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

Ewan H Forrest, Natasha Storey, Rohit Sinha, Stephen R Atkinson, Nikhil Vergis, Paul Richardson, Steven Masson, Stephen Ryder, Mark R Thursz, Michael Allison, Andrew Fraser, Andrew Austin, Anne McCune, Ashwin Dhanda, Dev Katarey, Jonathan Potts, Sumita Verma, Richard Parker, Peter Hayes

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aim: Treating severe alcoholic hepatitis involves the exposure of patients to corticosteroids for 7 days to assess ‘response’. The aim of this study was to assess the prognostic and therapeutic implications of baseline Neutrophil-to-Lymphocyte ratio (NLR) in patients with severe alcoholic hepatitis. Methods: NLR was derived retrospectively from STOPAH patients and an independent validation group. 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 it was associated with infection, acute kidney injury (AKI) and severity of alcoholic hepatitis. 90-day survival was not affected by prednisolone treatment with NLR<5 but mortality was reduced with prednisolone treatment when NLR 5-8: 21.0% cf. 34.5%; p=0.012. prednisolone treatment increased the chance of Lille response if the NLR≥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 NLR>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.
Original languageEnglish
JournalAlimentary Pharmacology and Therapeutics
Volume50
Issue number4
Early online date17 Jul 2019
DOIs
Publication statusPublished - Aug 2019

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