High neutrophil-lymphocyte ratio indicates poor prognosis for acute-on-chronic liver failure after liver transplantation

Table 1 Patient characteristics (P values indicate differences between two groups)

Variable	High NLR(n = 83)	Normal NLR(n = 70)	P value
Age (yr), mean ± SD	43.9 ± 14.9	48.6 ± 15.3	0.059
Gender			0.585
Male	51	46
Female	32	24
WBC (/pL)	(6.87 ± 2.37)	(4.76 ± 2.56)	< 0.001
Neutrophil (/pL)	(5.87 ± 2.43)	(2.80 ± 1.77)	< 0.001
Lymphocyte (/pL)	(0.55 ± 0.28)	(1.21 ± 0.81)	< 0.001
Monocyte (/pL)	(0.53 ± 0.35)	(0.52 ± 0.34)	0.900
PLR	129.33 ± 101.44	60.94 ± 33.53	< 0.001
LMR	1.33 ± 0.97	3.69 ± 4.72	< 0.001
Albumin	32.71 ± 6.92	32.41 ± 6.24	0.779
Serum creatinine > 133	15	9	0.377
AFP > 25	35	15	0.006
Total bilirubin (μmol/L)	419.75 ± 223.78	301.01 ± 182.62	0.001
MELD score	31.01 ± 7.19	28.63 ± 7.26	0.046
INR	2.67 ± 1.33	2.57 ± 1.05	0.605
Diabetes	8	3	0.202
Hypertension	8	0	0.021
HE	36	21	0.088
Child-Pugh scores	11.29 ± 1.16	11.37 ± 1.39	0.690
Total ischemia time (min)	293.91 ± 241.78	255.82 ± 264.47	0.358

WBC: White blood cell; PLR: Platelet-lymphocyte ratio; LMR: Lymphocyte-monocyte ratio; AFP: Alpha feto protein; MELD: Model for end-stage liver disease; INR: International normalized ratio; HE: Hepatic encephalopathy.

Table 2 Univariate analysis of variables affecting overall survival after liver transplant

Variable (cut-off value/median/n)	P value	HR (95%CI)
Gender
Male (n = 97)	0.370	1.429 (0.655-3.121)
Female (n = 56)	0.503	0.774 (0.366-1.638)
Age (46 yr)	< 0.001	4.860 (1.857-12.719)
NLR (4.6)	0.288	0.631 (0.270-1.475)
Albumin (35 g/L)	0.163	1.683 (0.809-3.500)
Total bilirubin (337 μmol/L)	0.010	3.251 (1.328-7.958)
MELD score (28)	0.824	0.912 (0.406-2.050)
Child-Pugh score (11)	0.360	1.371 (0.697-2.695)
INR (2.5)	< 0.001	3.823 (1.813-8.062)
Serum creatinine (133 μmol/L)	0.475	1.545 (0.468-5.100)
Pretransplant diabetes (11)	0.686	0.662 (0.090-4.873)
Hypertension before LT (8)	0.629	1.198 (0.576-2.491)
HE (57)	0.286	0.63 (0.27-1.472)
AFP (25 μg/L)

NLR: Neutrophil lymphocyte ratio; PLR: Platelet-lymphocyte ratio; LMR: Lymphocyte-monocyte ratio; AFP: Alpha feto protein; MELD: Model for end-stage liver disease; INR: International normalized ratio; HE: Hepatic encephalopathy.

Table 3 Multivariate analysis of factors affecting overall survival after liver transplant for acute-on-chronic liver failure

Variable	P value	HR (95%CI)
NLR ≥ 4.6	0.003	4.305 (1.637-11.322)
Serum creatinine ≥ 133	0.003	3.141 (1.486-6.639)
MELD ≥ 28	0.242	1.793 (0.674-4.766)

NLR: Neutrophil-lymphocyte ratio; MELD: Model for end-stage liver disease.