Anesth Pain Med.  2023 Oct;18(4):389-396. 10.17085/apm.23048.

Neutrophilia is more predictive than increased white blood cell counts for short-term mortality after liver transplantation in patients with acute-on-chronic liver failure

• Kim KS
• Kim JH
• Kwon HM
• Moon YJ
• Shin WJ
• Kim SH
• Jun IG
• Song JG
• Hwang GS

• KMID: 2550919
• DOI: http://doi.org/10.17085/apm.23048

Abstract

Background
Acute-on-chronic liver failure (ACLF) is a life-threatening disease that requires urgent liver transplantation (LT). Accurate identification of high-risk patients is essential for predicting post-LT survival. The chronic liver failure consortium ACLF score is a widely accepted risk-stratification score that includes total white blood cell (WBC) counts as a component. This study aimed to evaluate the predictive value of total and differential WBC counts for short-term mortality following LT in patients with ACLF. Methods: A total of 685 patients with ACLF who underwent LT between January 2008 and February 2019 were analyzed. Total and differential WBC counts were examined as a function of the model for end-stage liver disease for sodium (MELD-Na) score. The association between total and differential WBC counts and 90-day post-LT mortality was assessed using multivariable Cox proportional hazards regression analysis. Results: The total WBC counts and neutrophil ratio were higher in patients with ACLF than in those without ACLF. The neutrophil ratio was significantly associated with 90-day post-LT mortality after adjustment (hazard ratio [HR], 1.04; P = 0.001), whereas total WBC counts were not significantly associated with 90-day post-LT mortality in either univariate or multivariate Cox analyses. The neutrophil ratio demonstrated a relatively linear trend with an increasing MELD-Na score and HR for 90-day post-LT mortality, whereas the total WBC counts exhibited a plateaued pattern. Conclusions: Neutrophilia, rather than total WBC counts, is a better prognostic indicator for short-term post-LT mortality in patients with ACLF.

Keyword

Acute-on-chronic liver failure; Neutrophilia; Leukocytosis; Liver transplantation

Figure

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  Fig. 1. The trajectory of the total and differential (neutrophils, lymphocytes, and monocytes) WBC counts as a function of the severity of liver disease. WBC: white blood cell, MELD_Na score: sodium-adjusted model for end-stage liver disease score.

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  Fig. 2. Cubic spline curves of the hazard ratio for 90-day mortality following liver transplantation in patients with acute-on-chronic liver failure: total WBC counts vs. neutrophils ratio. WBC: white blood cell.

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