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• W2913869080 abstract "We read with interest the recently published article by Rice et al1Rice J. et al.Clin Gastroenterol Hepatol. 2018; 16: 1786-1791Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar illustrating the prognostic value of admission neutrophil-to-lymphocyte ratio (NLR) in patients with cirrhosis. The authors state in their Methods section that they did not find a statistically significant interaction between the NLR and the cause of admission. This is unexpected considering that several studies have shown the increase of NLR in bacterial infections and the association of NLR with the severity of infections.2Karakonstantis S. et al.Infect Dis. 2018; 50: 163-174Crossref PubMed Scopus (23) Google Scholar Indeed, in the Results section of their article, Rice et al1Rice J. et al.Clin Gastroenterol Hepatol. 2018; 16: 1786-1791Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar reported that the NLR was significantly higher in infection-related admissions compared with liver and nonliver admissions. Furthermore, gastrointestinal bleeding2Karakonstantis S. et al.Infect Dis. 2018; 50: 163-174Crossref PubMed Scopus (23) Google Scholar, 3Srygley F.D. et al.JAMA. 2012; 307: 1072-1079Crossref PubMed Scopus (126) Google Scholar (14% of the study’s patients), as well as several other stressors,2Karakonstantis S. et al.Infect Dis. 2018; 50: 163-174Crossref PubMed Scopus (23) Google Scholar also may result in increases of the NLR. Therefore, a table comparing the NLR values according to reason of admission (infection, gastrointestinal bleeding, renal/metabolic issues, encephalopathy) would provide useful information. Rice et al1Rice J. et al.Clin Gastroenterol Hepatol. 2018; 16: 1786-1791Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar also stated that 1-year mortality was not associated significantly with liver vs nonliver cause of hospitalization. However, as seen in Table 2 in their article, confirmed infection was associated significantly with 1-year mortality, in agreement with prior literature.4Arvaniti V. et al.Gastroenterology. 2010; 139: 1246-1256.e5Abstract Full Text Full Text PDF PubMed Scopus (760) Google Scholar Furthermore, admission resulting from gastrointestinal bleeding, a complication associated with high mortality5del Olmo J.A. et al.J Hepatol. 2000; 32: 19-24Abstract Full Text Full Text PDF PubMed Scopus (147) Google Scholar and a complication that likely is associated with a higher NLR,2Karakonstantis S. et al.Infect Dis. 2018; 50: 163-174Crossref PubMed Scopus (23) Google Scholar, 3Srygley F.D. et al.JAMA. 2012; 307: 1072-1079Crossref PubMed Scopus (126) Google Scholar also was not considered as an independent predictor of mortality. To prove that NLR is truly an independent predictor of mortality these variables ideally should be included in the multivariate analysis. Judging from Table 3 in the article by Rice et al,1Rice J. et al.Clin Gastroenterol Hepatol. 2018; 16: 1786-1791Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar it seems that these variables were excluded from the final model. Finally, considering the association of NLR with acute complications such as infection and gastrointestinal bleeding and with the severity of these complications, it is likely that the admission NLR is a better predictor of in-hospital and short-term mortality rather than longer-term mortality. Indeed, the association of admission NLR with 90-day mortality was stronger than the association with 1-year mortality. The NLR at discharge may be a better predictor of postdischarge re-admissions and mortality. If Rice et al1Rice J. et al.Clin Gastroenterol Hepatol. 2018; 16: 1786-1791Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar have the relevant data, it would be useful to repeat their analysis using the discharge NLR as a predictor. In conclusion, it is likely that the admission NLR might reflect the underlying complications leading to admission (eg, infection, gastrointestinal bleeding, and other acute stressors2Karakonstantis S. et al.Infect Dis. 2018; 50: 163-174Crossref PubMed Scopus (23) Google Scholar) and the severity of these complications and that the presence/severity of such complications (rather than the NLR) predict future mortality. Nevertheless, this does not diminish the value of the NLR as a simple objective measure to predict mortality in cirrhotic patients. Neutrophil-to-Lymphocyte Ratio Associates Independently With Mortality in Hospitalized Patients With CirrhosisClinical Gastroenterology and HepatologyVol. 16Issue 11PreviewThe neutrophil to lymphocyte ratio (NLR) is a biomarker of immune dysregulation in patients with cirrhosis and is inexpensive to measure. We investigated the association between NLR and mortality in hospitalized patients with cirrhosis at 4 liver transplant centers, controlling for severity of acute-on-chronic liver failure (ACLF). Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 17Issue 3PreviewWe appreciate the interest by Karakonstantis et al in our article showing that NLR associates with mortality in hospitalized patients with cirrhosis. Full-Text PDF" @default.
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• W2913869080 title "Neutrophil-to-Lymphocyte Ratio; an Independent Predictor of Mortality or Just a Surrogate Marker of Underlying Complications?" @default.
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