Neutrophil-to-Lymphocyte Ratio as a Microbiota-Dependent Indicator of Immune Dysfunction and a Long-Term Prognostic Factor in Patients with Cirrhosis

Aim: to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a microbiota-dependent indicator of immune dysfunction and a long-term prognostic factor in patients with cirrhosis.
Materials and methods. A prospective study included 47 patients with cirrhosis. Gut microbiota was analyzed using 16S rRNA gene sequencing. Long-term survival prognosis was assessed over a 4-year follow-up period, and medium-term survival prognosis was assessed over 1 year follow-up period.
Results. During the 4-year follow-up period, 15 patients died, including 6 who died within the first year. Deceased patients had a higher neutrophil-to-lymphocyte ratio compared to survivors. This was significant for both long-term and medium-term prognoses (p = 0.021 and p = 0.048, respectively). Multivariate regression analysis identified a high NLR and low serum albumin levels as independent predictors of mortality for both long- and medium-term outcomes. The NLR was inversely correlated with the abundance of Roseburia, Alistipes, Rikenellaceae, Parabacteroides, Robinsoniella, Paraprevotella, and Odoribacter in the gut microbiota, and positively correlated with the cumulative level of ethanol-producing bacteria. NLR values did not differ significantly between patients who received glucocorticosteroids and those who did not.
Conclusions. The neutrophil-to-lymphocyte ratio correlates with the composition of pro- and anti-inflammatory taxa of the gut microbiota and serves as an independent factor for medium- and long-term prognosis in patients with cirrhosis.

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