Neutrophil Lymphocyte Ratio in Prediction of Hepatocellular Carcinoma in Egyptian Patients with Chronic Hepatitis C

Introduction In Egypt, hepatocellular carcinoma (HCC) is a national health problem. It is now the first cause of cancer related mortality. This is mainly attributed to the heavy burden of chronic hepatitis C (CHC) virus infection (14.7 %). Among cirrhotic patients, 1-4 % will develop HCC every year. In recent years, accumulating evidence shows that increased systemic inflammation is associated with poor cancer-specific survival in a variety of cancers. The presence of a systemic inflammatory response can be detected by both the elevation of the C-reactive protein (CRP) level and neutrophil-lymphocyte ratio (NLR). Aim of the work The aim of this work is to examine the utility of neutrophil lymphocyte ratio in predicting the occurrence of HCC in chronic HCV Egyptian patients. Patients and Method The study included 111 patients with CHC and HCC (group I) and 222 patients with CHC without HCC (group II). CHC was diagnosed by ELISA for HCV Antibody and serum HCV RNA. HCC diagnosis was based on EASL criteria i. e. focal hepatic lesion with arterial phase enhancement and washout in portal and delayed phases, obtained by contrast enhanced abdominal CT and or MRI. NLR is derived from absolute neutrophil and absolute lymphocyte counts of the full blood count, provided that there was no ongoing bacterial infection at the time of blood sampling. Results NLR was significantly higher in group I than group II. It was 2.56 1.31 in group I versus 1.75.91 in group II (P 000). The cut off value of NLR above which there was a high risk of HCC occurrence was 2.015. Area under the curve (AUC) was 70.5 %, sensitivity was 60.7 %, specicity was 71.7 %, positive predictive value of 55.1 %, negative predictive value of 76.1 %, accuracy of 67.7 % and positive likelihood ratio of 2.14. The SSLR for HCC presence by NLR was 0.54 if NLR was less than 2, 1.74 if NLR was 2 to 4 and 7.14 if NLR was greater than4. Conclusion Neutrophil lymphocyte ratio (NLR) could be used as a predictor of HCC occurrence in chronic HCV Egyptian patients. Chronic HCV patients expressing NLR greater than4 are in need for much closer follow up.