Neutrophil-to-lymphocyte ratio and reversal of decompensation in primary biliary cholangitis: a retrospective cohort study.

Background: Hepatic recompensation can be achieved in a subset of patients with decompensated primary biliary cholangitis (PBC) following standard therapy. However, reliable early predictors for this clinically significant outcome remain elusive. This study assessed the association of the neutrophil-to-lymphocyte ratio (NLR) with hepatic recompensation in decompensated PBC. Methods: Of 736 consecutive patients diagnosed with decompensated PBC and undergoing standard therapy were included in this retrospective cohort study. The NLR was calculated from baseline hematological parameters. The primary outcome was hepatic recompensation. We assessed the impact of NLR on the incidence of recompensation using Cox regression, with robustness evaluated through subgroup, sensitivity, and trend analyses. Results: Among the 404 decompensated PBC patients (median age 61.0 years; 83.4% female), 114 (28.2%) achieved hepatic recompensation during follow-up. Multivariate analysis demonstrated that a higher NLR was independently associated with a reduced probability of hepatic recompensation [hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.79-0.99, P=0.03]. A significant linear trend for this inverse association was observed (HR: 0.72, 95% CI: 0.56-0.93, P for trend =0.01). Furthermore, subgroup analyses confirmed that this association remained consistent across patients with ascites (HR: 0.88, 95% CI: 0.78-0.99, P=0.03), without ascites (HR: 0.66, 95% CI: 0.48-0.92, P=0.01), and with bleeding (HR: 0.52, 95% CI: 0.34-0.80, P=0.003). Conclusions: NLR is independently associated with hepatic recompensation in PBC and may serve as a potential biomarker forindividualized clinical management.