Editorial commentary on the Indian Journal of Gastroenterology– May–June 2021

Abstract

Serum C-reactive protein and neutrophil to lymphocyte ratio as predictors of survival in cirrhotic patients with systemic inflammatory response syndrome and bacterial infection Patients with liver cirrhosis are at risk of significant morbidity and mortality from infectious complications [1]. Data on biochemical surrogates as predictors of infection are scarce. Tapadia et al. from Gleneagles Global Health City, Chennai, India assessed the predictive value of C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) alone and in combination in predicting infection in a cohort of 208 consecutive hospitalized patients with cirrhosis [2].In addition to standard assessments (laboratory, ultrasound and appropriate cultures), CRP and NLR were also obtained. Investigators noted an infection rate of 62% with 58.5% culture positivity and mortality of 30.8%. Optimal cut-off values for NLR and CRP to predict infection were 5.86 and 33.7, respectively. One-month mortality risk was 2-3 times with NLR and CRP above these cut-off values. The combination of NLR + CRP (≥5.86 and ≥ 33.7) increased specificity and diagnostic accuracy for infection suggesting that these may have a role in predicting infection and even culture positivity. Prospective controlled studies are needed to validate this interesting observation.