title: Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel-Razik
authors.forename: Nasser
authors.initials: N
authors.lastname: Mousa
authors.forename: Tarek A
authors.initials: TA
authors.lastname: Besheer
authors.forename: Mohamed
authors.initials: M
authors.lastname: Eissa
authors.forename: Rania
authors.initials: R
authors.lastname: Elhelaly
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arafa
authors.forename: Niveen
authors.initials: N
authors.lastname: El-Wakeel
authors.forename: Waleed
authors.initials: W
authors.lastname: Eldars
mesh_terms: D000328:Adult; D001772:Blood Cell Count; D016022:Case-Control Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications / Q000473:pathology; D006801:Humans; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology / Q000473:pathology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity