title: Neutrophil-to-lymphocyte ratio predicts mortality in patients listed for liver transplantation.
abstract: OBJECTIVE
  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.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, UK; NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK.
authors.forename: Joanna A
authors.initials: JA
authors.lastname: Leithead
authors.forename: Neil
authors.initials: N
authors.lastname: Rajoriya
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: James W
authors.initials: JW
authors.lastname: Ferguson
mesh_terms: D015415:Biomarkers; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality* / Q000473:pathology; D016031:Liver Transplantation; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology*; D016016:Proportional Hazards Models; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000401:mortality*; D014850:Waiting Lists / Q000401:mortality*
chemical_list: D015415:Biomarkers
keywords: inflammation; liver transplantation; mortality; neutrophil-to-lymphocyte ratio