Neutrophil-to-Lymphocyte Ratio as a Potential Early Marker of Antibiotic Resistance in Patients with Infected Cirrhotic Ascites

Abstract

Background: To evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in identification and management of infected ascites among patients with cirrhosis. Methods: A total of 439 patients (mean (SD) age: 64.5 (± 12.7) years, 63.3% were males) hospitalized with cirrhotic ascites were included in this retrospective study. Data on patient demographics, etiology of cirrhosis, type of ascites (sterile ascites, infected ascites), culture findings treatment response (antibiotic resistance vs. sensitivity) and baseline (Day 0), Day 1 and Day 2 levels for serum C-reactive protein (CRP; mg/L), and NLR were recorded. Receiver operating characteristics (ROC) curve was plotted to determine performance of % change from baseline NLR on Day 1 in identifying treatment response. Results: In patients with infected ascites, antibiotic resistant patients had significantly higher Day 1 (6.9 (1.9-74.9) vs. 4.9 (1.1-51.1), p = 0.001) and Day 2 (8.0 (2.6-75.9) vs. 4.0 (1.1-40.3), p = 0.000) levels for NLR as compared with antibiotic sensitive patients, while the two groups had similar baseline (Day 0) NLR values (5.8 (1.1-62.3) vs. 5.7 (1.1-72.3), p = 0.969). ROC analysis revealed less than 0.93% decrease from baseline NLR on Day 1 (AUC (95% CI): 0.852 (0.799-0.895), p < 0.001) to be a potential marker of antibiotic resistance with a sensitivity of 87.72% and specificity of 88.50%. Conclusions: Our findings indicate percent change from baseline NLR on Day 1 to be a potential early marker of antibiotic resistance in patients with infected cirrhotic ascites. Our findings emphasize the role of determining NLR levels in earlier recognition of treatment failure and thus prompt modification of antibiotic treatment in cirrhotic patients with infected ascites.

Neutrophil Gelatinase-Associated Lipocalin (NGAL): An Early Dual Biomarker in Diagnosis of Ascitic Fluid Infection and Acute Kidney Injury in Liver Cirrhosis in a Tertiary Centre, Egypt

“…There was a statistically significant difference between the two groups regarding gender as this study had 33 male patients of all 44 patients included in the study (75%). These results are in accordance with [2,23]. In contrast, [21,24] reported no significance difference between hepatic patients with and those without bacterial infection regarding gender.…”

“…In this study, there was a significant increase in AF WCCs, PMNLs in group1 versus the group 2. These results were in line with [23,35]. In contrast to these results, Jansen [36] stated that, although ascitic WCC is increased in SBP patients, it possesses low specificity as large proportion of sterile ascites patients may have increased WCC.…”