Neutrophil–Lymphocyte and Neutrophil–Lymphocyte–Albumin Ratio Prognostic Value in Alcohol-Related Liver Disease

Sachin Patil; Nivedita Tayamgol Reddy; Fouzia Almas

doi:10.15850/ijihs.v14n1.4793

Authors

Sachin Patil Department of General Medicine, Bidar Institute of Medical Sciences, Bidar, Karnataka, India
Nivedita Tayamgol Reddy Department of General Medicine, Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India
Fouzia Almas Department of General Medicine, Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India

DOI:

https://doi.org/10.15850/ijihs.v14n1.4793

Keywords:

Alcoholic liver disease, cirrhosis, mortality, neutrophil to lymphocyte ration, serum albumin

Abstract

Background: Alcohol-related liver disease (ALD) is a leading cause of preventable morbidity and mortality. The neutrophil-to-lymphocyte ratio (NLR) and neutrophil–lymphocyte-to-albumin (NLA) ratio are inexpensive, readily available biomarkers reflecting inflammatory and synthetic status.
Objective: To evaluate the prognostic utility of neutrophil-to-lymphocyte ratio (NLR) and neutrophil–lymphocyte-to-albumin (NLA) ratio in predicting 30-day and 90-day mortality in ALD.

Methods: This prospective observational study was conducted over 18 months (June 2024–November 2025) at a tertiary care teaching hospital in South India. Seventy consecutive male patients aged >18 years with alcohol-related liver disease were enrolled. NLR was calculated as the ratio of absolute neutrophil count to absolute lymphocyte count, and NLA as NLR divided by serum albumin. Patients were followed up for 90 days after discharge with mortality assessed at admission, 30 days, and at 90 days.

Results: In-hospital mortality was found to be 71.4%, with cumulative mortality of 20.0% at 30 days and 31.2% at 90 days among patients discharged from the hospital. NLR and NLA demonstrated high predictive performance at all time. At admission, NLR ≥8.6 (AUC 0.92) and NLA ≥32.5 (AUC 0.89) were found to be significantly associated with mortality (p≤0.001). Both markers maintained high sensitivity and specificity at 30 and 90 days.

Conclusion: NLR and NLA are simple, cost-effective prognostic markers that can reliably predict short-term mortality in alcohol-related liver disease. Their integration into routine clinical assessment will enhance early risk stratification and guide timely management decisions in cases of alcoholic liver disease.

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References

Mackowiak B, Fu Y, Maccioni L, Gao B. Alcohol-associated liver disease. J Clin Invest. 2024;134(3):e176345. doi:10.1172/JCI176345.

Shenoy K, Mukkadan J, Vijayalakshmi B, Bini B. Etiological spectrum, epidemiological characteristics in compensated and decompensated cirrhosis at first presentation. Asian J Pharm Res Health Care. 2023;15(4):329–34. doi:10.4103/ajprhc.ajprhc_97_23.

Sarin SK, Kumar M, Eslam M, George J, Al Mahtab M, Akbar SMF, et al. Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol. 2020;5(2):167–228. doi:10.1016/S2468-1253(19)30342-5.

Emenena I, Emenena B, Kweki AG, Aiwuyo HO, Osarenkhoe JO, Iloeje UN, et al. Model for End Stage Liver Disease (MELD) score: a tool for prognosis and prediction of mortality in patients with decompensated liver cirrhosis. Cureus. 2023;15(5):e39267. doi:10.7759/cureus.39267.

Abu Omar Y, Randhawa T, Attar B, Agrawal R, Wang Y, Pichardo R, et al. Prognostic value of neutrophil-lymphocyte ratio in patients with severe alcoholic hepatitis. Cureus. 2019;11(11):e6141. doi:10.7759/cureus.6141.

Hasa E, Hartmann P, Schnabl B. Liver cirrhosis and immune dysfunction. Int Immunol. 2022;34(9):455–66. doi:10.1093/intimm/dxac030.

Dewi NNGK, Mariadi IK, Dewi NLPY, Pamungkas KMN, Dewi PISL, Sindhughosa DA. A novel predictor compared to the Model for End-Stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores for predicting 30-day mortality in patients with liver cirrhosis. Cureus. 2025;17(3):e81446. doi:10.7759/cureus.81446.

Chiriac S, Stanciu C, Singeap AM, Sfarti CV, Cuciureanu T, Trifan A. Prognostic value of neutrophil-to-lymphocyte ratio in cirrhotic patients with acute-on-chronic liver failure. Turk J Gastroenterol. 2020;31(12):868–76. doi:10.5152/tjg.2020.19838.

Zhang M, Zhang Y, Liu L, Prithweeraj M, Xu H, Wu R, et al. Neutrophil-to-lymphocyte ratio and albumin: new serum biomarkers to predict the prognosis of male alcoholic cirrhosis patients. Biomed Res Int. 2020;2020:7268459. doi:10.1155/2020/7268459.

Maccali C, Augustinho FC, Zocche TL, Silva TE, Narciso-Schiavon JL, Schiavon LL. Neutrophil-lymphocyte ratio predicts short-term mortality in patients hospitalized for acute decompensation of cirrhosis. Arq Gastroenterol. 2021;58(2):131–8. doi:10.1590/S0004-2803.202100000-23.

Deng Y, Fan X, Ran Y, Xu X, Lin L, Cui B, et al. Prognostic impact of neutrophil-to-lymphocyte ratio in cirrhosis: a propensity score matching analysis with a prespecified cut-point. Liver Int. 2019;39(11):2153–63. doi:10.1111/liv.14211.

Liu J, Li H, Xia J, Zhang Y, Wang K, Huang H, et al. Baseline neutrophil-to-lymphocyte ratio is independently associated with 90-day transplant-free mortality in patients with cirrhosis. Front Med (Lausanne). 2021;8:726950. doi:10.3389/fmed.2021.726950.

Rice J, Dodge JL, Bambha KM, Bajaj JS, Reddy KR, Gralla J, et al. Neutrophil-to-lymphocyte ratio associates independently with mortality in hospitalized patients with cirrhosis. Clin Gastroenterol Hepatol. 2018;16(11):1786–91.e1. doi:10.1016/j.cgh.2018.04.045.