Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.477
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
End-stage liver disease (ESLD) carries a high mortality risk. Identifying reliable prognostic factors is important to guide management, but studies on the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in ESLD have reported conflicting results.
To comprehensively evaluate the association between NLR and ESLD prognosis through a systematic review and meta-analysis of existing literature.
To establish whether NLR is a useful prognostic biomarker for predicting mortality in patients with ESLD.
A systematic literature search was conducted through multiple databases. Studies evaluating the relationship between NLR and mortality in ESLD patients were selected and their data extracted. Pooled effect sizes were calculated using meta-analysis.
Higher NLR levels were associated with increased mortality risk in ESLD based on meta-analysis of 27 studies reporting hazard/odds ratios. NLR also distinguished survivors from non-survivors. The prognostic value of NLR was not influenced by patient characteristics but differed regionally.
NLR is clinically useful for prognostic assessment in ESLD patients, especially Asian populations, but optimal cut-off values require further investigation.
NLR represents a promising, readily available prognostic tool for risk stratifying ESLD patients. Future research should establish standardized NLR cut-offs and evaluate its utility accounting for potential confounders like severity of neutropenia.