A high neutrophil-to-lymphocyte ratio may predict poor response to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC), according to a study published in BMC Gastroenterology.
Neutrophils and lymphocytes are types of white blood cells. Their relationship has been found to predict outcomes in various types of chronic liver diseases, inflammatory diseases and malignancies.
“The first-line therapy in PBC is UDCA at a dose of 13–15mg/kg/day, which can significantly improve liver health biomarkers, delay disease progression, and improve liver-transplantation-free survival. However, approximately 40% of patients have an inadequate response to UDCA treatment,” the researchers stated.
“At present, there are no reliable clinical approaches to identify UDCA-non-responsive patients before treatment. Therefore, identifying optional biomarkers that can predict either responders or nonresponders to UDCA in the early stage has been of tremendous importance for improving clinical decision making.”
To evaluate the use of this easy-to-obtain prognostic indicator in PBC, the researchers analyzed the hospital records of 257 patients with PBC treated with UDCA between December 2013 and September 2021 at the Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University, China.
They evaluated the patients’ response to UDCA based on the levels of alkaline phosphatase, a molecule found in the liver, after 12 months of treatment. Alkaline phosphatase is a molecule released from liver cells into the bloodstream after they suffer significant damage. As such, alkaline phosphatase can, in combination with other blood markers, indicate overall liver health.
Those with high alkaline phosphatase levels were defined as non-responders to UDCA treatment. Moreover, the researchers statistically analyzed the relationship between alkaline phosphatase levels and the neutrophil-to-lymphocyte ratio.
According to the study results, increased neutrophil-to-lymphocyte ratio prior to UDCA treatment was positively associated with the lack of response to UDCA treatment. Patients of male sex, older age at diagnosis, increased levels of IgG antibodies, vitamin D deficiency, autoimmune hepatitis and symptoms of fatigue or pruritus may also respond poorly to UDCA treatment.
