The Value of Neutrophil-to-Lymphocyte Ratio in Predicting Mortality After Transjugular Intrahepatic Portosystemic Shunt Placement

Figures & data

Table 1 Baseline Characteristics of Surviving and Non-Surviving Patients

Variable	Total (n = 293)	Survivors (n = 249)	Non-Survivors (n = 44)	P value
Age, M (Q₁, Q₃)	59.0 (49.0–67.0)	57.0 (49.0–66.0)	64.0 (51.0–73.0)	0.008
Gender, n (%)				0.003
Male	174 (59.4)	139 (55.8)	35 (79.6)
Female	119 (40.6)	110 (44.2)	9 (20.5)
Etiology, n (%)				0.131
HBV	169 (57.7)	146 (58.6)	23 (52.3)
AIH	43 (14.7)	40 (16.1)	3 (6.8)
Schistosomiasis	41 (14.0)	34 (13.7)	7 (15.9)
Others	40 (13.7)	29 (11.7)	11 (25.0)
Early TIPS, n (%)	148 (50.5)	121 (48.6)	27 (61.4)	0.118
Diabetes, n (%)	68 (23.2)	60 (24.1)	8 (18.2)	0.392
Ascites, n (%)	155 (52.9)	130 (52.2)	25 (56.8)	0.572
Splenectomy, n (%)	40 (13.7)	36 (14.5)	4 (9.1)	0.339
Portal Vein Thrombosis, n (%)	81 (27.7)	69 (27.7)	12 (27.3)	0.952
Presence of Gastric Varices, n (%)	53 (18.1)	47 (18.9)	6 (13.6)	0.405
Child-Pugh Score, M (Q₁, Q₃)	7.0 (6.0–9.0)	7.0 (6.0–9.0)	7.5 (6.8–9.0)	0.282
Child-Pugh Grade, n (%)				0.335
A	101 (34.5)	90 (36.1)	11 (25.0)
B	159 (54.3)	131 (52.6)	28 (63.6)
C	33 (11.3)	28 (11.2)	5 (11.4)
MELD Score, M (Q₁, Q₃)	11.0 (9.0–13.0)	11.0 (9.0–13.0)	12.0 (10.0–13.0)	0.135
Total Bilirubin (µmol/L), M (Q₁, Q₃)	21.3 (15.4–29.9)	20.9 (15.4–28.5)	24.5 (15.8–33.5)	0.204
Albumin (g/L), M (Q₁, Q₃)	30.7 (26.9–34.3)	30.7 (26.8–34.3)	30.2 (27.0–33.5)	0.543
Pre-Albumin (g/L), M (Q₁, Q₃)	88.8 (63.2–110.1)	89.0 (65.1–112.2)	84.9 (55.9–108.9)	0.446
Creatinine (µmol/L), M (Q₁, Q₃)	62.8 (53.0–74.4)	62.6 (53.0–72.4)	69.0 (52.9–87.7)	0.067
Prothrombin Time (S), M (Q₁, Q₃)	15.9 (14.3–17.3)	15.8 (14.3–17.4)	16.1 (14.7–16.9)	0.699
International Normalized Ratio, M (Q₁, Q₃)	1.34 (1.21–1.48)	1.32 (1.20–1.49)	1.37 (1.25–1.46)	0.588
Platelet Count (×10^9/L), M (Q₁, Q₃)	69.0 (48.0–102.0)	69.0 (49.0–99.0)	67.0 (44.0–108.8)	0.795
White Blood Cell Count (×10^9/L), M (Q₁, Q₃)	4.9 (2.9–7.6)	4.8 (2.8–7.6)	5.0 (3.2–7.1)	0.877
Neutrophil Count (×10^9/L), M (Q₁, Q₃)	3.0 (1.7–5.5)	2.9 (1.6–5.3)	3.8 (2.3–7.1)	0.031
Lymphocyte Count (×10^9/L), M (Q₁, Q₃)	0.7 (0.5–1.0)	0.7 (0.5–1.0)	0.6 (0.4–0.9)	0.287
NLR, M (Q₁, Q₃)	4.4 (2.5–9.2)	4.1 (2.4–8.2)	6.8 (3.2–13.4)	0.005
Pre-TIPS PPG (mmHg), M (Q₁, Q₃)	26.0 (22.0–32.0)	27.0 (22.0–32.0)	24.0 (19.7–31.3)	0.217
Post-TIPS PPG (mmHg), M (Q₁, Q₃)	13.0 (9.6–16.0)	13.0 (9.6–16.0)	13.0 (9.8–15.0)	0.597
Portal Vein Puncture, n (%)				0.190
Left Portal Vein	185 (63.1)	152 (61.0)	33 (75.0)
Right Portal Vein	51 (17.4)	45 (18.1)	6 (13.6)
Main Portal Vein	57 (19.5)	52 (20.9)	5 (11.4)

Note: Data are expressed as median (IQR) or n (%).

Abbreviations: HBV, hepatitis B virus; AIH, autoimmune hepatitis; MELD, model for end-stage liver disease; NLR, neutrophil-to-lymphocyte ratio; TIPS, transjugular intrahepatic portosystemic shunt; PPG, portal pressure gradient.

Figure 1 Study flow diagram.

Figure 2 Distribution of NLR in different subgroups. (A) Early TIPS; (B) Splenectomy; (C) Etiologies; (D) Child-Pugh grade.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; TIPS, transjugular intrahepatic portosystemic shunt.

Figure 3 ROC curve to determine the cut-off value of the NLR for the prediction of 2-year mortality in EGVB patients undergoing TIPS. The optimal cut-off values for NLR (A), age (B), and creatinine (B) are 4.9, 63.0 and 71.9 respectively.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; EGVB, esophagogastric variceal bleeding; TIPS, transjugular intrahepatic portosystemic shunt.

Figure 4 Kaplan Meier survival curves after TIPS placement, by pre-TIPS NLR (A), age (B), and gender (C).

Abbreviations: TIPS, transjugular intrahepatic portosystemic shunt; NLR, neutrophil-to-lymphocyte ratio.

Table 2 Univariate and Multivariate Analysis of Risk Factors for 2-Year Mortality After TIPS

Variables	Univariable Analysis		Multivariable Analysis
	Hazard Ratio (95% CI)	P value	Hazard Ratio (95% CI)	P value
NLR ≥ 4.9 (yes vs no)	2.608 (1.398–4.865)	0.003	2.741 (1.467–5.121)	0.002
Age ≥ 63 (yes vs no)	2.450 (1.335–4.495)	0.004	3.403 (1.835–6.310)	< 0.001
Gender (male vs female)	2.842 (1.366–5.912)	0.005	3.677 (1.747–7.738)	0.001
Creatinine ≥ 71.9 (yes vs no)	2.384 (1.319–4.309)	0.004

Abbreviation: NLR, neutrophil-to-lymphocyte ratio.

Figure 5 NLR-driven subgroup analysis of survival outcomes in EGVB patients following TIPS procedures.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; EGVB, esophagogastric variceal bleeding; TIPS, transjugular intrahepatic portosystemic shunt.

Figure 6 Box plots of NLR values at different time points post-TIPS placement. Comparing NLR values at 1 month, 3 months, 6 months, and 12 months post-TIPS to the previous time point yielded P values of < 0.001, < 0.001, 0.051, and 0.154, respectively.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; TIPS, transjugular intrahepatic portosystemic shunt.

Data Sharing Statement

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author (Wei-Dong Wang).