title: Is the neutrophil to lymphocyte ratio associated with liver fibrosis in patients with chronic hepatitis B?
abstract: OBJECTIVE
  To determine the association between the neutrophil to lymphocyte (N/L) ratio and the degree of liver ﬁbrosis in patients with chronic hepatitis B (CHB) infection.
  
  
  METHODS
  Between December 2011 and February 2013, 129 consecutive CHB patients who were admitted to the study hospitals for histological evaluation of chronic hepatitis B-related liver ﬁbrosis were included in this retrospective study. The patients were divided into two groups based on the fibrosis score: individuals with a fibrosis score of F0 or F1 were included in the "no/minimal liver fibrosis" group, whereas patients with a fibrosis score of F2, F3, or F4 were included in the "advanced liver fibrosis" group. The Statistical Package for Social Sciences 18.0 for Windows was used to analyze the data. A P value of < 0.05 was accepted as statistically significant.
  
  
  RESULTS
  Three experienced and blinded pathologists evaluated the ﬁbrotic status and inﬂammatory activity of 129 liver biopsy samples from the CHB patients. Following histopathological examination, the "no/minimal fibrosis" group included 79 individuals, while the "advanced fibrosis" group included 50 individuals. Mean (N/L) ratio levels were notably lower in patients with advanced fibrosis when compared with patients with no/minimal fibrosis. The mean value of the aspartate aminotransferase-platelet ratio index was markedly higher in cases with advanced fibrosis compared to those with no/minimal fibrosis.
  
  
  CONCLUSIONS
  Reduced levels of the peripheral blood N/L ratio were found to give high sensitivity, speciﬁcity and predictive values in CHB patients with significant fibrosis. The prominent finding of our research suggests that the N/L ratio can be used as a novel noninvasive marker of fibrosis in patients with CHB.
authors.affiliation: Murat Kekilli, Serkan Ocal, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum 19000, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Kekilli
authors.affiliation: Murat Kekilli, Serkan Ocal, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum 19000, Turkey.
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Tanoglu
authors.affiliation: Murat Kekilli, Serkan Ocal, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum 19000, Turkey.
authors.forename: Yusuf Serdar
authors.initials: YS
authors.lastname: Sakin
authors.affiliation: Murat Kekilli, Serkan Ocal, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum 19000, Turkey.
authors.forename: Mevlut
authors.initials: M
authors.lastname: Kurt
authors.affiliation: Murat Kekilli, Serkan Ocal, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum 19000, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Ocal
authors.affiliation: Murat Kekilli, Serkan Ocal, Department of Gastroenterology, Hitit University Corum Training and Research Hospital, Corum 19000, Turkey.
authors.forename: Sait
authors.initials: S
authors.lastname: Bagci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D001219:Aspartate Aminotransferases
keywords: Chronic hepatitis B; Fibrotic stage; Inﬂammatory activity; Liver fibrosis; Neutrophil to lymphocyte ratio; Non-invasive marker