Prognostic and diagnostic value of the ratio of neutrophils to lymphocytes of patients with diseases of the gastrointestinal tract and liver

Abstract

The purpose of the  review is to  analyze  the  data  of  the  latest  scientific studies  assessing  the  diagnostic and  predictive  value of the indicator of the ratio of neutrophils to lymphocytes (NLR) in patients with diseases of the gastrointestinal tract and liver. Patients with non-alcoholic  fatty  liver  disease  (NAFLD)  have  the  increased  ratio  of  neutrophils  to  lymphocytes  correlated with the severity of fibrosis and the activity of the disease, and also made it possible to differentiate patients with steatosis and non-alcoholic steatohepatitis (NASH). NLR of patients with liver cirrhosis has shown its prognostic significance in the development  of death, comparable to the MELD and Child – Pugh scales, and in some studies even surpassed them. Contradictory data have been obtained regarding its predictive value at risk of infectious complications in this category of patients. In patients with Crohn’s disease (CD) and ulcerative colitis (UC), an increased value of NLR was associated with the activity of the disease. NLR serves as a predictor of death and a more severe course of acute pancreatitis. In patients with acute appendicitis, NLR has shown its diagnostic significance in identifying its severe forms. NLR has also shown its prognostic value in the development of death among patients with gastrointestinal cancer. NLR serves as a marker of systemic inflammation, which can be calculated using the parameters of the simple clinical bloode test, which is available in everyday clinical practice. The value of NLR is due to its non-invasiveness and low cost. The analysis of the literature showed its predictive and diagnostic value in certain diseases of the gastrointestinal tract and liver.  The higher the indicator under study, the worse the prognosis of the disease and/or life of the patient. However, there is no consensus on the gradation of NLR and cut-off levels fluctuate in various studies, and their results are often contradictory. Also, most studies are retrospective, so it is necessary to conduct major prospective studies in this direction.