Prognostic value of neutrophil-to-lymphocyte ratio in end-stage liver disease: A meta-analysis

Table 1 Characteristic of included studies

Ref.	Year	Location	Population	Patient number (male)	Mean age	Outcome	Etiology	NLR cutoff value	Analysis	NOS scores
Agiasotelli et al[8]	2016	Greece	ACLF patients	108 (80)	60.5	30-d & 180-d mortality	Mixed	NR	HR (Univariate & Multivariate)	8
Bernsmeier et al[27]	2020	Britain	DCC & ACLF patients	617 (386)	NR	90-d mortality	Mixed	30	OR (Univariate & Multivariate)	8
Cai et al[28]	2018	China	ACLF patients	203 (151)	51.14	90-d mortality	HBV	5.09	HR (Univariate & Multivariate)	8
Cai et al[18]	2017	China	ACLF patients	637 (486)	54	6-month, 1-yr & 3-yr mortality	Mixed	5.7	HR (Multivariate)	8
Chiriac et al[29]	2020	Romania	ACLF patients	70 (49)	62	In-hospital mortality	Mixed	5	NR	7
Fan et al[30]	2017	China	ACLF patients	560 (487)	44.9	30-d mortality	HBV	NR	OR (Multivariate)	8
Gao et al[31]	2017	China	ACLF patients	573 (478)	43.5	90-d mortality	HBV	NR	HR (Univariate & Multivariate)	8
Guan et al[32]	2019	China	ACLF patients	174 (135)	49.60	Mortality	HBV	6.5	OR (Univariate)	6
Li et al[33]	2022	China	LC patients with UGIB	376 (235)	60.25	1-yr mortality	Mixed	3.76	OR (Univariate)	7
Li et al[10]	2020	China	DCC patients	174 (139)	53.6	28-d mortality	HBV	3.78	HR (Univariate & Multivariate)	8
Liang et al[34]	2020	China	ACLF patients	227 (202)	46.4	90-d mortality	HBV	5.38	HR (Univariate)	6
Lin et al[35]	2018	China	DCC patients	235 (133)	60	30-d mortality	Mixed	NR	HR (Multivariate)	9
Liu et al[36]	2014	China	ACLF patients	216 (183)	45.58	8-wk mortality	HBV	6.12	NR	8
Liu et al[37]	2021	China	ACLF patients	160 (145)	46.1	28-d mortality	HBV	4.5	OR (Univariate)	7
Maccali et al[38]	2021	Brazil	DCC patients	320 (235)	55.67	90-d mortality	Mixed	NR	HR (Univariate & Multivariate)	8
Moreau et al[39]	2018	Belgium	ACLF patients	105 (72)	58	90-d mortality	Mixed	6.2	HR (Univariate & Multivariate)	7
Oikonomou et al[11]	2020	Greece	DCC patients	132 (NR)	NR	10-month mortality	Mixed	NR	HR (Univariate)	7
Qi et al[26]	2021	China	DCC patients	144 (115)	54.0	30-d mortality	HBV	3.78	OR (Univariate & Multivariate)	8
Qiang et al[40]	2021	China	ACLF patients	577 (494)	48.20	90-d mortality	HBV	4.09	HR (Univariate & Multivariate)	7
Shi et al[41]	2022	China	LC patients with HE	402 (323)	52	30-d mortality	HBV	4	HR (Univariate & Multivariate)	7
Sun et al[9]	2021	China	ACLF patients	412 (351)	NR	28-d & 90-d mortality	HBV	4.79	OR (Univariate & Multivariate)	9
Sun et al[42]	2021	China	ACLF patients	290 (252)	44	90-d mortality	HBV	4.78	HR (Univariate & Multivariate)	9
Wang et al[43]	2019	China	ACLF patients	270 (228)	46.56	90-d mortality	HBV	NR	OR (Univariate)	6
Wang et al[44]	2020	China	ACLF patients	102 (75)	42.9	90-d mortality	HBV	4.22	OR (Univariate)	6
Wu et al[45]	2018	China	ACLF patients	100 (89)	47.3	28-d mortality	HBV	NR	NR	6
Xue et al[46]	2021	China	LC patients with HE	116 (74)	60	30-d mortality	Mixed	4.4	OR (Univariate)	6
Zhang et al[47]	2016	China	DCC patients	148 (118)	53.2	30-d mortality	HBV	5	HR (Univariate & Multivariate)	7
Zhang et al[48]	2018	China	ACLF patients	133 (108)	44.9	90-d mortality	HBV	2.06	OR (Univariate)	5
Zhang et al[49]	2022	United State	DCC patients	264 (122)	58.31	30-d & 90-d mortality	Mixed	10.6	HR (Univariate & Multivariate)	9
Zhou et al[50]	2022	China	LC patients with acute UGIB	676 (398)	62.29	6-wk mortality	Mixed	5.04	OR (Univariate)	9

ACLF: Acute-on-chronic liver failure; DCC: Decompensated cirrhosis; HE: Hepatic encephalopathy; UGIB: Upper gastrointestinal bleeding; LC: Liver cirrhosis; NLR: Neutrophil-to-lymphocyte ratio; NOS: Newcastle-Ottawa Quality Assessment Scale.

Table 2 Subgroup analyses

	Number of subgroup data from studies	Effect size	95%CI	I2	Q between subgoup
Univariate HR
Mean age
> 50	9	1.072	1.043-1.101	85.63c	0.492
≤ 50	3	1.056	1.016-1.097	92.65c
Study location
Not Asian	6	1.049	1.018-1.082	63.92a	2.168
Asian	8	1.082	1.054-1.110	91.32c
Population
AD	8	1.076	1.044-1.110	85.60c	0.376
ACLF	6	1.062	1.032-1.093	92.03c
Primary outcome
≤ 30 mortality	5	1.097	1.057-1.139	80.06c	2.852
Long term mortality	9	1.057	1.034-1.080	90.95c
Etiology
HBV	8	1.082	1.054-1.110	91.95c	2.168
Mixed	6	1.049	1.018-1.082	63.92a
Multivariate HR
Mean age
> 50	12	1.082	1.051-1.113	90.10c	0.621
≤ 50	2	1.052	0.986-1.121	83.28b
Study location
Not Asian	6	1.030	1.000-1.061	70.153b	7.728b
Asian	11	1.087	1.061-1.113	87.451c
Population
AD	11	1.046	1.038-1.054	91.00c	3.472
ACLF	6	1.031	1.022-1.040	82.00c
Mortality
≤ 30 mortality	6	1.087	1.044-1.131	77.08c	1.297
Long term mortality	11	1.058	1.033-1.083	91.38c
Etiology
HBV	7	1.069	1.030-1.110	78.04c	0.864
Mixed	10	1.065	1.036-1.095	92.38c
Univariate OR
Mean age
> 50	4	1.323	1.077-1.625	78.80b	0.036
≤ 50	5	1.289	1.080-1.538	85.73c
Population
AD	4	1.329	1.058-1.669	78.80b	0.095
ACLF	7	1.388	1.179-1.634	92.12c
Mortality
≤ 30 mortality	3	1.329	1.127-1.567	87.61b	0.301
Long term mortality	7	1.256	1.117-1.412	93.79c
Etiology
HBV	8	1.375	1.247-1.515	90.93c	3.558
Mixed	4	1.166	1.013-1.081	76.32b

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

AD: Acute decompensation; ACLF: acute-on-chronic liver failure; HR: Hazard ratios; HBV: Hepatitis B virus.