Hepatic Medicine: Evidence and Research (Dec 2021)

The Prognostic Values of Neutrophil-to-lymphocyte Ratio and Platelet-to-Lymphocyte Ratio at Baseline in Predicting the In-hospital Mortality in Black African Patients with Advanced Hepatocellular Carcinoma in Palliative Treatment: A Comparative Cohort Study

  • Mahassadi AK,
  • Anzouan-Kacou Kissi H,
  • Attia AK

Journal volume & issue
Vol. Volume 13
pp. 123 – 134

Abstract

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Alassan Kouame Mahassadi, Henriette Anzouan-Kacou Kissi, Alain Koffi Attia Gastroenterology and Hepatology Unit, Yopougon Teaching Hospital, Abidjan, Côte d’Ivoire, West AfricaCorrespondence: Alassan Kouame MahassadiGastroenterology and Hepatology Unit, Yopougon Teaching Hospital, 21 BP 632 Abidjan 21, Abidjan, Côte d’Ivoire, West AfricaEmail [email protected]: The prognostic values of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in predicting the in-hospital mortality of Black African patients with advanced hepatocellular carcinoma (HCC) in palliative treatment is unknown.Aim: To determine the prognostic value of NLR and PLR compared with that of Child–Turcotte–Pugh (CTP), model for end-stage liver disease (MELD) scores and the Barcelona clinic liver cancer staging system (BCLC).Methods: The cutoffs, accuracies and association with the mortality of these prognostic scores were determined using a time-dependent area under receiver operating characteristic curves (AUC), the log rank test and Cox proportional hazards ratio.Results: A total of 104 patients with advanced HCC (median age=49.5 years, males=58.7%) were enrolled. All were hospitalized for an enlarged liver mass of at least 15.4 cm in size in the right thoracic quadrant. Overall, 46 (44.2%) patients died in hospital during follow-up. Patients with NLR > 2.5 (log rank test=7.11, p=0.01) or PLR > 92 (log rank test=5.63, p=0.02) had poor survival. Factors associated with the in-hospital mortality were the MELD score (p=0.01), NLR (p=0.03) and hemoglobin level (p=0.02). NLR exhibits better and stable accuracy in predicting the in hospital mortality at time points of 30 (AUC=0.618), 60 (AUC=0.680) and 90 (AUC=0.613) days of follow-up, compared with CTP, MELD scores, BCLC and PLR. However, PLR displayed an enhanced accuracy over 90 days of follow up (AUC=0.688).Conclusion: NLR is useful in predicting the in-hospital mortality in Black African patients with advanced stage HCC in clinical practice. NLR and PLR may be used concomitantly for long-term follow-up.Keywords: hepatocellular carcinoma, neutrophil-to-lymphocyte ratio, prognosis, sub-Saharan Africa

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