Neutrophil–lymphocyte ratio is associated with worse outcomes in patients with cirrhosis: insights from the PRO-LIVER Registry

• DOI: 10.1007/s11739-025-03955-x
• Publication Date: 2025-05-20T13:25:09Z
• Authors: Tania D’Amico; Marzia Miglionico; Roberto Cangemi; Giulio Francesco ...; Benedetta De Fabr...; Salvatore Fasano; Fabrizio Recchia; Lucia Stefanini; Valeria Raparelli; Francesco Violi; Stefania Basili; ; Giuseppe Palasciano; Felicia D’Alitto; Vincenzo Ostilio ...; Daniela Santovito; Dario Di Michele; Giuseppe Croce; David Sacerdoti; Silvia Brocco; Silvano Fasolato; Lara Cecchetto; Giancarlo Bombonato; Michele Bertoni; Tea Restuccia; Paola Andreozzi; Maria Livia Liguori; Francesco Perticone; Benedetto Caroleo; Maria Perticone; Orietta Staltari; Roberto Manfredini; Alfredo De Giorgi; Maurizio Averna; Antonina Giammanco; Alessandro Granito; Irene Pettinari; Sara Marinelli; Luigi Bolondi; Lorenzo Falsetti; Aldo Salvi; Emanuele Durante-...; Flavio Cesaro; Vincenza Farinaro; Enrico Ragone; Ignazio Morana; Angelo Andriulli; Antonio Ippolito; Angelo Iacobellis; Grazia Niro; Antonio Merla; Giovanni Raimondo; Sergio Maimone; Irene Cacciola; Doriana Varvara; Davide Drenaggi; Silvia Staffolani; Antonio Picardi; Umberto Vespasian...; Giovanni Galati; Paolo Gallo; Giovanni Davì; Cosima Schiavone; Francesca Santilli; Claudio Tana; Anna Licata; Maurizio Soresi; Giovanni Battista...; Isabella Carderi; Antonio Pinto; Antonino Tuttolom...; Giovanni Ferrari; Paolo Gresele; Tiziana Fierro; Olivia Morelli; Giacomo Laffi; Roberto Giulio Ro...; Umberto Arena; Cristina Stasi; Antonio Gasbarrini; Matteo Gargovich; Maria Assunta Zocco; Laura Riccardi; Maria Elena Ainora; William Capeci; Giuseppe Pio Martino; Lorenzo Nobili; Maurizio Cavallo; Pierluigi Frugiuele; Antonio Greco; Antonello Pietran...; Paolo Ventura; Chiara Cuoghi; Matteo Marcacci; Gaetano Serviddio; Gianluigi Vendemiale; Rosanna Villani; Ruggiero Gargano; Gianpaolo Vidili; Valentina Di Cesare; Maristella Masala; Giuseppe Delitala; Pietro Invernizzi; Giovanni Di Minno; Antonella Tufano; Francesco Purrello; Graziella Privitera; Alessandra Forgione; Valentina Curigliano; Marco Senzolo; Kryssia Isabel Ro...; Gianluigi Giannelli; Carla Serra; Sergio Neri; Mario Rizzetto; Wilma Debernardi ...; Gianluca Svegliat...; Gaetano Bergamaschi; Michela Masotti; Filippo Costanzo; Gino Roberto Corazza; Stephen Hugh Cald...; Francesco Angelico; Maria Del Ben; Laura Napoleone; Licia Polimeni; Marco Proietti; Valeria Raparelli; Giulio Francesco ...; Eleonora Ruscio; Andrea Severoni; Giovanni Talerico; Filippo Toriello; Annarita Vestri; Lucia Stefanini; Lucas Rumbolà; Giovanni Buoninfante; Francesca Maiorca; Annamaria Sabetta; Simone Di Cola

Abstract

Background Liver cirrhosis (LC) is a leading global cause of morbidity and mortality, with inflammation playing a key role in disease progression and clinical complications of LC. The Neutrophil/Lymphocyte Ratio (NLR), a readily available marker of systemic inflammation, has been linked to short-term adverse outcomes in LC, but data on long-term follow-up are limited. This study aimed to investigate the relationship between NLR and long-term all-cause mortality in an unselected cohort of LC patients.

Methods Data were gathered from the Italian multicenter observational study “PRO-LIVER”. Patients with available data to calculate NLR at baseline were included. Baseline clinical determinants of NLR and the association of NRL with all-cause mortality at 2-year follow-up were evaluated.

Results From the overall cohort (n = 753), 506 patients with LC (31% female, mean age 64.8 ± 11.9 years) were included in the analysis. Median value of NLR was 2.42 (Interquartile Range [IQR]: 1.61–3.52). At baseline, patients with NLR ≥ 2.42 were more likely to have Child–Pugh B or C, hepatocellular carcinoma (HCC), or portal vein thrombosis (PVT). After a median follow-up of 21 months, 129 patients died: 44 (17%) with NLR < 2.42 and 85 (34%) with NLR ≥ 2.42 (p < 0.001). At multiple-adjusted Cox regression analysis, NLR ≥ 2.42 was independently associated with all-cause mortality (HR: 1.65; 95% CI: 1.12–2.44; p = 0.012), along with age, Child–Pugh C class, HCC and PVT.

Conclusions NLR is associated with long-term all-cause mortality in LC. NLR may serve as a potentially easily available tool to aid risk refinement in LC.

Trial registration number ClinicalTrials.gov Identifier: NCT01470547.