Diagnostic role of simple indices in HCV-related liver cirrhosis outcomes: a prospective cross-sectional study

Aim of the study
To evaluate the diagnostic performance of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), albumin-bilirubin ratio (ABR) and albumin-bilirubin score (ALBI) in different outcomes of liver cirrhosis, including decompensated liver cirrhosis (DLC), acute-on-chronic liver failure (ACLF), hepatocellular carcinoma (HCC), and spontaneous bacterial peritonitis (SBP). A second objective was to find their cut-off values. Finally, we aimed to correlate these indices with the severity of liver cirrhosis.

Material and methods
The study included 149 patients with hepatitis C virus (HCV)-related liver cirrhosis. They were categorized into 3 groups according to severity of cirrhosis as compensated cirrhosis, decompensated liver cirrhosis and acute-on-chronic liver failure based on Child-Turcotte-Pugh (CTP) and MELD-Na scores. Patients were categorized according to presence of HCC and spontaneous bacterial peritonitis. All patients had a complete blood picture and liver profile. NLR, PLR, ALBI and ABR were calculated.

Results
NLR, PLR, ALBI and ABR correlated with CTP, and MELD-Na scores. NLR > 6.27 can be used to predict SBP in patients with ascites. NLR cut-off value > 3.61 and > 5.26 can be used to predict DLC and ACLF respectively in liver cirrhosis. ABR < 0.90 discriminated ACLF from DLC with OR = 2.93 (95% CI).

Conclusions
The simple inflammatory scores NLR and PLR together with simple ABR and ALBI scores can be used as quick tools to assess severity of liver cirrhosis. NLR can predict the presence of SBP in patients with ascites. ABR is superior to ALBI in discriminating ACLF from DLC.