

Aim: Hepatitis B virus-related acute-on-chronic liver failure has high short-term mortality. Artificial liver support systems (ALSS) may improve outcome and avoid liver transplantation, but predicting short-term prognosis in such patients is difficult. This study aimed to determine whether the neutrophil-lymphocyte ratio (NLR), an inflammation marker, predicted mortality in patients treated with ALSS.

Methods: A total of 560 patients with hepatitis B virus-related acute-on-chronic liver failure were enrolled, 338 were treated with ALSS and the others treated with standard of care(SOC). Clinical variables and the NLR were evaluated for prognostic value.

Results: Thirty-day mortality was 28.4% in ALSS and 55.4% in SOC patients. The NLR was lower in survivors than in ALSS or SOC patients who died. Univariate and multivariate analysis found that NLR and the chronic liver failure sequential organ failure assessment scores(CLIF-SOFA) were independently associated with 30-day mortality. Among patients with NLRs ≤ 3, 3-6, and >6, 30-day mortality was 7.7%,23.1%, and 69.2% in ALSS and 25.5%, 50.0%, and 75.0% in SOC patients. Among patients with NLRs ≤ 3 or 3-6, mortality was lower in ALSS than in SOC patients (P < 0.01). Mortality rates of ALSS and SOC patients with NLRs > 6 did not different (P >0.05). The area under curve of NLR and CLIF-SOFA was 0.82 and 0.88 in ALSS group, 0.78 and 0.86 in SOC group. The results suggest that liver function in most patients with NLRs ≤ 3 recovered with ALSS treatment, and patients with NLRs > 6 needed emergency liver transplantation.

Conclusion: NLR was an independent predictor of mortality in ALSS patients and may assist physicians in determining treatment options.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
ROC of prognostic variables for patients with HBV-ACLF in ALSS (A) and SOC(B) group.
Fig 2
Fig 2
Baseline median NLR (A), LC (B), and NC (C) in the ALSS group survivors (solid bars) and in patients who died (open bars). Error bars are IQRs.
Fig 3
Fig 3
Baseline median NLR (A), LC (B), and NC (C) in the SOC group survivors (solid bars) and in patients who died (open bars). Error bars are IQRs.
Fig 4
Fig 4
Cumulative 30-day mortality in ALSS (A) and SOC (B) patients with NLR ≤ 3, 3–6, and > 6.
See this image and copyright information in PMC

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