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.