Prognostic value of systemic inflammatory markers for disease severity and mortality in cirrhosis: a MIMIC-IV-based cohort study.

OBJECTIVE

The study aimed to investigate the associations between systemic inflammatory markers and disease severity and mortality in patients with cirrhosis and to identify robust prognostic indicators.

METHODS

Data from 2940 cirrhotic patients were obtained from the MIMIC-IV database(version 2.2). Generalized ordered logistic regression evaluated determinants of cirrhosis severity. Associations between inflammatory markers and mortality were examined using Cox proportional hazards models. Restricted cubic splines and two-piecewise Cox models were employed to explore nonlinear and threshold effects.

RESULTS

With increasing Child-Turcotte-Pugh class, inflammatory markers including neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-platelet ratio (NPR) increased progressively, whereas lymphocyte counts decreased. After collinearity assessment, aspartate aminotransferase-to-platelet ratio index, NPR, NLR, age, and Simplified Acute Physiology Score were retained for multivariable analyses. In multivariable Cox regression, NPR emerged as an independent predictor of mortality, with each unit increase in NPR associated with a higher risk of 28-day mortality [hazard ratio = 1.55, 95% confidence interval (CI)= 1.30-1.84; P < 0.001] and 365-day mortality (hazard ratio = 1.31, 95% CI = 1.18-1.46; P < 0.001). Analyses demonstrated a significant J-shaped association between NPR and mortality, with a consistent inflection point at NPR = 0.05, above which mortality risk markedly increased.

CONCLUSION

NPR independently predicts short- and long-term all-cause mortality in cirrhosis, exhibiting a clinically meaningful nonlinear threshold relationship. These findings emphasize the role of systemic inflammation in cirrhosis progression and highlight NPR as a practical biomarker for clinical risk stratification.