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Background <p>Liver cirrhosis (LC) is a leading global cause of morbidity and mortality, with inflammation playing a key role in disease progression and clinical complications of LC. The Neutrophil/Lymphocyte Ratio (NLR), a readily available marker of systemic inflammation, has been linked to short-term adverse outcomes in LC, but data on long-term follow-up are limited. This study aimed to investigate the relationship between NLR and long-term all-cause mortality in an unselected cohort of LC patients.</p> Methods <p>Data were gathered from the Italian multicenter observational study “PRO-LIVER”. Patients with available data to calculate NLR at baseline were included. Baseline clinical determinants of NLR and the association of NRL with all-cause mortality at 2-year follow-up were evaluated.</p> Results <p>From the overall cohort (<i>n</i> = 753), 506 patients with LC (31% female, mean age 64.8 ± 11.9&#xa0;years) were included in the analysis. Median value of NLR was 2.42 (Interquartile Range [IQR]: 1.61–3.52). At baseline, patients with NLR ≥ 2.42 were more likely to have Child–Pugh B or C, hepatocellular carcinoma (HCC), or portal vein thrombosis (PVT). After a median follow-up of 21&#xa0;months, 129 patients died: 44 (17%) with NLR &lt; 2.42 and 85 (34%) with NLR ≥ 2.42 (<i>p</i> &lt; 0.001). At multiple-adjusted Cox regression analysis, NLR ≥ 2.42 was independently associated with all-cause mortality (HR: 1.65; 95% CI: 1.12–2.44; <i>p</i> = 0.012), along with age, Child–Pugh C class, HCC and PVT.</p> Conclusions <p>NLR is associated with long-term all-cause mortality in LC. NLR may serve as a potentially easily available tool to aid risk refinement in LC.</p> Trial registration number <p>ClinicalTrials.gov Identifier: NCT01470547.</p>

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Neutrophil–lymphocyte ratio is associated with worse outcomes in patients with cirrhosis: insights from the PRO-LIVER Registry

