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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 (1) determine the optimal NLR cutoff that best predicts malnutrition risk and (2) clarify the association between NLR and nutrition status. Methods: A total of 135 hospitalized patients with cirrhosis 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 the Royal Free Hospital–Nutritional Prioritizing Tool (RFH‐NPT). Receiver operating characteristic (ROC) curve was implemented to determine the best NLR cutoff that 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 cutoff to predict malnutrition risk was NLR > 4.2, with a sensitivity of 47.2%, specificity of 81.0%, negative predictive value of 58.0%, and positive predictive value of 74.5%, respectively. Patients with NLR > 4.2 exhibited a higher RFH‐NPT score, serum platelet‐to‐lymphocyte ratio, and CRP. A positive correlation was found between NLR values and Child‐Turcotte‐Pugh (r = 0.22; P =.010), model for end‐stage liver disease (r = 0.36; P <.001), and RFH‐NPT scores (r = 0.31; P <.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. [ABSTRACT FROM AUTHOR]

Background: Alterations in body compositions are related to poor outcomes and the presence of complications in cirrhosis. However, no predictive tools combining all these anthropometric parameters are applicable in the clinical setting. We aimed to clarify the potential utility of body compositions and develop a nomogram incorporating any independent factor for prognosticating long-term mortality in cirrhosis.Methods: A total of 414 patients were randomized into primary (n = 274) and validation (n = 140) cohorts. X-tile was performed to identify optimal cut points for stratifying participants. Multivariate Cox regression was performed, and nomogram incorporating body compositions were generated. The utility of developed models was evaluated by Harrell concordance index (C-index), calibration curve, and decision curve analysis (DCA).Results: Stratifying by X-tilederived cut points, low skeletal muscle index (myopenia), high intramuscular adipose tissue content (myosteatosis), and the ratio of high visceral to subcutaneous adipose tissue area (adiposity) was independently associated with 3-year mortality. A sex-stratified nomogram incorporating anthropometric indices and clinical factors resulted in moderate discriminative accuracy, with a C-index of 0.787 (95% CI, 0.736-0.838) and 0.789 (95% CI, 0.727-0.851) in males and females, respectively. The calibration curve showed predictive survival corresponding optimally with the actual outcomes. Our models were feasible in the clinical settings based on DCA. Similar results were observed in the validation cohort. Additionally, participants could be classified into 3 distinct risk groups by the nomogram.Conclusions: Our proposed nomogram embedding body compositions rendered an individualized predictive tool for long-term mortality in cirrhosis. [ABSTRACT FROM AUTHOR]

Aim: It is well known that the use of proton pump inhibitor (PPI) is widespread in patients with liver cirrhosis. PPI counteracts H2 receptor inhibitor (H2RA) with its strong acid suppression effect. However, there is always a concern that PPI use may increase spontaneous bacteria peritonitis (SBP) development in cirrhotic patients. We aimed to investigate the association between acid suppression therapy (i.e. PPI or H2RA) and SBP through meta‐analysis. Methods: We searched PubMed, Medline, Web of Science, Cochrane library, and Embase for relevant studies published up to April 2019. Pooled OR and 95% CI were calculated by a random‐effects model. Funnel plots and Egger's tests were performed for the evaluation of publication bias. Non‐parametric "trim‐and‐fill" tests were conducted for sensitivity analysis. Results: A total of 20 original articles including 9566 cirrhotic patients were analyzed. The overall meta‐analysis highlighted that PPI use was associated with the risk of SBP (pooled OR 1.77, 95% CI 1.49–2.11). The conclusion was irrespective of study methods, whereas the result was inconsistent only in South America. However, the conclusion might not be stable enough and should be extrapolated with caution. Unlike PPI, we found H2RA was not associated with SBP (pooled OR 1.06, 95% CI 0.75–1.48). Conclusions: In conclusion, PPI use, but not H2RA, will increase the incidence of SBP in cirrhotic patients. In addition, H2RA might be beneficial for patients who require long‐term acid suppression therapy. [ABSTRACT FROM AUTHOR]

Background & Aims: An elevated neutrophil‐to‐lymphocyte ratio (NLR) has received attention as a prognostic surrogate across chronic liver diseases. However, an exact threshold has not been fully elucidated. Methods: A total number of 589 patients with cirrhosis (LC) were included. The value of NLR was calculated and its optimal cut‐off was initially determined by X‐tile program. Independent predictors of 90‐day mortality were identified with Cox regression model. The Kaplan‐Meier method was used to generate survival curves. To reduce influences of selection bias and possible confounders, a 1:2 propensity score matching (PSM) was performed. Results: The X‐tile indicated that the difference in survival was most significant for NLR more than 8.9. Serum NLR > 8.9 was an independent indicator in the entire cohort and PSM subset (HR 4.268, 95% CI 2.211‐8.238, P < .001; HR 4.209, 95% CI 1.448‐12.238, P = .008 respectively). Subgroup analysis showed that NLR > 8.9 was an independent risk factor of 90‐day mortality regardless of age, gender, CTP or MELD score. Conclusions: The value of NLR more than 8.9 is a feasible cut‐off across clinical settings among applicable population. The adding of NLR to other conventional predictive systems has the potential to provide incremental value without extra economic cost. [ABSTRACT FROM AUTHOR]