Accuracy of Combined Neutrophil to Lymphocyte Ratio and C-Reactive Protein for Diagnosis of Spontaneous Bacterial Peritonitis Among Cirrhotic Patients

Authors

  • Asif Ali Department of Medicine, Ibn-E-Siena Hospital Multan, Pakistan
  • Farjad Saif Department of Medicine, Ibn-E-Siena Hospital Multan, Pakistan
  • Ummyia Faisal Department of Medicine, Ibn-E-Siena Hospital Multan, Pakistan
  • Zainab Noor Department of Gynecology and Obstetrics, Ibn-E-Siena Hospital Multan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.1719

Keywords:

Spontaneous bacterial peritonitis, cirrhosis, neutrophil-to-lymphocyte ratio, C-reactive protein, non-invasive diagnostics, ascites

Abstract

Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis associated with high morbidity and mortality. While ascitic fluid analysis remains the diagnostic gold standard, it is invasive and not always feasible. There is a need for simple, non-invasive, and cost-effective alternatives to diagnose SBP early, especially in resource-limited settings. Objective: To determine the diagnostic accuracy of combined neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels in diagnosing SBP among cirrhotic patients, using ascitic fluid PMN count as the gold standard. Methods: This descriptive cross-sectional study was conducted over six months from April 2024 to September 2024, at the Department of Medicine, Ibn-e-Siena Hospital, Multan. A total of 131 cirrhotic patients with ascites were included through non-probability consecutive sampling. All patients underwent diagnostic paracentesis. SBP was confirmed if PMN count in ascitic fluid was ≥250/mm³. NLR and CRP were assessed using venous blood samples. A cut-off of NLR ≥2.9 and CRP >11.3 mg/dL was used to define SBP positivity. Diagnostic indices were calculated using 2×2 contingency tables. Results: Out of 131 patients, 91 (69.5%) were confirmed to have SBP by ascitic fluid analysis. The combination of NLR and CRP showed a sensitivity of 94.5%, specificity of 85.0%, positive predictive value of 93.5%, negative predictive value of 87.2%, and overall diagnostic accuracy of 91.6%. Stratified analysis revealed consistent diagnostic performance across gender and duration of liver disease. Conclusion: Combined NLR and CRP are accurate, readily available, and non-invasive diagnostic markers for SBP in cirrhotic patients. Their application may complement or, in selected cases, substitute ascitic fluid analysis, improving early detection and outcomes in resource-limited settings such as Pakistan.

Downloads

Download data is not yet available.

References

Abbas Z, Shazi L, Jafri W. Clinical features, outcomes and predictors of mortality in patients with cirrhosis and spontaneous bacterial peritonitis in Pakistan. Trop Gastroenterol. 2020;41(2):104–10.

Villanueva C, Albillos A, Genescà J, et al. Bacterial infections adversely influence the risk of decompensation and survival in compensated cirrhosis. J Hepatol. 2021;75(3):589–99.

Butt AS, Sharif F. Viral hepatitis in Pakistan: past, present, and future. Eur J Hepatol Gastroenterol. 2021;6(2):45–52.

Kabir MA, Sarkar MM, Bodruddoza K, et al. Role of ascitic fluid study in early detection of spontaneous bacterial peritonitis in asymptomatic patients of cirrhosis. Bangladesh J Med. 2019;30(1):9–18.

Patturelli M, Pignata L, Venetucci P, Guarino M. Lights and shadows of paracentesis: is an ultrasound guided approach enough to prevent bleeding complications?.Livers. 2023;3(1):54–62.

Chen J, Yasrebinia S, Ghaedi A, et al. Meta-analysis of the role of neutrophil to lymphocyte ratio in neonatal sepsis. BMC Infect Dis. 2023;23(1):837.

Parisien M, Lima LV, Dagostino C, et al. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Sci Transl Med. 2022;14(644):eabj9954.

Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018;9:754.

Elhendawy RI, Elghoneimy SM, Elnemr SA, et al. Predictive value of neutrophil to lymphocyte ratio combined with C-reactive protein for diagnosis of spontaneous bacterial peritonitis among cirrhotic patients. Egypt J Hosp Med. 2023;91(1):4380–6.

Mousa N, Besheer T, Abdel-Razik A, et al. Can combined blood neutrophil to lymphocyte ratio and C-reactive protein be used for diagnosis of spontaneous bacterial peritonitis? Br J Biomed Sci. 2018;75(2):71–5.

Zuberi BF, Quraishy MS, Ahmed M, et al. Factors influencing outcome of spontaneous bacterial peritonitis in cirrhotic patients in Pakistan. Saudi J Gastroenterol. 2021;27(3):168–72.

Huang Z, Zheng Z, Ni L, et al. Diagnostic performance of inflammatory markers for spontaneous bacterial peritonitis: a meta-analysis. Clin Chim Acta. 2023;544:117374.

Elhendawy RI, Elghoneimy SM, Elnemr SA, Salem AA, Abdelkader AH. Predictive value of neutrophil to lymphocyte ratio combined with C-reactive protein for diagnosis of spontaneous bacterial peritonitis among cirrhotic patients. Egypt J Hosp Med. 2023;91(1):4380–6.

Mousa N, Besheer T, Abdel-Razik A, Hamed M, Deiab AG, Sheta T. Can combined blood neutrophil to lymphocyte ratio and C-reactive protein be used for diagnosis of spontaneous bacterial peritonitis? Br J Biomed Sci. 2019;76(2):71–5.

Kumar D, Giri S, Sharma A, et al. Diagnostic utility of neutrophil-lymphocyte ratio and CRP in spontaneous bacterial peritonitis among cirrhotic patients with ascites. J Clin Exp Hepatol. 2021;11(4):459–64.

Abdel-Razik A, Mousa N, Abdel-Aal A, et al. Serum procalcitonin and CRP in prediction of spontaneous bacterial peritonitis: Diagnostic accuracy and role in prognosis. Clin Exp Hepatol. 2020;6(3):168–75.

Chen J, Yasrebinia S, Ghaedi A, et al. Meta-analysis of the role of neutrophil to lymphocyte ratio in neonatal sepsis. BMC Infect Dis. 2023;23(1):837.

Huang Z, Zheng Z, Ni L, et al. Diagnostic performance of inflammatory markers for spontaneous bacterial peritonitis: a meta-analysis. Clin Chim Acta. 2023;544:117374.

Downloads

Published

2025-05-31

How to Cite

Ali, A. ., Saif, F. ., Faisal, U. ., & Noor, Z. . (2025). Accuracy of Combined Neutrophil to Lymphocyte Ratio and C-Reactive Protein for Diagnosis of Spontaneous Bacterial Peritonitis Among Cirrhotic Patients. Biological and Clinical Sciences Research Journal, 6(5), 23–26. https://doi.org/10.54112/bcsrj.v6i5.1719

Issue

Section

Original Research Articles