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 numberClinicalTrials.gov Identifier: NCT01470547.
Neutrophil–lymphocyte ratio is associated with worse outcomes in patients with cirrhosis: insights from the PRO-LIVER Registry / D'Amico, T.; Miglionico, M.; Cangemi, R.; Romiti, G. F.; De Fabrizio, B.; Fasano, S.; Recchia, F.; Stefanini, L.; Raparelli, V.; Violi, F.; Basili, S.; Di Cola, S.; Sabetta, A.; Maiorca, F.; Buoninfante, G.; Rumbolà, L.; Stefanini, L.; Vestri, A.; Toriello, F.; Talerico, G.; Severoni, A.; Ruscio, E.; Romiti, G. F.; Raparelli, V.; Proietti, M.; Polimeni, L.; Napoleone, L.; Del Ben, M.; Angelico, F.; Caldwell, S. H.; Corazza, G. R.; Costanzo, F.; Masotti, M.; Bergamaschi, G.; Svegliati Baroni, G.; Debernardi Venon, W.; Rizzetto, M.; Neri, S.; Serra, C.; Giannelli, G.; Rodríguez-Castro, K. I.; Senzolo, M.; Curigliano, V.; Forgione, A.; Privitera, G.; Purrello, F.; Tufano, A.; Di Minno, G.; Invernizzi, P.; Delitala, G.; Masala, M.; Di Cesare, V.; Vidili, G.; Gargano, R.; Villani, R.; Vendemiale, G.; Serviddio, G.; Marcacci, M.; Cuoghi, C.; Ventura, P.; Pietrangelo, A.; Greco, A.; Frugiuele, P.; Cavallo, M.; Nobili, L.; Martino, G. P.; Capeci, W.; Ainora, M. E.; Riccardi, L.; Zocco, M. A.; Gargovich, M.; Gasbarrini, A.; Stasi, C.; Arena, U.; Romanelli, R. G.; Laffi, G.; Morelli, O.; Fierro, T.; Gresele, P.; Ferrari, G.; Tuttolomondo, A.; Pinto, A.; Carderi, I.; Bianchi, G. B.; Soresi, M.; Licata, A.; Tana, C.; Santilli, F.; Schiavone, C.; Davì, G.; Gallo, P.; Galati, G.; Vespasiani-Gentilucci, U.; Picardi, A.; Staffolani, S.; Drenaggi, D.; Varvara, D.; Cacciola, I.; Maimone, S.; Raimondo, G.. - In: INTERNAL AND EMERGENCY MEDICINE. - ISSN 1828-0447. - (2025), pp. 1-2. [10.1007/s11739-025-03955-x]
Neutrophil–lymphocyte ratio is associated with worse outcomes in patients with cirrhosis: insights from the PRO-LIVER Registry
Fasano S.;Stefanini L.;Violi F.;Stefanini L.;Vestri A.;Costanzo F.;Purrello F.;Marcacci M.;Cuoghi C.;Ventura P.;Pietrangelo A.;Nobili L.;Santilli F.;Schiavone C.;Gallo P.;Raimondo G.
2025
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 numberClinicalTrials.gov Identifier: NCT01470547.
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