Baseline neutrophil-to-lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis

Forrest, Ewan H, Storey, Natasha, Sinha, Rohit, Atkinson, Stephen R, Vergis, Nikhil, Richardson, Paul, Masson, Steven, Ryder, Stephen, Thursz, Mark R, Allison, Michael, Fraser, Andrew, Austin, Andrew, Mccune, Anne, Dhanda, Ashwin, Katarey, Dev, Potts, Jonathan, Verma, Sumita, Parker, Richard and Hayes, Peter C (2019) Baseline neutrophil-to-lymphocyte ratio predicts response to corticosteroids and is associated with infection and renal dysfunction in alcoholic hepatitis. Alimentary Pharmacology and Therapeutics, 50 (4). pp. 442-453. ISSN 0269-2813

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Abstract

Background
Treating severe alcoholic hepatitis involves the exposure of patients to corticosteroids for 7 days to assess “response”.

Aim
To assess the prognostic and therapeutic implications of baseline neutrophil‐to‐lymphocyte ratio (NLR) in patients with severe alcoholic hepatitis.

Methods
Patients recruited to the STOPAH trial and an independent validation group were analysed retrospectively. Area under the receiver operating curve (AUC) analysis was performed. Kaplan‐Meier analysis was used to assess survival. Log‐rank test and odds ratio (OR) were used for comparative analysis.

Results
Baseline NLR was available for 789 STOPAH patients. The AUC for NLR was modest for 90‐day outcome (0.660), but was associated with infection, acute kidney injury (AKI) and severity of alcoholic hepatitis. Ninety‐day survival was not affected by prednisolone treatment if NLR < 5 or > 8 but mortality was reduced with prednisolone treatment when the NLR was 5‐8 (21.0% cf. 34.5%; P = 0.012). Prednisolone treatment increased the chance of Lille response if the NLR was ≥ 5 (56.5% cf. 41.1%: P = 0.01; OR 1.86) but increased the risk of day 7 infection (17.3% cf. 7.4%: P = 0.006; OR 2.60) and AKI (20.8% cf. 7.0%: P = 0.008; OR 3.46) if the NLR was > 8. Incorporation of NLR into a modified Glasgow alcoholic hepatitis score (mGAHS) improved the AUC to 0.783 and 0.739 for 28‐day and 90‐day outcome, respectively.

Conclusion
The NLR is associated with AKI and infection in severe alcoholic hepatitis. The NLR identifies those most likely to benefit from corticosteroids at baseline (NLR 5‐8). The mGAHS has a good predictive value for 28‐ and 90‐day outcomes.

Item Type: Article
Keywords: Alcoholic Hepatitis; Corticosteroids; Neutrophils; Lymphocytes
Schools and Departments: Brighton and Sussex Medical School > Clinical and Experimental Medicine
Subjects: R Medicine
R Medicine > R Medicine (General)
Depositing User: Sumita Verma
Date Deposited: 15 May 2019 14:55
Last Modified: 07 Aug 2019 16:00
URI: http://sro.sussex.ac.uk/id/eprint/83789

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