The role of neutrophil to lymphocyte ratio for the assessment of liver fibrosis and cirrhosis: a systematic review

Abstract

Neutrophil to lymphocyte ratio (NLR) is widely used to assess inflammatory diseases. We performed a systematic review to explore the prognostic role of NLR for the assessment of liver fibrosis and cirrhosis. Areas covered: We searched the PubMed and EMBASE databases for the eligible papers which explored the association between NLR and liver fibrosis/cirrhosis or investigated the prognostic value of NLR in cirrhotic patients. Expert commentary: In accordance with assessment of liver fibrosis stage, we classified papers into four subgroups by etiology. For the patients with nonalcoholic fatty liver disease (NAFLD) there was a significant association between NLR and fibrosis stage and nonalcoholic fatty liver disease activity score (NAS), while NLR had a negative correlation with fibrosis stage for the patients with chronic hepatitis B (CHB). As for the patients with and chronic hepatitis C (CHC), NLR might not be significantly associated with fibrosis stage. Moreover, NLR seemed to be significantly useful for predicting outcomes in cirrhotic patients. Hence, NLR might be associated with liver fibrosis stage, especially in patients with NAFLD. Furthermore, NLR might be a useful biomarker for evaluating the prognosis in cirrhotic patients.

A novel predictive model based on inflammatory markers to assess the prognosis of patients with HBV-related acute-on-chronic liver failure: a retrospective cohort study

“…The NLR has been researched in many diseases including liver disease. Increased NLR is predictive of mortality in advanced illnesses apart from infections including malignancy, acute coronary syndrome, intracerebral hemorrhage, chronic kidney disease and rheumatic diseases [ 24 , 25 ], and elevated NLR has a tight relationship with the prognosis of hepatitis, liver cirrhosis and liver cancer [ 14 , 26 , 27 ]. In our study, the NLR value significantly elevated in the HBV-ACLF death group, and was an independent risk factor for 90-day death in HBV-ACLF patients, which was consistent with the study by Cai J, et al [ 15 ], but the specific mechanism of HBV-ACLF patients’ poor prognosis and NLR elevation is unclear.…”

A novel predictive model based on inflammatory markers to assess the prognosis of patients with HBV-related acute-on-chronic liver failure:a retrospective cohort study

“…The NLR has been researched in many diseases including liver disease. Increased NLR is predictive of mortality in advanced illnesses apart from infections including malignancy, acute coronary syndrome, intracerebral hemorrhage, chronic kidney disease and rheumatic diseases [25,26], and elevated NLR has a tight relationship with the prognosis of hepatitis, liver cirrhosis and liver cancer [14,27,28]. In our study, the NLR value significantly elevated in the HBV-ACLF death group, and was an independent risk factor for 90-day death in HBV-ACLF patients, which was consistent with the study by Cai J, et al [15], but the specific mechanism of HBV-ACLF patients' poor prognosis and NLR elevation is unclear.…”

Neutrophil-lymphocyte ratio and mean platelet volume as predictive factors for liver fibrosis and steatosis in patients with chronic hepatitis B

“…A group of researchers led by Peng has presented the usefulness of NLR in patients with NAFLD. They obtained a negative correlation between NLR and liver fibrosis in patients with HBV [19]. Another group of scientists stated that the cut-off value for NLR, which is the same or lower than 2.36, was predictive of a lower mortality rate among patients with acute CHB, and that a value higher than 6.12 could be treated as a warning against a higher risk of death [3].…”