Combination of Neutrophil to Lymphocyte Ratio and Glasgow Prognostic Score Improves Prognostic Accuracy in Lung Transplantation: Validation of 9 Preoperative Prognostic Scoring Methods

Purpose Recently, various disciplines have recognized the importance of preoperative nutritional and inflammatory status in influencing postoperative clinical outcomes. However, the usefulness of existing prognostic scoring methods has not yet been validated in lung transplantation (LT), except for the prognostic nutrition index. In the present study, we evaluated the usefulness of 9 prognostic scoring methods related to nutrition and inflammation in LT, which have been shown to be useful for predicting surgical prognosis in other fields. We also analyzed most accurate combination of the scoring methods in predicting prognosis after LT. Methods We conducted a single-center retrospective cohort study of 150 recipients of LT. We used 9 prognostic scoring methods (Figure 1A) for survival analysis by the log-rank test. Next, we performed a receiver operating characteristic analysis for overall mortality on all 36 combinations of two scoring methods out of the 9 scoring methods to detect the best combination to improve prognostic accuracy in LT. Survival analysis was performed on the best combination of scoring methods by the log-rank test. Results All of the 9 scoring methods significantly predicted prognosis after LT (Figure 1A). Among the 36 combinations, the combination of neutrophil to lymphocyte ratio (NLR) and Glasgow prognostic score (GPS) demonstrated the highest concordance index (c-index, 0.706), enabling the prognostic stratification in LT (NLR low and GPS 0: 0 point, NLR low and GPS 1-2 or NLR high and GPS 0: 1 point, NLR high and GPS 1-2: 2 point) (Figure 1B). Conclusion All of the 9 scoring methods significantly predicted prognosis even after LT. The combination of NLR and GPS predicted prognosis most accurately of 36 combination of two scoring methods, which could be a more accurate prognostic predictor than a single scoring method.