Neutrophil to Lymphocyte Ratio, is it A Good Marker for Determining Degree of Fibrosis in Biliary Atresia?
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Abstract
Biliary atresia (BA) can progress to liver fibrosis and cirrhosis. The Neutrophil-to-lymphocyte ratio (NLR) integrates two immune pathways - neutrophils, which illustrate continuous inflammation, and lymphocytes, which illustrate the regulatory pathways. It has been used to evaluate the degree of fibrosis in other liver diseases, such as fatty liver disease and chronic hepatitis. This study aims to correlate NLR and the degree of fibrosis in infants with BA. A cross-sectional study was conducted at Dr. Soetomo General Academic Hospital, Surabaya between January 2014 and April 2019. Twenty-six paraffin blocks of wedge liver biopsy from Kasai procedure in BA children were examined. All paraffin blocks were re-stained with Masson's trichrome. The degree of liver fibrosis was evaluated. The fibrosis scores were calculated using the Metavir scoring system in 5 classes (F0 no fibrosis; F1 fibrous portal expansion; F2 few bridges or septa; F3 numerous bridges or septa; F4 cirrhosis). NLR was assessed from a complete blood count one week before surgery. Spearman correlation with p-value < 0.05 is considered significant. A total of 17 of 26 children were female. The median age at surgery was 159 (80-216) days. The mean NLR was 1.85 (0.39-5.97). After histopathologic examination, Metavir scores of F2, F3, and F4 were found in 2/26 patients, 12/26 patients, and 12/26 patients, respectively. There was no correlation between NLR and the degree of fibrosis (r=-0.31; p=0.882). The neutrophil-to-lymphocyte ratio could not represent fibrosis severity in BA children.
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References
I. Scottoni F and Davenport M. Biliary atresia: Potential for a new decade. Semin Pediatr Surg. 2020; 29:150940.
doi: 10.1016/j.sempedsurg.2020.150940
II. Govindarajan KK. Biliary atresia: Where do we stand now? World J Hepatol. 2016:8:1593-601. doi:10.4254/wjh.v8.i36.1593
III. Fabre Y, Bueno MR, Rincón-Sánchez AR, Saldaña-Cortés J, Vargas R, Armendáriz-Borunda J. Mexican infant with extrahepatic biliary astresia display different fibrosis activity. Hepatol Res 2004;28:79–86. doi:10.1016/j.hepres.2003.10.004
IV. Asai A, Miethke A, and Bezerra JA. Pathogenesis of biliary atresia: Defining biology to understand clinical phenotypes. Nat Rev Gastroenterol Hepatol 2015; 12:342–52. doi:10.1038/nrgastro.2015.74
V. Dong R, Jiang J, Zhang S, Shen Z, Chen G, Huang Y, et al. Development and validation of novel diagnostic models for biliary atresia in a large cohort of Chinese patients. EBioMedicine. 2018; 34:223–30. doi:10.1016/j.ebiom.2018.07.025
VI. Weerasooriya VS, White F V., Shepherd RW. Hepatic fibrosis and survival in biliary atresia. J Pediatr2004;144:123–5. doi:10.1016/j.jpeds.2003.09.042 123
VII. Nakamura H, Yamataka A. Non-invasive and accurate diagnostic system for biliary atresia. EBioMedicine. 2018;36:16–7.
doi: 10.1016/j.ebiom.2018.09.032
VIII. Elhenawy IA, Ghanem HS, Sultan MM, and Sira MM. Utility of noninvasive serum biomarkers of liver fibrosis in infants with biliary atresia. Adv Res Gastroentero Hepatol. 2017;3:1-6.
doi: 10.19080/ARGH.2017.03.555607
IX. Tomita H, Fuchimoto Y, Fujino A, Hoshino K, Yamada Y, Masugi Y, et al. Development and validation of a novel fibrosis marker in biliary atresia during infancy. Cin Transl Gastroenterol. 2015; 6:e127. doi:10.1038/ctg.2015.55
X. Peng Y, Li Y, He Y, Wei Q, Xie Q, Zhang L, et al. The role of neutrophil to lymphocyte ratio for the assessment of liver fbrosis and cirrhosis: a systemtic review. Expert Rev Gastroentero Hepatol.
;12:503-13. doi:10.1080/17474124.2018.1463158
XI. Abdel-Razik A, Mousa N, Shabana W, Refaey M, ElMahdy Y, Elhelaly R, et al. A novel model using mean platelet volume and neutrophil to lymphocyte ratio as a marker of nonalcoholic statohepatitis in NAFLD patients: mulcentric study. Eur J Gastroenterol Hepatol. 2016;28(1):e1-9..doi:10.1097/MEG.0000000000000486.
XII. Shiha G and Zalata K. Ishak versus METAVIR: Terminology, convertibility and correlation with laboratory changes in chronic hepatitis C. 2011. Available from:
XIII. Haafiz AB. Liver fibrosis in biliary atresia. Expert Rev Gastroenterol Hepatol 2010;4(3):335–43. doi:10.1586/EGH.10.29
XIV. Moyer K, Kaimal V, Pacheco C, Mourya R, Xu H, Shivakumar P, et al. Staging of biliary atresia at diagnosis by molecular profiling of the liver. Genome Med 2010;2. doi: 10.1186/gm154
XV. Sastiono S, Maheranny M, Oswari H. Factors Affecting the Success Rate of Kasai Portoenterostomy. New Ropanasuri J Surg 2016;1:27–30. doi: 10.7454/nrjs.v1i1.8
XVI. Gunadi, Sirait DN, Budiarti LR, Paramita VMW, Fauzi AR, Ryantono F, et al. Histopathological findings for prediction of liver cirrhosis and survival in biliary atresia patients after Kasai procedure. Diagn Pathol 2020;15:1–8. doi: 10.1186/s13000-020-00996-y
XVII. Kekilli M, Tanoglu A, Sakin YS, Kurt M, Ocal S, Bagci S. Is the neutrophil to lymphocyte ratio associated with liver fibrosis in patients with chronic hepatitis B? World J Gastroenterol 2015;21:5575–81. doi: 10.3748/wjg.v21.i18.5575
XVIII. Alkhouri N, Morris-Stiff G, Campbell C, Lopez R, Tamimi TAR, Yerian L, et al. Neutrophil to lymphocyte ratio: A new marker for predicting steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease. Liver Int 2012;32:297–302.
doi: 10.1111/j.1478-3231.2011.02639.x
XIX. Bonilla MA and Menell JS. Disorders of white blood cells. In: Lanzkowsky’s manual of pediatric hemotology and oncology. 6th ed. London: Elsevier: 2016: 209-2s30.