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

ABSTRACT

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.

KEYWORDS:

• Cirrhosis
• malnutrition risk
• monocyte-to-lymphocyte ratio
• systemic inflammation
• prediction
• RFH-NPT

Acknowledgments

We thank all our authors listed in this manuscript.

Disclosure of any financial/other conflicts of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Contributions

Yuchao Wu, Mengmeng Zhang, Tianzhi Ni, Yuan Yang and Yingren Zhao contributed to conception/design of the research; Yuchao Wu, Mengmeng Zhang, Yage Zhu, Ruojing Wang, Xiaoli Zhang and Juan Du contributed to acquisition of the data; Yuchao Wu, Yage Zhu, Tianzhi Ni, Li Zhu, and Mengmeng Zhang contributed to analysis, and interpretation of the data; Yuchao Wu, Mengmeng Zhang, Tianzhi Ni, Yuan Yang and Yingren Zhao drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Clinical trial registration

This cohort study is registered in the China National Medical Research Registration Information System (registration identification number: MR-61-20-004605).

Consent to participate

This study was approved by the ethics committee of the First Affiliated Hospital of Xi’an Jiaotong University (no. XJTU1AF2020LSL-023).

Consent to publish

All authors contributed to the interpretation of data and reviewed and approved the manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2022.2110600

Additional information

Funding

This research was supported by hospital grant of first affiliated hospital of Xi’an Jiaotong University (No. XJTU1AF2020LSL-023), the Nature Science Foundation of Shaanxi (2020JM-394), Key R&D Program of Shaanxi (2018ZDXM-SF-037)and the National 13th Five‑Year Special Grand Project for Infectious Disease of China (grant no. 2017ZX10202203‑007‑009).