Neutrophil Lymphocyte Ratio can Preempt Development of Sepsis After Adult Living Donor Liver Transplantation

Shashwat Sarin; Viniyendra Pamecha; Piyush K Sinha; Nilesh Patil; Nihar Mahapatra

doi:10.1016/j.jceh.2021.11.008

Neutrophil Lymphocyte Ratio can Preempt Development of Sepsis After Adult Living Donor Liver Transplantation

J Clin Exp Hepatol. 2022 Jul-Aug;12(4):1142-1149. doi: 10.1016/j.jceh.2021.11.008. Epub 2021 Nov 23.

Authors

Shashwat Sarin¹, Viniyendra Pamecha¹, Piyush K Sinha¹, Nilesh Patil¹, Nihar Mahapatra¹

Affiliation

¹ Department of Liver Transplant and Hepato Pancreato Biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.

Abstract

Background: Development of sepsis is a major contributor to poor outcomes after liver transplant. The neutrophil-lymphocyte ratio (NLR) is an easily calculable inflammatory biomarker. We aim to utilize NLR to diagnose and predict the onset of sepsis in patients undergoing living donor liver transplants (LDLT).

Materials and methods: Analysis of the perioperative course of 314 consecutive adult patients who underwent elective ABO compatible LDLT was done. Patients were divided into two cohorts; those who developed sepsis and a control group. Sepsis was defined by the combination of SIRS and clinical/radiological suspicion of infection. NLR was calculated by dividing the percentage of neutrophils by the percentage of lymphocytes in peripheral blood.

Results: ostoperatively, 127 out of 314 patients (40.5%) having at least one episode of sepsis were included in the septic cohort and were compared to the 187 (59.5%) patients in the control group. Demographic and baseline characteristics, including NLR (13.74 ± 0.99 vs. 12.65 ± 0.57, P = 0.294) were comparable preoperatively. The NLR of the septic cohort was significantly higher than the control cohort (15.01 ± 1.67 vs. 9.98 ± 0.63, P = 0.001) 3 days prior to sepsis and remained significantly higher till the day of sepsis. The area under the cover was maximum for NLR 1 day prior to the development of sepsis (r = 0.707) with a sensitivity, specificity, positive predictive value, and negative predictive value of 62.4%, 62.2%, 51.4%, and 72.0%, respectively, at a cutoff of 8.5.

Conclusion: NLR is a useful tool in diagnosing and pre-empting development of sepsis in LDLT.

Keywords: ACLF, Acute-on-Chronic Liver Failure; AUC, Area Under Curve; CLD, Chronic Liver Disease; CRP, C Reactive Protein; GRWR, Graft Recipient Weight Ratio; LDLT, Living Donor Liver Transplantation; MELD Na, Model for End-stage Liver Disease Sodium; MHV, Middle hepatic vein; NLR; NLR, Neutrophil Lymphocyte Ratio; POD, Postoperative Day; ROC, Receiver Operator Curve; SIRS, Systemic Inflammatory Response Syndrome; TLC, Total Leukocyte Count; biomarker; infection; neutrophil lymphocyte ratio; sepsis.