Abstract
Background and aim: Cirrhotic patients have increased mortality and longer hospital stay due to increased susceptibility to develop bacterial infection. Herein, we aimed to evaluate the role of neutrophil to lymphocytes ratio(NLR) and high sensitivity C-reactive protein(Hs-CRP) in diagnosis of infection and prediction of short term mortality in hospitalized cirrhotic patients. Patients and methods: The study included 50 cirrhotic patients hospitalized in ICU of a central Liver hospital. The presence of overt infection was evaluated. The NLR was calculated as the ratio of the neutrophils to lymphocytes in the peripheral blood. Hs-CRP concentration was measured by Immunoturbidimetric assay. Model for End-Stage Liver Disease(MELD) score, Child-Pugh score and the presence of systemic inflammatory response syndrome(SIRS) were assessed.
Results: The main cause of admission was refractory ascites(50%), followed by hematemesis(24%), spontaneous bacterial peritonitis(18%) and hepatic encephalopathy(8%). Development of SIRS occurred in 24(48%) patients and death occurred in 15(30%) patients. NLR and Hs-CRP were significantly higher in patients who developed SIRS(0.03and P= 0.01) respectively. For predicting short-term survival, MELD score, NLR and Hs-CRP were significant factors(P = 0.03, 0.01 and 0.01 respectively).
Conclusion: NLR and Hs-CRP are helpful diagnostic markers of infection and development of SIRS in hospitalized cirrhotic patients. In addition to the classical MELD score, NLR may be a useful predictor of the short-term mortality in hospitalized cirrhotic patients particularly in Child–Pugh class C.
Keywords: high sensitivity C-reactive protein, Neutrophil-to-lymphocyte ratio, Liver cirrhosis, SIRS, short-term Survival