Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Mar 27, 2024; 16(3): 477-489
Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.477
Prognostic value of neutrophil-to-lymphocyte ratio in end-stage liver disease: A meta-analysis
Xiang-Hao Cai, Yun-Ming Tang, Shu-Ru Chen, Jia-Hui Pang, Yu-Tian Chong, Hong Cao, Xin-Hua Li
Xiang-Hao Cai, Yun-Ming Tang, Shu-Ru Chen, Jia-Hui Pang, Yu-Tian Chong, Hong Cao, Xin-Hua Li, Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Co-first authors: Xiang-Hao Cai and Yun-Ming Tang.
Co-corresponding authors: Xin-Hua Li and Hong Cao.
Author contributions: Li XH and Cao H contributed to study concept and design; Cai XH and Tang YM contributed to drafting of the manuscript; and Pang JH collected data of including articles; Cai XH and Chen SR performed the analysis of the project; Pang JH compiled the figures and tables. Li XH and Cao H contributed to critical revision of the manuscript for important content; Chong YT, Li XH, and Cao H contributed to obtaining funding. Cai XH and Tang YM are co-first authors due to their significant involvement in drafting the manuscript and collecting data, showcasing their strong understanding of the research findings. Li XH and Cao H are likely the corresponding authors because of their significant contributions to the study's concept, design, and funding acquisition. The pivotal roles of Li XH and Cao H in shaping the study's foundation and ensuring its continued support position them as the lead corresponding authors in this collaborative effort. Chong YT and Li XH contributed to obtained funding. This collaboration between Li XH and Cao H is crucial for the publication of this manuscript. Their combined efforts reflect their shared responsibility for the scholarly work and ensure that their individual contributions are duly recognized and attributed. All authors approved submission.
Supported by the Science and Technology Planning Project of Guangdong Province, China, No. 2019B020228001; 5010 Project of Sun Yat-sen University, No. 2018024; and Science and Technology Program of Guangzhou, China, No. 202103000060.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Hua Li, MD, PhD, Doctor, Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. lixinh8@mail.sysu.edu.cn
Received: November 12, 2023
Peer-review started: November 12, 2023
First decision: December 7, 2023
Revised: January 3, 2024
Accepted: February 6, 2024
Article in press: February 6, 2024
Published online: March 27, 2024
Abstract
BACKGROUND

The neutrophil-to-lymphocyte ratio (NLR) is commonly utilized as a prognostic indicator in end-stage liver disease (ESLD), encompassing conditions like liver failure and decompensated cirrhosis. Nevertheless, some studies have contested the prognostic value of NLR in ESLD.

AIM

To investigate the ability of NLR to predict ESLD.

METHODS

Databases, such as Embase, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Weipu, and Wanfang, were comprehensively searched to identify studies published before October 2022 assessing the prognostic ability of NLR to predict mortality in patients with ESLD. Effect sizes were calculated using comprehensive meta-analysis software and SATAT 15.1.

RESULTS

A total of thirty studies involving patients with end-stage liver disease (ESLD) were included in the evaluation. Among the pooled results of eight studies, it was observed that the Neutrophil-to-Lymphocyte Ratio (NLR) was significantly higher in non-survivors compared to survivors (random-effects model: standardized mean difference = 1.02, 95% confidence interval = 0.67-1.37). Additionally, twenty-seven studies examined the associations between NLR and mortality in ESLD patients, reporting either hazard ratios (HR) or odds ratios (OR). The combined findings indicated a link between NLR and ESLD mortality (random-effects model; univariate HR = 1.07, 95%CI = 1.05-1.09; multivariate HR = 1.07, 95%CI = 1.07-1.09; univariate OR = 1.29, 95%CI = 1.18-1.39; multivariate OR = 1.29, 95%CI = 1.09-1.49). Furthermore, subgroup and meta-regression analyses revealed regional variations in the impact of NLR on ESLD mortality, with Asian studies demonstrating a more pronounced effect.

CONCLUSION

Increased NLR in patients with ESLD is associated with a higher risk of mortality, particularly in Asian patients. NLR is a useful prognostic biomarker in patients with ESLD.

Keywords: Neutrophil-to-lymphocyte ratio, End stage liver diseases, Prognosis, Meta-analysis, Mortality

Core Tip: This meta-analysis examines the association between neutrophil-to-lymphocyte ratio (NLR) and mortality in patients with end-stage liver disease (ESLD). It finds that elevated NLR is correlated with higher risk of death. Specifically, NLR levels were higher in non-survivors than survivors, and high NLR predicted increased mortality risk as indicated by univariate and multivariate hazards ratios and odds ratios. Moreover, NLR had stronger prognostic value in Asian populations, suggesting it may be a useful biomarker for identifying high-risk ESLD patients, particularly in Asia.