Abstract
BACKGROUND: The derived monocyte to lymphocyte ratio (dMLR) serves as an indicator of the overall systemic inflammatory and immune status. This study seeks to investigate the correlation between dMLR and 90-day mortality in patients diagnosed with decompensated liver cirrhosis (DLC). METHODS: A total of 1,342 eligible patients from three medical centres were included in this study. Multivariable Firth-corrected logistic regression analysis was conducted to explore the independent association between dMLR and 90-day mortality. Additionally, restricted cubic spline (RCS) analysis was employed to examine the relationship between dMLR and mortality risk. These findings were subsequently validated in two independent cohorts. In the total cohort, the prognostic accuracy of dMLR for predicting outcomes in DLC patients was evaluated through receiver operating characteristic (ROC) curve analysis. RESULTS: In the initial cohort, the observed 90-day mortality rate was 12.5%. ROC analysis showed that dMLR had comparable predictive ability to the Model for End-Stage Liver Disease. The multivariable Firth-corrected logistic regression analysis revealed that dMLR is an independent predictor of 90-day mortality. Furthermore, RCS analysis demonstrated that an increase in dMLR values corresponded with an elevated risk of mortality. These findings were corroborated in two validation cohorts. CONCLUSIONS: The dMLR is independently associated with 90-day mortality in patients with DLC, with an increasing risk of death corresponding to higher dMLR values. dMLR may function as a simple, cost-effective, and reliable biomarker, assisting clinicians in identifying high-risk patients and may guide risk stratification and management.