Neutrophil-to-lymphocyte ratio is associated with malnutrition risk estimated by the Royal Free Hospital-Nutritional Prioritizing Tool in hospitalized cirrhosis.

BACKGROUND Liver cirrhosis is characterized by immune dysfunction contributing to malnutrition. We previously revealed neutrophil-to-lymphocyte ratio (NLR) as an indicator of disordered immune system. Herein we aimed to i) determine the optimal NLR cut-off that best predicts malnutrition risk; ii) clarify the association between NLR and nutritional status. METHODS A total of 135 hospitalized cirrhotics were included. Immune dysfunction was evaluated by levels of serum C-reactive protein (CRP), NLR and other parameters. Malnutrition was screened by a risk score referring to Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). ROC curve was implemented to determine the best NLR cut-off which predicts malnutrition risk. Correlation between NLR and indicators of hepatic and physical function (handgrip strength) were also examined. Multivariable logistic regression was used to assess the association between NLR and malnutrition risk. RESULTS ROC curve revealed that the optimum cut-off to predict malnutrition risk was NLR > 4.2 with a sensitivity of 47.2%, specificity of 81.0%, NPV of 58.0% and PPV of 74.5%, respectively. Patients with NLR > 4.2 exhibited higher RFH-NPT score, higher serum platelet-to-lymphocyte ratio, and CRP. A positive correlation was found between NLR values and CTP (r = 0.22, p = 0.010), MELD (r = 0.36, p < 0.001) and RFH-NPT score (r = 0.31, p < 0.001). NLR was a risk factor for malnutrition independently of alcoholic liver disease and presence of ascites. CONCLUSIONS Immune dysfunction measured by NLR was associated with malnutrition risk estimated by RFH-NPT in cirrhosis. This article is protected by copyright. All rights reserved.