Abstracts Asociación Mexicana de Hepatología (AMH) 2024
More infoThe neutrophil-lymphocyte ratio (NLR) has been used as a predictor of survival in critically ill patients. However, there are scarce studies that evaluate the relationship between NLR and alcoholic hepatitis. Thus, we aimed to determine the association between NLR with mortality and the degree of acute-on-chronic liver failure (ACLF).
Materials and PatientsLongitudinal, retrospective, observational and descriptive cohort study of a hospital center. Patients who attended from March 1, 2022, to April 30, 2024, to Gastroenterology service were included. The subjects met criteria for alcohol hepatitis established by the National Institute on Alcohol Abuse and Alcoholism: alcohol consumption >40 g/day (women) or >60 g/day (men) for six or more months, jaundice during the previous eight weeks, AST > 50 IU/L, AST/ALT ratio > 1.5, and both values < 400 IU/L, BT > 3.0 mg/dL. Patients with concomitant infections or conditions that could alter the NLR (steroid use, pancreatitis, hemorrhage, neoplasms) were excluded. Statistical analysis was performed with the SPSS version 26 program. To compare clinical values, Student's T-test or Mann Whitney U test were performed according to the distribution of the data. The association analysis between NLR and 30-day mortality, as well as the association between NLR and ACLF degrees, were carried out using a point-biserial correlation. Cohen's d test was performed to determine the effect size.
ResultsThis study included 58 patients with alcoholic hepatis (98% men). The mean of the INL was 24.3. There was significant difference between patients who died within 28 days compared with those who survived (Table 1). The main differences were observed in the following data: leukocytes (p < 0.001), creatinine levels (p = 0.007), BT (p < 0.001); as well as, in the indexes: INL (p < 0.001), CLIF SCORE (p <0.001), MELD (p = 0.02) and MELD Na (p = 0.01). (Table 1). The mean NLR value in patients who survived was approximately three times the value presented in patients who died within 28 days [23.0 (19.1, 28.6) vs. 8.0 (5.0, 11.0); (p < 0.001)]. A gradual increase in severity-dependent NLR was identified based on the CLIF SCORE scale (significant difference among the three groups considering CLIF SCORE 0). In addition, significant associations between NLR and 28-day mortality (p < 0.001), and between NLR and the degree of ACLF (p < 0.001) were found. According to Cohen's test, the effect size of the NLR was moderate (0.678).
ConclusionsThe association between high NLR levels and mortality within 28 days is confirmed. Furthermore, there is an association between NLR and the severity of ACLF. Therefore, the NLR could be a useful prognostic factor in the clinical practice for alcoholic hepatitis. However, more studies with larger sample sizes are required.
Ethical statement: The protocol was registered and approved by the Ethics Committee. Patient confidentiality was maintained, and informed consent was obtained.
Declaration of interests: None.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Comparison of clinical data and severity scales between surviving and non-surviving subjects at 28 days.
BT, Total bilirubin; CLIF SCORE, Chronic Liver Failure score; Cr, Creatinine; INR, International Normalized Ratio; MADDREY, Maddrey's discriminant function; MELD, Model for End-Stage Liver Disease; MELD NA, MELD sodium; NLR, Neutrophil-lymphocyte ratio; PT, Prothrombin Time.
