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

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 ra- tio (NLR) integrates information on the inflammatory milieu and physiological stress. Aim : We aimed to investigate the clinical utility of NLR to pre- dict 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. Pro- inflammatory cytokines [tumor necrosis factor-alpha (TNF-a) and interleukin-6 (IL-6)] were measured by an enzyme-linked immuno- sorbent assay. Results : Patients with HOMA-IR > 3 had a higher NLR com- pared 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-a 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. (Acta gastroenterol. belg., 2015, 78, 386-392).