The neutrophil-to-lymphocyte ratio represents a systemic inflammation marker and reflects the relationship with 90-day mortality in non-cirrhotic chronic severe hepatitis.

Abstract

Systemic inflammatory responses are common in patients with chronic severe hepatitis (CSH) and increase their risk of mortality. Knowledge regarding the impact of the systemic inflammatory response on short-term outcomes in noncirrhotic CSH patients is limited. We collected data from two prospective, multicenter cohorts from the CATCH-LIFE non-cirrhotic cohort. Cox regression was used to explore the association between systemic inflammation markers and 90-day liver transplant (LT)-free mortality. Generalized additive model (GAM) was used to illustrate the quantitative curve relationship between the neutrophil-to-lymphocyte ratio (NLR) and 90-day LT-free mortality. Kaplan-Meier methods were used to estimate the 90-year LT-free survival rates. The prevalence of CSH in the CATCH-LIFE study was 20.5% (226/1103). The 28-day and 90-day LT-free mortality rates were 17.7% and 26.1%, respectively. Noninfected patients accounted for 75% of CSH patients, and the NLR was independently associated with 90-day LT-free mortality. Quantitative analysis of the association between the NLR and 90-day LT-free mortality showed that an NLR of 2.9 may represent the starting point for disease deterioration in CSH patients without infection. This study identified the NLR as an independent risk factor for 90-day LT-free mortality in noncirrhotic CLD patients. The NLR can better indicate the systemic inflammatory response in noninfected CSH patients. An NLR of 2.9 may be the cutoff for disease aggravation onset in CSH patients without infection.