Impact of Neutrophil Lymphocyte Ratio (NLR) Platelet Lymphocyte Ratio(PLR), Albumin Globulin Ratio (AGR) and Aspartatetranaminase Platelet Ratio Index (APRI) on Predicting Outcomes after Liver Resection

Abstract

Introduction: The presence of various biomarkers like NLR, PLR, AGR and APRI has been associated with increased morbidity and mortality in several malignancies. Methods: Retrospective analysis of a prospectively maintained database of 309 patients undergoing liver resection for benign and malignant indications during January 2013 to December 2016 was performed. The association of preoperative NLR, PLR, AGR. APRI with clinicopathological characteristics and prognosis were assessed. Receiver operating characteristic (ROC) curve with Youden index was used to establish the cut-off value of NLR (3.6 for preoperative value and 8.6 for post-operative value) in predicting morbidity and mortality. Results: Median age was 52.57±13.99 years (Range; 7-84 years). The high-NLR, PLR group had a significantly higher morbidity (40.2 % vs 28.4% P=< 0.044) High NLR was also associated with decrease disease-free survival (37.7 % vs 52.7 %, P = 0.04) and overall survival (59 % vs 80.1 %, P < 0.001) than the low-NLR group. AGR did not affect peri-operative as well as long term outcomes. High APRI group was associated with increased post-operative mortality (p=0.052) without influencing overall outcomes. Conclusion: Preoperative NLR had a statistically significant association with preoperative morbidity and mortality and also OS and DFS at 3 years and may be considered as a low cost, reliable marker for predicting postoperative morbidity and oncological outcomes.