The impact of immature granulocytes on the outcome of patients with decompensated cirrhosis.

Background: Higher immature granulocyte levels have a predictive role in several clinical conditions, although data concerning cirrhosis are scarce. Reduced muscle mass is a known factor affecting the outcome of these patients. The aim of the study was to evaluate the association of immature granulocytes with muscle mass and their role in predicting the outcome (survival, death or liver transplantation) in patients with stable decompensated cirrhosis.

Methods: We prospectively studied 210 patients with decompensated cirrhosis awaiting liver transplantation. Their clinical and laboratory characteristics were recorded, including complete blood count with immature granulocyte count and immature granulocyte percentage. The severity of liver disease was evaluated by estimating the Child-Turcotte-Pugh and MELD-sodium scores. Dual energy X-ray absorptiometry was used to quantify the total and regional lean mass, while mid-arm muscle circumference was used for the evaluation of upper limb muscle mass.

Results: Immature granulocyte percentage was proved to be the only factor independently associated with transplant-free survival (Hazard Ratio: 1.98, 95% confidence interval [1.03-3.81], p = .04). Stratification of our cohort based on the best discriminative cut-off values of immature granulocyte count and percentage revealed significant differences in the outcome based on Kaplan-Meier curves, while immature granulocyte count and percentage were significantly associated with parameters of body composition.

Conclusions: Higher immature granulocyte count and percentage have a significant prognostic role and are associated with worse outcome in patients with stable decompensated cirrhosis.