Usefulness Of Leucocyte Ratios In Predicting In-Hospital Mortality Of Patients With Decompensated Chronic Liver Disease - Experience From A Tertiary Care Referral Center

Background and Aim: Different leucocyte ratios like Neutrophil to Lymphocyte Ratio (NLR), Monocyte to Lymphocyte Ratio (MLR) and Neutrophil to Monocyte Ratio (NMR) have been used as markers of inflammation in various conditions. In the recent times, these ratios are being explored as markers for predicting mortality in patients with Decompensated Chronic Liver Disease (DCLD). Aim is to demonstrate the usefulness of Leucocyte ratios as biomarkers for mortality prediction in Decompensated CLD. Methods: A retrospective analysis of Decompensated CLD patients managed at our center from January 2019 - June 2021 was performed. Besides demographic and etiologic information, leucocyte ratios were calculated from the available admission investigations and comparison was done between those who survived to hospital discharge (survivors) and those who did not (non survivors). Results: A total of 103 patients (mean age 51.2±9.7, 86.4% males) were included in the final analysis. Most common etiology of CLD was alcohol (67.9%), followed by Non-Alcoholic Steato-Hepatitis (NASH-13.6%) and chronic hepatitis b (CHB-11.7%). Ninety (87.4%) had some grade of ascites and encephalopathy was seen in 41 patients (39.8%). 29.1% (30) had Acute-on-Chronic Liver Failure as per the APASL definition. The in-hospital mortality of the cohort was 39.8% (41) and it was significantly higher in those who had ACLF (60% vs 31.5%; p=0.007). Median NLR (10.6 vs 4; p<0.001), NMR (20.6 vs 11.5; p<0.001) and MELD score (29 vs 22; p<0.001), but not MLR (0.5 vs 0.3; p=0.58) were significantly elevated in non-survivors compared to survivors. On logistic regression, MELD score>32 (OR-3.1, 95%CI:1.04-9.1) and NLR>7 (OR-8.5, 95%CI:3.04-23.9) were significantly associated with in-hospital mortality. Conclusion: Leucocyte ratios, being simple and easily available, have a great potential to be used as biomarkers in decompensated CLD patients for mortality predictions. Further large-scale prospective studies are needed to accurately identify the association and their utility in routine practice.