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Research Paper | Medical Science | India | Volume 12 Issue 4, April 2023
A Reliable Non Invasive Biomarker for SBP: Neutrophil - To - lymphocyte Ratio as a Diagnostic Tool for Spontaneous Bacterial Peritonitis
Gunaranjan Jeedigunta | Shanmughanathan S [2] | Ganesh P [9] | Koushik A K [2]
Abstract: Spontaneous bacterial peritonitis (SBP) is one of the major complications in patients with cirrhosis and ascites [1]. The diagnosis of SBP is based on the neutrophil count and culture positivity in ascitic fluid [5]. Despite the diagnostic and treatment recommendations in the guidelines, in a retrospective study made in the USA, only 52.4% of patients diagnosed with SBP met the criteria and only 67.3% of patients received appropriate treatment [8]. Secondly, doing paracentesis for diagnosis is a invasive test and itself might introduce infection into the ascetic fluid. Neutrophil to Lymphocyte ratio (NLR) is a simple parameter which gives practical insight into the immune system activity. So, we aimed to study NLR as one of the biological markers that were associated with SBP and its usefulness in diagnosis. Method: Our retrospective, observational study included 100 patients with liver cirrhosis who were hospitalised between December 2020 and December 2022 at our institute in Chennai, Tamil Nadu. After following inclusion and exclusion criteria, patients were divided into two groups: One group of patients with SBP and the other without SBP. The diagnosis of SBP was made when patients presented with PMN >250 mm3 or culture positivity. This data was analysed and showed an association between biological parameters such as serum white blood counts, NLR, INR, serum sodium, Total bilirubin, Ascitic low sugar, low albumin, high protein, high MELD and CTP scores with Spontaneous bacterial peritonitis. Multivariate analysis with ROC identified NLR and CRP as very good biomarkers in the diagnosis of SBP. The area under the curve (AUC) was 87.6 [P<0.001, 95% confidence interval (CI) 80.3 ? 94.8] for NLR and AUC was 73 (P<0.001, 95% CI 62.8 - 83.2) for CRP respec?tively. Conclusion: NLR is a very good non invasive biomarker for diagnosing and predicting SBP, diagnostic accuracy of which increase with combination of CRP. This study could be of clinical utility in diagnosis of SBP as it is non - invasive, bedside and easy to use.
Keywords: Neutrophil to lymphocyte ratio (NLR), Spontaneous bacterial peritonitis, Ascites, C - Reactive protein, Cirrhosis, Paracentesis, Total bilirubin
Edition: Volume 12 Issue 4, April 2023,
Pages: 598 - 603