Neutrophil-lymphocyte ratio predicts hospital-acquired bacterial infections in decompensated cirrhosis

- The clinical utility of the baseline NLR to predict the HA infections in patients with cirrhosis is unclear.
- Decompensated cirrhotics with development of HA infections have higher NLR value and worse baseline liver function.
- Total bilirubin, albumin, white cell count and NLR were demonstrated as the independent predictors of HA infections.
- NLR > 4.33 categorized decompensated cirrhotic patients into high risk for HA infections.

BackgroundBacterial infection is a frequent complication and severe burden in cirrhotic patients. We determined the utility of neutrophil-to-lymphocyte ratio (NLR) to predict the hospital-acquired (HA) bacterial infections episode in patients with decompensated cirrhosis.MethodsWe retrospectively included 2066 consecutive decompensated cirrhotic patients from two separate tertiary hospitals, divided into training (n = 1377) and validation (n = 689) set. All data were collected on admission and all overt bacterial infections occurring after > 48 h of hospital stay were registered.ResultsThe incidence of HA bacterial infections in training and validation cohort was 35.87% and 31.05% respectively. Multivariate analysis showed that total bilirubin (TBil), albumin, white blood cell count (WBC) and NLR were independent predictors of HA bacterial infections. We established a Model_NTWA using these four variables and a Model_TWA which did not include NLR. Areas under the curves (AUC) of Model_NTWA (0.859) and NLR (0.824) were higher than which of Model_TWA (0.713), WBC (0.675), TBil (0.593) and Albumin (0.583). Consistent with training cohort, validation cohort showed similar results. Patients with NLR of at least 4.33 had a significantly lower survival (P < 0.001).ConclusionsNLR can be used as a novel noninvasive marker to predict the occurrence of HA bacterial infections in decompensated cirrhotic patients.