WHAT IS THE PROGNOSTIC VALUE OF A BLOOD TEST COUNT IN PATIENTS WITH ALCOHOLIC HEPATITIS?

Introduction and Objectives

A blood test count is an accessible resource at all levels of healthcare. Few studies have evaluated its usefulness in patients with alcoholic hepatitis (AH).

The aim is to determine the association between the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and systemic immune-inflammation index (SI-II) with 28-day mortality in patients with AH.

Materials and Methods

Longitudinal, retrospective, observational and descriptive cohort study. Subjects met criteria for AH. Patients with conditions that could alter the blood count were excluded. Absolute values ​​of NLR: (neutrophils/lymphocytes), PLR: platelets/lymphocytes, SI-II (neutrophils x platelets/lymphocytes) were estimated.

Statistical analysis was performed with the Jamovi program. To compare clinical values, Student's T-test or Mann Whitney U test were performed. The association analysis between NLR, PLR and SI-II with 28-day mortality, were carried out using a point-biserial correlation. An ROC curve was performed using GraphPad Prism version 10.2.3 to establish the cutoff point of the NLR and determine the sensitivity and specificity.

Results

Eighty-nine patients were included, 86 (96%) men and 3 (4%) women. The mean NLR value in patients who survived was four times the value presented in patients who died within 28 days, two times for the PLR and five times for SI-II (Table 1). The cutoff point of the NLR was >12.9 (AUC 0.986), with a p value <0.0001, sensitivity 92.7% and specificity 94.1% (95% CI).

Conclusions

A blood test count is an accessible resource that could be considered a useful prognostic factor in clinical practice for alcoholic hepatitis.

Conflict of interest: None

Table 1. Comparison table of survival at 28 days using prognostic scales.

Variable	Death in the first 28 days (n=55)	Survivors after 28 days (n=34)	p
Age	45.7 ± 9.1	46.0 ± 12.3	0.909
Leukocytes (x10^3 mm^3)	23.3 ± 8.3	11.7 ± 5.4	< 0.001
Platelets (x10^3 uL)	154.0 (84.5, 239.0)	89.5 (56.0, 158.0)	0.008
TP (s)	23.6 (19.8, 28.3)	23.6 (18.3, 29.1)	0.233
BT (mg/dL)	24.1 ± 10.7	16.4 ± 10.0	0.001
AST (U/L)	153 (101, 206)	160 (104, 244)	0.346
ALT (U/L)	54.0 (39.5, 71.5)	60.0 (40.5, 91.3)	0.646
INR	2.15 (1.79, 2.52)	2.03 (1.54, 2.67)	< 0.001
Cr (mg/dL)	2.16 (1.46, 3.54)	1.16 (0.73, 2.30)	0.004
NLR	30.5 (17.2, 32.1)	7.0 (5.0, 8.8)	< 0.001
CLIF SCORE	56.1 ± 6.6	49.3 ± 8.9	< 0.001
MADDREY	79.2 (55.5, 98.2)	69.2 (40.5, 102.0)	0.111
MELD	35.3 ± 11.5	26.8 ± 9.3	< 0.001
MELD NA	36.1 ± 9.3	28.7 ± 8.8	< 0.001
PLR	153 (116, 293)	89.5 (51.3, 104)	< 0.001
SI-II	3269 (1870, 5357)	704 (365, 1102)	< 0.001

Abbreviations: NLR: neutrophil-lymphocyte ratio, PLR: platelet-lymphocyte ratio, SI-II: systemic immune-inflammation index

ROC curve for NLR