Prognostic value of neutrophil-to-lymphocyte ratio in septic patients with liver cirrhosis: a cohort study

Inflammation plays a critical role in the pathogenesis of both sepsis and cirrhosis. The neutrophil-to-lymphocyte ratio (NLR), a composite inflammatory marker, has garnered increasing attention. However, the association between NLR and the risk of mortality in patients with cirrhosis and sepsis remains unclarified. Clinical information on patients with cirrhosis and sepsis was sourced from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database. Clinical endpoints were all-cause mortality. The link between NLR and mortality was examined through restricted cubic splines (RCS), logistic regression, and Cox regression analyses. The predictive value of NLR for in-hospital all-cause mortality in individuals with liver cirrhosis and sepsis was investigated using Receiver Operating Characteristic (ROC) analysis. Subgroup analysis was implemented to check the consistency of the association. A total of 1,372 patients were enrolled and stratified into a survival group (n = 1,271) and a non-survival group (n = 101) based on in-hospital survival status, yielding a mortality rate of 7.4%. In the unadjusted model, a notable link was revealed between NLR and all causes of death in septic patients with cirrhosis (Odds ratio [ORs]: 1.03, 95% Confidence intervals [CI]: 1.02-1.04, P < 0.001). RCS analysis revealed a nonlinear association between NLR and mortality risk (P for nonlinearity < 0.001; P for overall association < 0.001). ROC curves uncovered a higher Area Under the Curve (AUC) for NLR (0.752) than that for sequential organ failure assessment (SOFA) scores (0.711). Subgroup analysis indicated no pronounced interaction between NLR and etiology (interaction P > 0.05). NLR is an independent risk factor for in-hospital all-cause death in septic patients with cirrhosis, and it can guide interventions for this high-risk population.