Prognosis of systemic inflammation at an early stage of cirrhosis using the monocyte-to-lymphocyte ratio during malnutrition risk screening: a prospective cohort study

医学 肝硬化 营养不良 内科学 单核细胞 前瞻性队列研究 免疫学 淋巴细胞 队列 队列研究 全身炎症 阶段(地层学) 炎症 生物 古生物学
作者
Yuchao Wu,Mengmeng Zhang,Tianzhi Ni,Xiaoli Zhang,Ruojing Wang,Li Zhu,Du Juan,Yage Zhu,Shihua Zhao,Yuan Yang
出处
期刊:Postgraduate Medicine [Taylor & Francis]
卷期号:134 (8): 801-809 被引量:1
标识
DOI:10.1080/00325481.2022.2110600
摘要

Objective To determine whether the monocyte-to-lymphocyte ratio (MLR), as a systemic inflammation index, predicts malnutrition risk during the early stages of cirrhosis.Methods We conducted a single-center prospective cohort study, enrolling patients from June 2016 to September 2020. The patients underwent malnutrition risk assessments upon admission. The patients were classified into five clinical stages according to portal hypertension. The malnutrition risk was scored using the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) and validated by the Nutritional Risk Screening 2002 (NRS-2002) or Liver Disease Undernutrition Screening Tool (LDUST). Routine clinical laboratory measurements were performed to calculate the MLR, Child–Turcotte–Pugh (CTP) class, and model for end-stage liver disease (MELD) score. The patients were followed up for 2 years.Results Among the 154 patients with cirrhosis, 60 had compensated cirrhosis and 94 had decompensated cirrhosis. The optimal cutoff value of the MLR, >0.4, was effective in predicting malnutrition related to death or liver transplantation. Those with a high malnutrition risk defined by the NRS-2002 or RFH-NPT had a higher MLR than those with a low malnutrition risk. For patients with class A CTP cirrhosis or a MELD score of <10, an MLR cutoff of <0.4 significantly distinguished more patients with a low malnutrition risk than those with a high malnutrition risk. Both the RFH-NPT score and MLR increased significantly across the decompensated cirrhosis substages. Interestingly, the MLR exhibited a positive correlation with the RFH-NPT score until varices appeared, but the correlation was the highest at the substage of a history of variceal bleeding (r = 0.714, P = 0.009). Multivariable analysis demonstrated that an MLR of >0.4 was an independent factor for malnutrition risk by screening with the RFH-NPT, and this was confirmed using the LDUST and NRS-2002.Conclusion Immune-related inflammatory dysfunction predicts malnutrition risk during the early stages of cirrhosis.
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