Archives of Pediatrics

Volume 2017; Issue 1
11 Sep 2017

Platelet to Lymphocyte Ratio in Hepatitis B

Research Article

Altun D1*, Karacaer Z2, Okur G3, UmitSarici S4

1Ufuk University Faculty of Medicine, Ankara, Turkey
2Etimesgut Military Hospital, Department of Infectious Disease, Ankara, Turkey
3Etimesgut Military Hospital, Department of Radiology, Ankara, Turkey
4Ufuk University Faculty of Medicine, Department of Pediatrics, Division of Neonatology,Ankara, Turkey

*Corresponding author:Altun D, Ufuk University School of Medicine, Ankara, Turkey, Tel: +90 312-204 4000; E-mail:

Received Date: 18 January, 2016; Accepted Date:23 February, 2017; Published Date: 3 February, 2017






Suggested Citation





We aimed to investigate diagnostic performance ofplatelet to lymphocyte ratio (PLR),aspartate amino transferase to platelet ratio index (APRI) and neutrophil to lymphocyte ratio (NLR) as comparative in chronic hepatitis B (CHB) patientsacquired at childhood.




We retrospectively analyzed 164 male patients diagnosed with CHB acquired at childhood as study group. The control group consisted of 164 heathy subjects.Liver biopsy was performed and fibrosis scoresand histological activity index (HAI) were assessed according to the Ishak scoring system. The patients were divided into twogroups on the basis of the fibrosis scores as follows: F0-1 No/early stage fibrosis, F2-6 significant fibrosis. APRI, NLR and PLR of patients were calculated from bloodsamples taken at the same time as the biopsy.




Histopathologic analysis showed that 71(43.3%) patientshad F0–1 and 93(56.7%) patients had ≥F2. APRI scores and NLR of the study group were significantly higher than those of the control group (p<0.001, p=0.02, respectively), whereasPLR was significantly lower (p=0.01). In addition, correlation analyses revealed that PLR has a negative and significant relationship with both fibrosis and HAI. ((r:-0,220, p:0,005), (r:-0,146, p:0,02), respectively).




The present study has shown, for thefirst time, PLR isstrongly associated with histological severity and canbe used to identify patients with advanced disease in CHB. Our findings suggested PLR,in combination with other noninvasive parameters such as APRI score and NLR,may assist in identifying individuals at high risk ofhaving advanced and progressive disease.


Keywords:APRI- fibrosis-hepatitis B-neutrophil to lymphocyte ratio-platelet to lymphocyte ratio




ALT:      Alanine transaminase

AST:       aspartate transaminase

APRI:     Aspartate amino transferase to platelet ratio index

CHB:     chronic hepatitis B

HBV:     hepatitis B virus

HCC:     hepatocellular carcinoma

NLR:      neutrophil to lymphocyte ratio

PLR:       platelet to lymphocyte ratio



Worldwide, it is estimatedthatmorethan 4 billionpeoplehavebeeninfectedwithhepatitis B virus (HBV), and 350 millionindividualshavebeendiagnosedwithchronichepatitis B (CHB)[1]. Although a rather benign course of chronic HBV infection during childhood has been described, 3-5% and 0.01-0.03% of chronic carriers develop cirrhosis or hepatocellular carcinoma (HCC) before adulthood. Considering the whole lifetime, the risk of HCC rises to 9-24% and the incidence of cirrhosis to 2-3% per year [2]. Disease morbidity and mortality in CHB depends on the continuation of viral replication and progression of the disease to cirrhosis and HCC. The goal of treatment is to improve quality of life and survival by preventing progression of the disease to advanced stages like cirrhosis and HCC. Therefore, establishing the status of hepatic fibrosis is important to decide the treatment and management[3]. Liverbiopsy has long been an essential tool for assessing the degree of liver fibrosis [4]. Currently, theplace of liver biopsyas the standard of reference for assessing liver fibrosis has been challenged by the increasing awareness of a number of drawbacks related to its use (invasiveness, sampling error, inter-/intraobserver variability). In parallel with this, noninvasive assessment of liver fibrosis has experienced explosive growth in recent years and a wide spectrum of noninvasive methods ranging from serum assays to imaging techniques have been developed [5].


Aspartate amino transferase to platelet ratio index (APRI) has been used to determine chronic hepatitis C (CHC) patients with advanced fibrosis [6]and it also predicts significant fibrosis in CHB [7].Recently, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) have attracted attention as inflammatory biomarkers. They can be calculated easily from complete blood counts and are easily accessible markers which indicate the state of inflammation in the body. NLR is considered to evaluate disease prognosis in HCC [8,9]. It can be used also as a novel non-invasive marker to predict advanced disease in non alcoholic steatohepatitis[10]. However, there are few studies conducted to assess APRI or NLR for predicting the fibrosis stage of patients with HBV-related fibrosis and inflammation. The aim of the present study was to investigate the diagnostic performance of these markers as comparative for the prediction of significant fibrosis and inflammation in CHB patients who had HBV since their childhood. In the meantime, this study aimed to evaluate the efficacy of PLR to predict significant fibrosis in CHB for the first time in the literature.


