OBJECTIVE: Biliary atresia (BA) can progress to liver fibrosis and cirrhosis. Neutrophil-to-lymphocyte ratio (NLR) is an inflammation index that has been used as non-invasive method to evaluate degree of fibrosis in other liver diseases such as fatty liver disease and hepatitis. NLR integrates two immune pathways - neutrophils which illustrate continuous inflammation and lymphocytes which illustrate the regulatory pathways. This study is aimed to calculate NLR and correlate this to the degree of fibrosis in infant with BA.
METHOD: A cross-sectional study examined 26 parafin blocks of wedge liver biopsy during Kasai procedure from BA children between January 2014 and April 2019 in Dr. Soetomo Academic General Hospital Surabaya. All paraffin blocks were re-stained using Masson Trichrome to evalute the degree of liver fibrosis. Fibrosis scores were calculated using 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 evaluated from complete blood count obtained within a week prior to surgery. Spearman correlation with P value < 0.05 was regarded as significant.
RESULT: About 17/26 children were female with the median age at surgery was 159 (80-
216) days. The median neutrophil to lymphocyte ratio was 1.85 (0.39-5.97). Following
histopathological examination, Metavir score of F2, F3 and F4 showed in 2/26 patients,
12/26 patients, and 12/26 patients, respectively. Degree of fibrosis had a positive correlation
with age at surgery (r=0.432; P=0.028). The neutrophil to lymphocyte ratio had no correlation
with the degree of fibrosis (r=-0.31; P=0.882).
CONCLUSION: Neutrophil to lymphocyte ratio could not represent fibrosis severity in infants
with biliary atresia.