{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:11:21Z","timestamp":1792613481377,"version":"4.5.0"},"reference-count":47,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,7,19]],"date-time":"2020-07-19T00:00:00Z","timestamp":1595116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["159984"],"award-info":[{"award-number":["159984"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009253","name":"European Association for the Study of the Liver","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009253","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In patients with cirrhosis, progression to acute decompensation (AD) and acute\u2010on\u2010chronic liver failure (ACLF) has been associated with poor prognosis. Differential leucocyte ratios might predict mortality in systemic inflammatory conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate differential leucocyte ratios as prognostic biomarkers in patients with cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with AD and ACLF were recruited from four centres in three countries. Peripheral blood differential leucocytes were measured (three centres using flow cytometry) on hospital admission and at 48 hours. Ratios were correlated to model for end\u2010stage liver disease (MELD), chronic liver failure\u2010sequential organ failure (CLIF\u2010SOFA), suspected\/culture\u2010positive bacterial infection and survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine hundred twenty\u2010six patients (562 (61%) male, median age 55 (25\u201094) years) were studied. Overall, 350 (37%) did not survive to hospital discharge. Neutrophil\u2010lymphocyte ratio (NLR) and monocyte\u2010lymphocyte ratio (MLR) were elevated in patients with AD and ACLF who died during their hospital stay. On multivariate analysis NLR retained statistical significance independently of CLIF\u2010SOFA or MELD. NLR &gt;30 was associated with an 80% 90\u2010day mortality in patients with ACLF but not AD. On sensitivity analysis for subgroups (alcohol\u2010related liver disease and suspected sepsis), NLR and MLR retained statistically robust accuracy for the prediction of mortality. Significant predictive accuracy was only observed in centres using flow cytometry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Leucocyte ratios are simple and robust biomarkers of outcome in ACLF, which are comparable to CLIF\u2010SOFA score but dependent on leucocyte quantification method. NLR and MLR may be used as screening tools for mortality prediction in patients with acutely deteriorating cirrhosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.15932","type":"journal-article","created":{"date-parts":[[2020,7,19]],"date-time":"2020-07-19T14:29:09Z","timestamp":1595168949000},"page":"855-865","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Leucocyte ratios are biomarkers of mortality in patients with acute decompensation of cirrhosis and acute\u2010on\u2010chronic liver failure"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5558-0503","authenticated-orcid":false,"given":"Christine","family":"Bernsmeier","sequence":"first","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"},{"name":"Gastroenterology and Hepatology Cantonal Hospital St Gallen Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Cavazza","sequence":"additional","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"},{"name":"Division of Digestive Diseases Imperial College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia M.","family":"Fatourou","sequence":"additional","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"},{"name":"Division of Digestive Diseases Imperial College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8136-3927","authenticated-orcid":false,"given":"Eleni","family":"Theocharidou","sequence":"additional","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abisoye","family":"Akintimehin","sequence":"additional","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Baumgartner","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Cantonal Hospital St Gallen Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameet","family":"Dhar","sequence":"additional","affiliation":[{"name":"Division of Digestive Diseases Imperial College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Auzinger","sequence":"additional","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Thursz","sequence":"additional","affiliation":[{"name":"Division of Digestive Diseases Imperial College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Bernal","sequence":"additional","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia A.","family":"Wendon","sequence":"additional","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1555-1089","authenticated-orcid":false,"given":"Constantine J.","family":"Karvellas","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology (Liver Unit) and Department of Critical Care Medicine University of Alberta Edmonton AB Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalambos G.","family":"Antoniades","sequence":"additional","affiliation":[{"name":"Liver Intensive Therapy Unit Kings College Hospital King\u2019s College London UK"},{"name":"Division of Digestive Diseases Imperial College London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5449-2424","authenticated-orcid":false,"given":"Mark J. 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