title: High neutrophil-lymphocyte ratio indicates poor prognosis for acute-on-chronic liver failure after liver transplantation.
abstract: OBJECTIVE
  To investigate the significance of pre-transplant neutrophil-lymphocyte ratio (NLR) in determining the prognosis of liver transplant (LT) recipients with acute-on-chronic liver failure (ACLF).
  
  
  METHODS
  Data were collected from the liver transplantation data bank. The NLR values and other conventional inflammatory markers were evaluated for their ability to predict the prognosis of 153 patients with ACLF after LT. The NLR cut-off value was based on a receiver operating characteristic curve analysis. A Kaplan-Meier curve analysis and univariate and multivariate Cox regression models were used to define the independent risk factors for poor outcomes.
  
  
  RESULTS
  The optimal NLR cut-off value was 4.6. Out of 153 patients, 83 (54.2%) had an NLR ≥ 4.6. The 1-, 3-, and 5-year overall survival rates were 94.3%, 92.5% and 92.5%, respectively, in the normal NLR group and 74.7%, 71.8% and 69.8%, respectively, in patients with high NLRs (P < 0.001). Furthermore, there was a significant difference in infectious complications after LT between the high and normal NLR groups. There were no significant differences for other complications. In the multivariate Cox regression model, a high NLR was defined as a significant predictor of poor outcomes for LT.
  
  
  CONCLUSIONS
  A high NLR is a convenient and available predictor for prognosis of LT patients and can potentially optimize the current criteria for LT in ACLF.
authors: Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors: Bing-Yi
authors: BY
authors: Lin
authors: Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors: Lin
authors: L
authors: Zhou
authors: Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors: Lei
authors: L
authors: Geng
authors: Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors: Zhi-Yun
authors: ZY
authors: Zheng
authors: Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors: Jun-Jun
authors: JJ
authors: Jia
authors: Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors: Jing
authors: J
authors: Zhang
authors: Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors: Jia
authors: J
authors: Yao
authors: Bing-Yi Lin, Lin Zhou, Zhi-Yun Zheng, Jun-Jun Jia, Jing Zhang, Shu-Sen Zheng, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China.
authors: Shu-Sen
authors: SS
authors: Zheng
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute liver failure; Acute-on-chronic liver failure; Inflammation; Liver transplantation; Neutrophil-lymphocyte ratio