Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection

Ahmed Abdel-Razik, Nasser Mousa, Tarek A Besheer, Mohamed Eissa, Rania Elhelaly, Mohammad Arafa, Niveen El-Wakeel, Waleed Eldars

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BACKGROUND: Hepatitis C virus (HCV) is one of the most noxious infectious diseases. Chronic hepatitis C (CHC) had biochemical evidence of insulin resistance (IR). The neutrophil/lymphocyte ratio (NLR) integrates information on the inflammatory milieu and physiological stress.

AIM: We aimed to investigate the clinical utility of NLR to predict the presence of IR and fibrosis in CHCvirus infection.

METHODS: The study included 234 CHC patients and 50 healthy controls. The CHC group was divided into two subgroups ; CHC with HOMA-IR>3 and CHC with HOMA-IR≤3. Liver biopsy, homeostasis model assessment-IR (HOMA-IR), neutrophil and lymphocyte counts were recorded ; and NLR was calculated. Proinflammatory cytokines [tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)] were measured by an enzyme-linked immunosorbent assay.

RESULTS: Patients with HOMA-IR>3 had a higher NLR compared with patients with HOMA-IR≤3 [2.61±0.95 and 1.92±0.86, respectively, P<0.001]. The NLR ratio was positively correlated with HOMA-IR, C-reactive protein, TNF-α and IL-6 cytokines ; P<0.001). Patients with advanced fibrosis (F3-4) had an elevated N/L ratio [2.4±0.99] compared with patients with fibrosis stage 1-2 [1.86±0.66], P<0.001.

CONCLUSIONS: The N/L ratio is higher in patients with CHC with HOMA-IR>3 and advanced fibrosis. This ratio can be used as a novel noninvasive marker to predict IR and advanced disease.

Original languageEnglish
Pages (from-to)386-92
Number of pages7
JournalActa gastro-enterologica Belgica
Issue number4
Publication statusPublished - Dec 2015


  • Adult
  • Blood Cell Count
  • Case-Control Studies
  • Female
  • Hepatitis C, Chronic/blood
  • Humans
  • Insulin Resistance
  • Liver Cirrhosis/blood
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Neutrophils
  • Reproducibility of Results
  • Sensitivity and Specificity

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