The The Role of Neutrophil-Lymphocyte Ratio (NLR), Red Blood Cell Distribution Width (RDW) and Red Blood Cell Distribution Width-Platelet Ratio (RPR) in Assessment of Severity of Liver Damage in Cirrhotic Patients

Abstract

Background: Liver cirrhosis is a major worldwide health issue, marked by ongoing liver damage that leads to the development of fibrosis and regenerative nodules. The conversion of compensated to decompensated cirrhosis indicates an unwanted outcome. This necessitates tools to assess severity and guide clinical management. This study evaluates the utility of hematological indices Neutrophil-Lymphocyte Ratio (NLR), Red Cell Distribution Width (RDW), and RDW-to-Platelet Ratio (RPR) as non-invasive markers of cirrhosis severity, compared to established scoring systems like Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver disease (MELD).

Materials and Methods: A cross-sectional type of observational study was conducted on 100 cirrhotic patients at Khulna Medical College, Khulna (KMCH), Khulna. Data was collected on selected age group, their clinical history, and laboratory values. Hematological indices (NLR, RDW, RPR) were compared against CTP scores to evaluate diagnostic accuracy. Statistical analyses were done using SPSS-26, and a p-value < 0.05 is considered significant.

Results: Among the patients, RPR demonstrated the highest diagnostic accuracy (AUC=0.805, sensitivity=76.5%, specificity=53.3%) for cirrhosis severity, followed by RDW (AUC=0.780). NLR showed limited diagnostic value (AUC=0.541). Elevated RDW and RPR correlated significantly with advanced cirrhosis (p<0.001). Patients predominantly presented with ascites (57%), and hepatitis B was the leading etiology (55%).

Conclusion: RPR and RDW are promising non-invasive markers for assessing liver cirrhosis severity, with RPR being the most reliable. Incorporating these indices into traditional scoring systems could enhance diagnostic accuracy and risk stratification.