Neutrophil-lymphocyte ratio and mean platelet volume as predictive factors for liver fibrosis and steatosis in patients with chronic hepatitis B
More details
Hide details
Department and Clinic of Infectious Diseases, Medical University of Lublin, Poland
Evaluation of the neutrophil-lymphocyte ratio and mean platelet volume as predictive factors for liver fibrosis and steatosis in HBV patients qualified for antiviral treatment.

Material and methods:
The study comprised 38 CHB patients who had commenced antiviral treatment, and 20 healthy volunteers who constituted the clinical control group. All patients had their blood count taken and underwent hepatic assessment using transient elastography with CAP (controlled attenuation parameter).

It was found that the mean hepatic fibrosis was 8.7 kPa (±8.8) and the mean liver steatosis – 286 db/m (±64). Mean NLR – 2.78(±1.1), whereas in the control group the mean NLR value was 1.64(±0.98). A negative linear correlation (r= -0.34; p=0.035) was found between liver fibrosis and the NLR value in the study group. No correlation was observed between hepatic steatosis and the NLR. Mean MPV – 12.6fl (±3.1), which was considerably higher in the CBH patients than in the control group. A positive correlation (r= 0.79, p= 0.001) was found between MPV and disease severity evaluated with transient elastography.

The NLR and the MPV were significantly higher in the CHB patients than in the healthy volunteers. Both the NLR and the MPV can be treated as predictive factors for liver fibrosis in this group of patients.

Agnieszka Pokora Rodak   
Department and Clinic of Infectious Diseases, Medical University of Lublin, Staszica, 16, 20-081 Lublin, Poland
1. Fan Y, Li X, Zhou XF, et al. Value of neutrophil-lymphocyte ratio in predicting hepatitis B-related liver failure. Zhonghua Gan Zang Bing Za Zhi 2017; 25: 726–731.
2. Moreau N, Wittebole X, Fleury Y, et al. Neutrophil-to-Lymphocyte Ratio Predicts Death in Acute-on-Chronic Liver Failure Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study. Shock. 2018; 49: 385–392.
3. Liu H, Zhang H, Wan G, et al. Neutrophil-lymphocyte ratio: a novel predictor for short-term prognosis in acute-on-chronic hepatitis B liver failure. J Viral Hepat. 2014; 21: 499–507.
4. Romano A, Parrinello NL, Vetro C, et al. Prognostic meaning of neutrophil to lymphocyte ratio (NLR) and lymphocyte to monocyte ration (LMR) in newly diagnosed Hodgkin lymphoma patients treated upfront with a PET-2 based strategy. Ann Hematol. 2018; 97(6): 1009–1018.
5. Marcheselli R, Bari A, Tadmor T, et al. Neutrophil-lymphocyte ratio at diagnosis is an independent prognostic factor in patients with nodular sclerosis Hodgkin lymphoma: results of a large multicenter study involving 990 patients. Hematol Oncol. 2017; 35: 561–566.
6. Reddy J, Hernandez M, Gunther J, et al. Pre-treatment neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are prognostic of progression in early stage classical Hodgkin lymphoma. Haematol. 2018; 180: 545–549.
7. Go SI, Park S, Kim JH, et al. A New Prognostic Model using the NCCN-IPI and Neutrophil-to-Lymphocyte Ratio in Diffuse Large B-Cell Lymphoma. Tumori. 2017: tj5000694. doi: 10.5301/tj.5000694.
8. Yao C, Zhang Z, Yao Y, et al. Predictive value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio for acute deep vein thrombosis after total joint arthroplasty: a retrospective study. Orthop Surg Res. 2018; 13: 40.
9. Kim H, Ro SM, Yang JH, et al. The neutrophil-to-lymphocyte ratio prechemotherapy and postchemotherapy as a prognostic marker in metastatic gastric cancer. Korean J Intern Med. 2018. doi: 10.3904/kjim.2016.293.
10. Ming L, Jiang Z, Ma J. Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and platelet indices in patients with acute deep vein thrombosis. 2018; 47: 143–147.
11. Gong J, Liang YL, Zhou W, et al. Prognostic value of neutrophil-to-lymphocyte ratio associated with prognosis in HBV-infected patients. J Med Virol. 2018; 90: 730–735.
12. Zhong GC, Wu YL, Hao FB, et al. Current but not past hepatitis B virus infection is associated with a decreased risk of nonalcoholic fatty liver disease in the Chinese population: A case-control study with propensity score analysis. J Viral Hepat. 2018. doi: 10.1111/jvh.12878.
13. Xiong J, Zhang H, Wang Y, et al. Hepatitis B virus infection and the risk of nonalcoholic fatty liver disease: a meta-analysis. Oncotarget. 2017; 8: 107295–107302.
14. Joo EJ, Chang Y Yeom JS, et al. Hepatitis B virus infection and decreased risk of nonalcoholic fatty liver disease: A cohort study. Hepatology. 2017; 6: 828–835.
15. Karagoz E, Ulcay A, Tanoglu A, et al. Clinical usefulness of mean platelet volume and red blood cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in chronic hepatitis B virus patients. Eur J Gastroenterol Hepatol. 2014; 26: 1320–4.
16. Pan Y, Muheremu A, Wu X. Relationship between platelet parameters and hepatic pathology in patients with chronic hepatitis B infection – a retrospective cohort study of 677 patients. J Int Med Res. 2016; 44: 779–86.
17. Shen F, Zheng R, Mi YQ, et al. Controlled attenuation parameter for non-invasive assessment of hepatic steatosis in Chinese patients. World J Gastroenterol. 2014; 20: 4702–11.
18. Yilmaz B, Aydin H, Can G, et al. The relationship between fibrosis level and blood neutrophil to lymphocyte ratio in inactive hepatitis B carriers. Eur J Gastroenterol Hepatol. 2014; 26: 1325–8.
19. Peng Y, Li Y, He Y, et al. The role of neutrophil to lymphocyte ratio for the assessment of liver fibrosis and cirrhosis: a systematic review. Expert Rev Gastroenterol Hepatol. 2018; 12: 503–513.
20. Yilmaz H, Yalcin KS, Namuslu M, et al. Neutrophil-Lymphocyte Ratio (NLR) Could Be Better Predictor than C-reactive Protein (CRP) for Liver Fibrosis in Non-alcoholic Steatohepatitis(NASH). Ann Clin Lab Sci. 2015; 45(3): 278–86.