Neutrophil‐to‐lymphocyte ratio predicts mortality in patients listed for liver transplantation. (7th October 2014)

• Record Type: Journal Article
• Authors: Leithead, Joanna A.; Rajoriya, Neil; Gunson, Bridget K.; Ferguson, James W.
• Is Part Of: Liver international. Volume 35:Number 2(2015:Feb.)
• Page Start: 502
• Page End: 509
• Publication Date: 2014-10-07
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12688
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" id="liv12688-abs-0001"> <title>Abstract</title> <sec id="liv12688-sec-0001" sec-type="section"> <title>Background & Aims</title> <p>In the absence of overt infection, the systemic inflammatory response is increasingly recognised as a pathogenetic factor in the circulatory dysfunction of advanced cirrhosis. Our aim was to determine whether the neutrophil‐to‐lymphocyte ratio, a marker of systemic inflammation, is predictive of mortality in patients with end‐stage cirrhosis listed for liver transplantation.</p> </sec> <sec id="liv12688-sec-0002" sec-type="section"> <title>Methods</title> <p>A single centre study of 570 patients listed for first elective single‐organ liver transplantation January 2007–June 2011.</p> </sec> <sec id="liv12688-sec-0003" sec-type="section"> <title>Results</title> <p>The median listing neutrophil‐to‐lymphocyte ratio was 2.9 (IQR 1.9–4.7). Neutrophil‐to‐lymphocyte ratio demonstrated a positive correlation with listing serum bilirubin (<italic>P</italic> < 0.001), negative correlation with serum sodium (<italic>P</italic> < 0.001), and positive correlation with the MELD score (<italic>P</italic> < 0.001). Neutrophil‐to‐lymphocyte ratio increased with increasing severity of ascites (<italic>P</italic> < 0.001). A higher neutrophil count (<italic>P</italic> < 0.001) and lower lymphocyte count (<italic>P</italic> = 0.001) were predictors of wait‐list death. In a multivariate competing risk Cox model, neutrophil‐to‐lymphocyte ratio remained independently associated with mortality (HR 1.10; 95% CI 1.05–1.15, <italic>P</italic> < 0.001). The proportion of patients with a neutrophil‐to‐lymphocyte ratio <2, 2–4.9, and ≥5 who had died by 3 months of listing was 3%, 13.8% and 37.3% respectively (<italic>P</italic> < 0.001). After adjusting for MELD, increasing increments of neutrophil‐to‐lymphocyte ratio were predictive of death by 3 months (<italic>P</italic> = 0.043).</p> </sec> <sec id="liv12688-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The blood neutrophil‐to‐lymphocyte ratio, a simple and readily available marker of systemic inflammation, is an independent predictor of mortality in patients with liver failure listed for liver transplantation.</p> </sec> </abstract>