Clinical utility of Neutrophil Lymphocyte Ratio (NLR) as a marker of Spontaneous Bacterial Peritonitis (SBP) in patients with cirrhosis-An exploratory study

Ashish Baweja 1, Rajat Jhamb 2, Roshan Kumar 2, *, Seema Garg 3 and Priyanka Gogoi 4

1 Department of General Medicine, AIIMS, Rishikesh, India.
2 Department of Medicine, UCMS & GTB Hospital, New Delhi, India.
3 Department of Biochemistry, UCMS & GTB Hospital, New Delhi, India.
4 Department of Pathology, UCMS & GTB Hospital, New Delhi, India.

 

Research Article
International Journal of Science and Research Archive, 2021, 03(02), 031–042.
Article DOI: 10.30574/ijsra.2021.3.2.0131
Publication history: 
Received on 08 August 2021; revised on 11 September 2021; accepted on 13 September 2021
 
Abstract: 
Background and objective: The diagnosis of spontaneous bacterial peritonitis (SBP) is made by presence of ≥250 polymorphonuclear neutrophil (PMN)/mm3 in the ascitic fluid. Paracentesis despite being the gold standard has its inherent risks and complications. Blood neutrophil-lymphocyte ratio is a simple test for inflammation. Highly sensitive C reactive protein (hsCRP) is a marker of inflammation which is mainly synthesized by the liver. We aimed to evaluate clinical utility of NLR and hsCRP as less invasive tests for diagnosis of SBP.
Methods: Fifty cases of cirrhosis with ascites with SBP and 50 age and sex matched controls of cirrhosis with ascites without SBP were enrolled for the study. NLR was calculated and hsCRP value was determined in both the groups and compared using independent t test. The sensitivity and specificity of NLR was estimated as a test for SBP diagnosis by using receiver operator characteristics (ROC) curve.
Results: NLR was found to be significantly higher in SBP patients (6.75 +/- 2.7) than those without it (2.81+/-1.06) with p value < 0.01. hsCRP was raised in both groups, 18.93+/-5.00 and 17.46+/-6.19 in cases and controls respectively, but there was no statistical difference between the two groups. For SBP diagnosis, a blood NLR > 3.38 had a sensitivity of 94% and a specificity of 80%.
Interpretation and conclusions: NLR could be used as a novel and less invasive test for diagnosis of SBP. hsCRP has a blunted rise in patients with cirrhosis with SBP and cannot be used as diagnostic marker.
 
Keywords: 
Highly sensitive C reactive protein; Neutrophil lymphocyte ratio; Spontaneous bacterial peritonitis.
 
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