Neutrophil-lymphocyte ratio predicts hospital-acquired bacterial infections in decompensated cirrhosis

Background. Bacterial infection is a frequent complication and severe burden in cirrhotic patients. We determined the utility of neutrophil-to-lymphocyte ratio (NLR) to predict the hospital-acquired (HA) bacterial infections episode in patients with decompensated cirrhosis. Methods: We retrospectively included 2066 consecutive decompensated cirrhotic patients from two separate tertiary hospitals, divided into training (n = 1377) and validation (n = 689) set. All data were collected on admission and all overt bacterial infections occurring after > 48 h of hospital stay were registered. Results: The incidence of HA bacterial infections in training and validation cohort was 35.87% and 31.05% respectively. Multivariate analysis showed that total bilirubin (TBil), albumin, white blood cell count (WBC) and NLR were independent predictors of HA bacterial infections. We established a Model-NTWA using these four variables and a Model-TWA which did not include NLR. Areas under the curves (AUC) of Model-NTWA (0.859) and NLR (0.824) were higher than which of Model TWA (0.713), WBC (0.675), TBil (0.593) and Albumin (0.583). Consistent with training cohort, validation cohort showed similar results. Patients with NLR of at least 4.33 had a significantly lower survival (P < 0.001). Conclusions: NLR can be used as a novel noninvasive marker to predict the occurrence of HA bacterial infections in decompensated cirrhotic patients.