Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2015; 21(18): 5575-5581
Published online May 14, 2015. doi: 10.3748/wjg.v21.i18.5575
Is the neutrophil to lymphocyte ratio associated with liver fibrosis in patients with chronic hepatitis B?
Murat Kekilli, Alpaslan Tanoglu, Yusuf Serdar Sakin, Mevlut Kurt, Serkan Ocal, Sait Bagci
Murat Kekilli, Serkan Ocal, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum 19000, Turkey
Alpaslan Tanoglu, Department of Gastroenterology, GATA Haydarpasa Training Hospital, 34668 Istanbul, Turkey
Yusuf Serdar Sakin, Sait Bagci, Department of Gastroenterology, Gulhane Military Medical Academy, School of Medicine, 06291 Ankara, Turkey
Mevlut Kurt, Department of Gastroenterology, Abant İzzet Baysal Faculty of Medicine, Training and Research Hospital, 14280 Bolu, Turkey
Author contributions: All authors contributed to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Murat Kekilli, MD, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Bahcelievler Mh. Camlık Cd. No.2, Merkez, Corum 19000, Turkey. drkekilli@gmail.com
Telephone: +90-364-2230300 Fax: +90-364-2230300
Received: June 28, 2014
Peer-review started: June 30, 2014
First decision: August 6, 2014
Revised: August 22, 2014
Accepted: September 29, 2014
Article in press: September 30, 2014
Published online: May 14, 2015
Processing time: 323 Days and 23.8 Hours
Abstract

AIM: To determine the association between the neutrophil to lymphocyte (N/L) ratio and the degree of liver fibrosis in patients with chronic hepatitis B (CHB) infection.

METHODS: Between December 2011 and February 2013, 129 consecutive CHB patients who were admitted to the study hospitals for histological evaluation of chronic hepatitis B-related liver fibrosis were included in this retrospective study. The patients were divided into two groups based on the fibrosis score: individuals with a fibrosis score of F0 or F1 were included in the “no/minimal liver fibrosis” group, whereas patients with a fibrosis score of F2, F3, or F4 were included in the “advanced liver fibrosis” group. The Statistical Package for Social Sciences 18.0 for Windows was used to analyze the data. A P value of < 0.05 was accepted as statistically significant.

RESULTS: Three experienced and blinded pathologists evaluated the fibrotic status and inflammatory activity of 129 liver biopsy samples from the CHB patients. Following histopathological examination, the “no/minimal fibrosis” group included 79 individuals, while the “advanced fibrosis” group included 50 individuals. Mean (N/L) ratio levels were notably lower in patients with advanced fibrosis when compared with patients with no/minimal fibrosis. The mean value of the aspartate aminotransferase-platelet ratio index was markedly higher in cases with advanced fibrosis compared to those with no/minimal fibrosis.

CONCLUSION: Reduced levels of the peripheral blood N/L ratio were found to give high sensitivity, specificity and predictive values in CHB patients with significant fibrosis. The prominent finding of our research suggests that the N/L ratio can be used as a novel noninvasive marker of fibrosis in patients with CHB.

Keywords: Chronic hepatitis B; Liver fibrosis; Neutrophil to lymphocyte ratio; Fibrotic stage; Inflammatory activity; Non-invasive marker

Core tip: Reduced levels of the peripheral blood neutrophil to lymphocyte ratio were found to give high sensitivity, specificity and predictive values in chronic hepatitis B (CHB) patients with significant fibrosis. The neutrophil to lymphocyte ratio can be used as a novel noninvasive marker of fibrosis in patients with CHB.