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  • 发表日期：

    2025年5月20日

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  • Tania D’Amico,
  • Marzia Miglionico,
  • Roberto Cangemi,
  • Giulio Francesco Romiti,
  • Benedetta De Fabrizio,
  • Salvatore Fasano,
  • Fabrizio Recchia,
  • Lucia Stefanini,
  • Valeria Raparelli,
  • Francesco Violi,
  • Stefania Basili,
  • Giuseppe Palasciano,
  • Felicia D’Alitto,
  • Vincenzo Ostilio Palmieri,
  • Daniela Santovito,
  • Dario Di Michele,
  • Giuseppe Croce,
  • David Sacerdoti,
  • Silvia Brocco,
  • Silvano Fasolato,
  • Lara Cecchetto,
  • Giancarlo Bombonato,
  • Michele Bertoni,
  • Tea Restuccia,
  • Paola Andreozzi,
  • Maria Livia Liguori,
  • Francesco Perticone,
  • Benedetto Caroleo,
  • Maria Perticone,
  • Orietta Staltari ,
  • Roberto Manfredini,
  • Alfredo De Giorgi ,
  • Maurizio Averna,
  • Antonina Giammanco,
  • Alessandro Granito,
  • Irene Pettinari,
  • Sara Marinelli,
  • Luigi Bolondi,
  • Lorenzo Falsetti,
  • Aldo Salvi,
  • Emanuele Durante-Mangoni,
  • Flavio Cesaro,
  • Vincenza Farinaro,
  • Enrico Ragone,
  • Ignazio Morana,
  • Angelo Andriulli,
  • Antonio Ippolito,
  • Angelo Iacobellis,
  • Grazia Niro,
  • Antonio Merla,
  • Giovanni Raimondo,
  • Sergio Maimone,
  • Irene Cacciola,
  • Doriana Varvara,
  • Davide Drenaggi,
  • Silvia Staffolani,
  • Antonio Picardi,
  • Umberto Vespasiani-Gentilucci,
  • Giovanni Galati,
  • Paolo Gallo,
  • Giovanni Davì,
  • Cosima Schiavone,
  • Francesca Santilli,
  • Claudio Tana,
  • Anna Licata,
  • Maurizio Soresi,
  • Giovanni Battista Bianchi,
  • Isabella Carderi,
  • Antonio Pinto,
  • Antonino Tuttolomondo,
  • Giovanni Ferrari,
  • Paolo Gresele,
  • Tiziana Fierro,
  • Olivia Morelli,
  • Giacomo Laffi,
  • Roberto Giulio Romanelli,
  • Umberto Arena,
  • Cristina Stasi,
  • Antonio Gasbarrini,
  • Matteo Gargovich,
  • Maria Assunta Zocco,
  • Laura Riccardi,
  • Maria Elena Ainora,
  • William Capeci,
  • Giuseppe Pio Martino,
  • Lorenzo Nobili,
  • Maurizio Cavallo,
  • Pierluigi Frugiuele,
  • Antonio Greco,
  • Antonello Pietrangelo,
  • Paolo Ventura,
  • Chiara Cuoghi,
  • Matteo Marcacci,
  • Gaetano Serviddio,
  • Gianluigi Vendemiale,
  • Rosanna Villani,
  • Ruggiero Gargano,
  • Gianpaolo Vidili,
  • Valentina Di Cesare,
  • Maristella Masala,
  • Giuseppe Delitala,
  • Pietro Invernizzi,
  • Giovanni Di Minno,
  • Antonella Tufano,
  • Francesco Purrello,
  • Graziella Privitera,
  • Alessandra Forgione,
  • Valentina Curigliano,
  • Marco Senzolo,
  • Kryssia Isabel Rodríguez-Castro,
  • Gianluigi Giannelli,
  • Carla Serra,
  • Sergio Neri,
  • Mario Rizzetto,
  • Wilma Debernardi Venon,
  • Gianluca Svegliati Baroni,
  • Gaetano Bergamaschi,
  • Michela Masotti,
  • Filippo Costanzo,
  • Gino Roberto Corazza,
  • Stephen Hugh Caldwell,
  • Francesco Angelico,
  • Maria Del Ben,
  • Laura Napoleone,
  • Licia Polimeni,
  • Marco Proietti,
  • Valeria Raparelli,
  • Giulio Francesco Romiti,
  • Eleonora Ruscio,
  • Andrea Severoni,
  • Giovanni Talerico,
  • Filippo Toriello,
  • Annarita Vestri,
  • Lucia Stefanini,
  • Lucas Rumbolà,
  • Giovanni Buoninfante,
  • Francesca Maiorca,
  • Annamaria Sabetta,
  • Simone Di Cola

摘要

Background

Liver cirrhosis (LC) is a leading global cause of morbidity and mortality, with inflammation playing a key role in disease progression and clinical complications of LC. The Neutrophil/Lymphocyte Ratio (NLR), a readily available marker of systemic inflammation, has been linked to short-term adverse outcomes in LC, but data on long-term follow-up are limited. This study aimed to investigate the relationship between NLR and long-term all-cause mortality in an unselected cohort of LC patients.

Methods

Data were gathered from the Italian multicenter observational study “PRO-LIVER”. Patients with available data to calculate NLR at baseline were included. Baseline clinical determinants of NLR and the association of NRL with all-cause mortality at 2-year follow-up were evaluated.

Results

From the overall cohort (n = 753), 506 patients with LC (31% female, mean age 64.8 ± 11.9 years) were included in the analysis. Median value of NLR was 2.42 (Interquartile Range [IQR]: 1.61–3.52). At baseline, patients with NLR ≥ 2.42 were more likely to have Child–Pugh B or C, hepatocellular carcinoma (HCC), or portal vein thrombosis (PVT). After a median follow-up of 21 months, 129 patients died: 44 (17%) with NLR < 2.42 and 85 (34%) with NLR ≥ 2.42 (p < 0.001). At multiple-adjusted Cox regression analysis, NLR ≥ 2.42 was independently associated with all-cause mortality (HR: 1.65; 95% CI: 1.12–2.44; p = 0.012), along with age, Child–Pugh C class, HCC and PVT.

Conclusions

NLR is associated with long-term all-cause mortality in LC. NLR may serve as a potentially easily available tool to aid risk refinement in LC.

Trial registration number

ClinicalTrials.gov Identifier: NCT01470547.