Abstract
Biliary atresia (BA) can progress to liver fibrosis and cirrhosis. The Neutrophil-to-lymphocyte ratio (NLR) integrates two immune pathways - neutrophils, which illustrate continuous inflammation, and lymphocytes, which illustrate the regulatory pathways. It has been used to evaluate the degree of fibrosis in other liver diseases, such as fatty liver disease and chronic hepatitis. This study aims to correlate NLR and the degree of fibrosis in infants with BA. A cross-sectional study was conducted at Dr. Soetomo General Academic Hospital, Surabaya between January 2014 and April 2019. Twenty-six paraffin blocks of wedge liver biopsy from Kasai procedure in BA children were examined. All paraffin blocks were re-stained with Masson's trichrome. The degree of liver fibrosis was evaluated. The fibrosis scores were calculated using the 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 assessed from a complete blood count one week before surgery. Spearman correlation with p-value < 0.05 is considered significant. A total of 17 of 26 children were female. The median age at surgery was 159 (80-216) days. The mean NLR was 1.85 (0.39-5.97). After histopathologic examination, Metavir scores of F2, F3, and F4 were found in 2/26 patients, 12/26 patients, and 12/26 patients, respectively. There was no correlation between NLR and the degree of fibrosis (r=-0.31; p=0.882). The neutrophil-to-lymphocyte ratio could not represent fibrosis severity in BA children
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