Neutrophil to Lymphocyte Ratio (NLR) as a Predictor of Mortality in Critically Ill Cirrhotic Patients

Document Type : Original Article


The Department of Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University


Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammation score that has been shown to predict poor clinical outcomes. Aim of Study: Is to explore the utility of NLR as a predictor of short-term mortality in critically ill cirrhotic patients. Patients and Methods: This is a prospective observational cohort study in which fifty critically ill cirrhotic patients admitted in the intensive care unit without hepatocellular carcinoma were enrolled between December 2017 and June 2018. NLR in comparison with CTP, MELD, SOFA, APACHE II scores was assessed for the prediction of mortality. Results: Patients were 32 males and 18 females with mean age of 57.8±11.3 years. The etiologies of liver cirrhosis included HCV infection (n=38), HBV (2), AIH (3), NASH (1), Wilson disease (1) and cryptogenic (5). The follow-up duration was 28 days, during which 28 patients died (56%). The median NLRs were 12.8 and 11 in non-surviving and surviving patients respectively (p-value=0.536). The lone factor that correlated with mortality was serum sodium level (p 0.049). NLR score was found significant in correlation with MELD score (p-value=0.002). Conclusion: We found a higher NLR among non-survived patients but without statistical significance. Serum sodium played a clearer role in predictingmortality. A significant correlation was found between NLR and MELD to predict early mortality in critically ill cirrhotic patients and no single independent score effectively predicted mortality.