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Neutrophil‐to‐lymphocyte ratio predicts mortality in patients listed for liver transplantation
Author(s) -
Leithead Joanna A.,
Rajoriya Neil,
Gunson Bridget K.,
Ferguson James W.
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12688
Subject(s) - medicine , neutrophil to lymphocyte ratio , liver transplantation , lymphocyte , gastroenterology , absolute neutrophil count , cirrhosis , systemic inflammation , ascites , transplantation , confidence interval , immunology , inflammation , neutropenia , toxicity
Background & Aims 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. Methods A single centre study of 570 patients listed for first elective single‐organ liver transplantation January 2007–June 2011. Results 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 ( P < 0.001), negative correlation with serum sodium ( P < 0.001), and positive correlation with the MELD score ( P < 0.001). Neutrophil‐to‐lymphocyte ratio increased with increasing severity of ascites ( P < 0.001). A higher neutrophil count ( P < 0.001) and lower lymphocyte count ( P = 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, P < 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 ( P < 0.001). After adjusting for MELD , increasing increments of neutrophil‐to‐lymphocyte ratio were predictive of death by 3 months ( P = 0.043). Conclusions 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.