studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 1225A
2085
Neutrophil to Lymphocyte Ratio (NLR) Predicts Liver
Related Death in Low MELD Cirrhotic Patients Awaiting
Liver Transplant
Avash Kalra 1 , Joel P. Wedd 2 , Kiran Bambha 1 , Jane Gralla 1 , Hugo
R. Rosen 1 , Scott W. Biggins 1 ; 1 University of Colorado Denver,
Aurora, CO; 2 Division of Digestive Diseases, Emory, Atlanta, GA
MELD score has reduced accuracy in cirrhotic patients with
MELD ≤20. The D’Amico 5 Stages of Cirrhosis model is a
cumulative clinical staging tool and aids in identifying low
MELD patients at higher risk for liver related death (Liver Transpl
2014; 20:1193-1201). High (≥4, J Hepatol 2013; 58:58-64)
Neutrophil to Lymphocyte Ratio (NLR) is associated with inflammatory
states and may predict cirrhotic decompensation and
low MELD death in cirrhosis. AIM: To evaluate the prognostic
utility of high NLR (≥4) for liver related death among low MELD
patients listed for liver transplant (LT), controlling for Cirrhosis
Stage. METHODS: A nested case-control study was performed
using adults (>17 yo) with cirrhosis awaiting LT from 2/2002-
5/2011; Cases= liver related death and MELD≤20 within 90
days of death; and Controls= alive for ≥90 days after LT listing.
Controls were randomly chosen from all listed patients
and matched (up to 3:1) to Cases by listing year, lab MELD,
age, gender, and disease etiology. NLR, Cirrhosis Stage, Na,
albumin, and hepatic encephalopathy (HE) were assessed at
date of lowest MELD within 90 days of death for Cases and
within 90 days after listing for Controls. Cirrhosis Stages are
1=no varices or ascites, 2=varices, 3=variceal bleed, 4=ascites,
5=ascites and variceal bleed. Conditional logistic regression
was used to evaluate risk of liver related death. RESULTS:
There were 41 Cases and 66 Controls; MELD scores were similar.
Clinical states contributing to death in Cases were: sepsis
49%, spontaneous bacterial peritonitis 15%, variceal bleeding
24%, and hepatorenal syndrome 22%. NLR 25 th , 50 th , 75 th
percentile cut offs were 1.9, 3.1, and 6.8. NLR was ≥4 in
4/41 (59%) Cases and 14/66 (21%) Controls. Median (IQR)
NLR for Cases and Controls was 5.0 (3.0-10.3) and 2.35
(1.6-3.9). In univariate analysis, NLR (continuous, ≥1.9, ≥4,
≥6.8), increasing Cirrhosis Stage (**categorical,1-5), variceal
bleeding, large ascites, HE, Na, Albumin were significantly
(p 30 ng/ml) had significantly (P = 0.009) higher daily
exposure to all thresholds of lux intensities, as compared to
patients with vitamin D deficiency. A seasonal comparison confirmed
significantly higher lux accrued in spring and summer (P
< 0.0001). Median dietary vitamin D intake (1.48 mcg/day,
0.26 - 12.12) was lower than typical intakes in the general
population (2 - 4 mcg). We observed no correlations between
light exposure and BMI or physical activity, neither between
body fat mass and serum vitamin D levels. Light intensity was
the only independent predictor of serum vitamin D level in multivariate
regression analysis (P = 0.004). Serum vitamin D levels
were highest in patients with > 30 min exposure at > 1000
lux/day (P = 0.002). Conclusions: In CLD patients, serum vitamin
D levels positively correlate with light exposure but not with
dietary vitamin D intake. The contribution of vitamin D from diet
is minimal and below the recently revised recommendations for
vitamin D intake. In contrast, our findings highlight the need
for combined interventions to treat vitamin D deficiency and
may guide specific recommendations for sunlight exposure in
patients with CLD.
Disclosures:
The following authors have nothing to disclose: Elisabeth Nick, Ralf Kaiser, Frank
Lammert, Caroline S. Stokes