High neutrophil-lymphocyte ratio indicates a worse response to ursodeoxycholic acid in primary biliary cholangitis: a retrospective cohort study

Abstract

Abstract Background: Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease characterized by inflammation of the interlobular bile ducts. Ursodeoxycholic acid (UDCA) is the only FDA approved first-line therapy for PBC, but up to 40% of patients with PBC have an incomplete response to UDCA. Neutrophil-to-lymphocyte (NLR) has been used to predict prognosis in various liver diseases. There is limited evidence on the treatment response to UDCA in PBC patients. The aim of this study was to elucidate the changes in NLR in response to one-year UDCA treatment of PBC patients. Methods:A total number of 257 primary biliary cholangitis (PBC) patients treated with UDCA (13–15 mg/kg/d) were enrolled in this retrospective study. The response to treatment was evaluated based on alkaline phosphatase levels < 1.67 times the upper limit of the normal value after 12 months of UDCA treatment. Multivariable logistic regression analysis was performed to investigate the association between NLR at baseline and the response to 12- month UDCA treatment after adjusting for important confounding variables. The quartiles of increased baseline NLR was assessed as a predictor of future nonresponse to UDCA treatment. The stability of the results was evaluated by unadjusted and adjusted models. Results: The result of multiple regression analysis showed that NLR at baseline was positively associated with the nonresponse to UDCA treatment after adjustments for potential confounders (age, sex, BMI, hypertension, arterial plaque,thyroid disease, jaundice, albumin, globulin, total bile acid, ALP, GGT, LDLC, total cholesterol, hemoglobin, and APTT) (OR = 1.370, 95% CI 1.066-1.761). When NLR was translated into a categorical variable, the OR and 95% CI in the fourth quartile versus the first quartile was OR = 3.782, 95% CI 1.094-13.073, respectively (P for trend = 0.036). These results reveal that NLR is an independent risk factor of UDCA treatment nonresponse. Conclusions: Our results suggest that NLR is an independent risk factor of UDCA treatment nonresponse.