Neutrophil-To-Lymphocyte Ratio: Is There Value in Assessing the Severity and Complications of Liver Cirrhosis?

Background: The neutrophil-to-lymphocyte ratio (NLR) is a simple, inexpensive, and readily available inflammatory marker. It has been studied as a prognostic factor in several chronic diseases, particularly liver diseases. The objective of this study was to evaluate the utility of NLR in assessing the severity of liver cirrhosis and its complications. [1-3] Patients and Methods: This was a single-center cross-sectional study including 50 patients with liver cirrhosis. NLR was calculated from the complete blood count. Cirrhosis severity was evaluated using the Child-Pugh classification, MELD score, and ALBI score. Associations between NLR and complications of cirrhosis—ascites, hepatic encephalopathy, digestive hemorrhage, ascitic fluid infection, and jaundice—were analyzed using Spearman's correlation coefficient, Mann-Whitney test, and Chi-square test. Results: Fifty patients were included. The median NLR was 2.75 (range: 0.87–15.42). Median NLR values were 3.00 in Child-Pugh class A, 2.62 in Child-Pugh class B, and 2.00 in Child-Pugh class C, with no significant difference (p = 0.332). No significant correlation was observed between NLR and MELD (rho = -0.196; p = 0.177), ALBI (rho = 0.024; p = 0.869), bilirubin, albumin, INR, or platelet count. Similarly, NLR was not significantly associated with ascites, hepatic encephalopathy, digestive hemorrhage, ascitic fluid infection, or jaundice. A non-significant trend toward a higher NLR was observed in patients with ascitic fluid infection (7.58 vs. 2.72; p = 0.138). Conclusion: In this cohort of cirrhotic patients, NLR was not significantly associated with cirrhosis severity evaluated by Child-Pugh, MELD, or ALBI, nor with the main complications of the disease. These results suggest that NLR alone does not allow stratification of cirrhosis severity in this population. Larger studies are needed to clarify its interest, particularly in ascitic fluid infection.