Neutrophil/Lymphocyte ratio in patients with spontaneous bacterial peritonitis.

Introduction and Objectives

Spontaneous bacterial peritonitis (SBP) is a complication secondary to hemodynamic and structural changes and portal hypertension generating a increase intestinal permeability and proinflammatory state. In cirrhosis it has been shown there is an immune dysfunction with changes in the cellular response associated lack of regulation of neutrophils, a decrease in lymphocytes and synthesis of anti-inflammatory cytokines which make the response to an infectious agent deficient due to theses change the use of inflammatory biomarkers it´s limited. The neutrophil/lymphocyte ratio (NLR) has been shown to be a prognostic and diagnostic predictor in different pathologies but in liver their use has been inconclusive.

Our objective is to determine the rol of the neutrophil/lymphocyte ratio in hospitalized patients with acute on chronic liver failure (ACLF) and without ACLF in hospitalized patients with spontaneous bacterial peritonitis at the Gastroenterology Department of the Hospital Juarez de Mexico.

Materials and Patients

Observational, descriptive, retrospective, longitudinal study; patients with PBE were selected and divided into two populations: with ACLF criteria and without ACLF accord EASL guidelines. Inclusion criteria: Patients with ascites secondary to cirrhosis, without the use of primary SBP prophylaxis, admitted to the hospitalization service without other identified sources of infection. NLR was performed at the time of hospitalization and after antibiotic use. Measures of central tendency for dispersion and Pearson correlation between Child Pugh and Meld Na scores with NLR were applied.

Results

A total of 128 patients were collected, 25 patients fulfilling the inclusion criteria: 15 without ACLF and 10 with ACLF. Mortality in both groups was 40%; in patients without ACLF it corresponded to 20%, whereas in patients with ACLF mortality was 70%, which corresponded to Grade 2 (50%) and Grade 3 (80%). Regarding the NLR index, patients with ACLF did not have higher values ​​compared to those without ACLF. The correlation with the scores was not significant between ACLF - NLR (r=0.35) and Meld Na – NLR (r=0.035). Seventeen patients responded to antibiotic treatment, 13 in the group without ACLF and 4 in the group with ACLF, in all of which there was a decrease in the NLR after ascites fluid control. However, it was found that the index values ​​were correlated before and after the use of antibiotics at 48 hours of treatment (r= 0.88) in comparison with the NLR before and after no response to treatment at 48 hours (r= 0.31).

Conclusions

We found that NLR was not associated with severity, stage and mortality in patients with SBP, however there is a strong relationship between NLR values before and after antibiotic use at 48 hours, which could allow its use as a biomarker for assessment of antibiotic response.

Ethical statement

The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Table 1. Study population characteristics.

	Without ACLF (n=15)	ACLF (n=10)
Gender
Male	4 (26.6%)	8 (80%)
Female	6 (73.4%)	2 (20%)
Age	49 años (30 -67)	58.2 años (44 -78)
Etiology.
Alcohol.	6 (73.4%)	6 (60%)
Autoimmune Hepatitis.	0	1 (10%)
Primary biliary cholangitis.	1 (6.6%)	1 (10%)
Overlap Syndrome	2 (13.2%)	0
Hepatitis C vrius.	3 (19.8%)	0
Cryptogenic.	3(19.8%)	2 (20%)
CHILD PUGH
A	1 (6.6%)	0
B	6 (39.6%)	2 (20%)
C	8 (52.8%)	8 (80%)
Meld- Na	19.53 points (8 -28)	27 points (14 – 40)
Mortality.	3 (20%)	7 (70%)
ACLF
Grade II		4 (40%)
Grade III		6 (60%)
Polymorphonuclear cells at diagnostis	2150 cels/mm^3 (50 -16,200)	1782.6 cels/mm^3 (188 -6180)
Response to treatment.
Yes .	13 (87%)	4 (40%)
No.	2 (13%)	6 (60%)
Ascites Fluid Proteins.	1.76 g /dl (0.5 – 4.6)	1.84 (0.6 – 4.6)
NLR
Before treatment.	8.82 (1.86 – 21.16)	23.65 (1.60 – 59.60)
After treatment.	4.87 (1.4 – 14.61)	18.62 (1.2 – 52.8)