Materıals And Methods


Study population


This study was conducted between January 2012 and October 2014 at Etimesgut Military Hospital in Turkey. We retrospectively analyzed 164 male patients diagnosed with CHB acquired at childhood who had undergone percutaneous liver biopsy. Inclusion criteria were accepted as follows: positive surface antigen of HBV and elevated aspartate transaminase (AST), alanine transaminase (ALT) levels for at least 6 months, HBV DNA ≥10000 copy/mL, patients with pretreatment liver biopsies and have received diagnosis by 18 years age.Exclusion criteria for participation were determined as positive serology for hepatitis C virus, human immunodeficiency virüs and hepatitis D, presence of any other causes of liver disease, any evidence of hepatic decompensation or prior antiviral treatment and alcohol use.


The control group consisted of 164 individuals with normal liver tests without systemic disease. Their gender and ages were similar with study group. All cases were evaluated for clinical and medical background. Our study was conducted in accordance with the principles of the Helsinki Declaration. This retrospectively designed study was approved by the Ethical Committee of our hospital. All study subjects gave informed concent for the liver biopsy.


Data collection and calculation of indirect fibrosis markers


The medical record data of study group and control group were collected via retrospective chart review. Age, diagnosis age of CHB, duration of CHB in years, AST, ALT, HbeAg status, HBV DNA levels, histopathological results were recorded for groups. Laboratory data was obtained from blood samples taken at the same time as liver biopsy and used for calculations. APRI score was calculated with the formula (AST/upper limit of normal)/platelet (109/L) × 100 [6]. An AST value of 37 was used as the upper limit of normal for our laboratory. NLR and PLR were calculated by dividing the absolute neutrophil and platelet count by the absolute lymphocyte count.




Liverbiopsywasperformedusing a 16-gauge Menginineedleunderlocalanesthesiacondition. Livertissueswerefixedfor 24 hours in 10% neutralbufferedformalin, routinelyprocessedandtheembedded in parafin wax. Four-micron-thicksectionswerecutandstainedwithhematoxylin&eosin, Periodicacid-Schiff. Allslideswereexaminedwith a lightmicroscope. A singleexperiencedpathologistperformedhistopathologicalexamination in a blindedfashion. Patients’ fibrosisscoresandhistologicalactivityindex (HAI) werecalculatedaccordingtotheIshakscoringsystem[11]. Fibrosisscorewasrecognized as follows: F0-1 No/earlystagefibrosis, F2-6 significantfibrosis. Significantliverfibrosiswasdefined as an Ishakscore of ≥ 2.


Statistical analysis


Statistical analysiswasperformedusingIBMSPSS 22.0 (SPSS Inc., Chicago, IL, United States). Thestudywascomprised of studyandcontrolgroups. Ineachgroup, descriptivestatisticswereapplied. Pearson qui-square test (x2) wasusedtocomparefrequenciesormeans. Theappropriate test for normal distribution of variableswasperformedbyKolmogorov-Smirnov test. Non-parametricmethodswereusedfornon-normallydistributed values (Mann-Whitney U). Because of non-normallydistributed, continuousvariableswereexpressed as median (minimum-maximum). Categoricalvariableswerepresented as frequencyandpercentage. Spearman’s correlation analysis was used for ordinal and scale variables. A p-value of < 0.05 wasconsideredstatisticallysignificant.




Inthisstudy, 164 patientswith mean age of 21 years (range, 20–34 years) and 164healthysubjects with mean age of 21 years (range, 20–32 years)wereincluded in the study and control group, respectively.The gender of both groups was male because our hospital was a military hospital. The control and patient groups were age-matched.Thedemographicandlaboratory data of thegroupsweresummarized in Table 1.CHB diagnosis ages of patients was minimum 6 monthsand maximum 18 years.


Histopathologicexaminationshowedthat71 (43.3%) patients had fibrosisscore F0–1, whereas93 (56.7%) patientswerefoundtohavefibrosisscore≥F2 fibrosis.


APRI scoresand NLR of thestudygroupweresignificantlyhigher than those of thecontrolgroup(p< 0.001, p= 0.02, respectively). PLR was significantly lower than those of thecontrolgroup(p=0.01). Inaddition, as expected, plateletcount, AST and ALT values weresignificantlydifferentfromthose of the control group (p< 0.001). Whileplateletandlymphocytecount was lower, AST, ALT levels and neutrophilcountwerehigher in thepatientgroup (Table 1).


In CHB patients, whensignificantfibrosiswascomparedwithearly-stagefibrosis, thegroupsshowednodifference in APRI scores while there was a significant difference in terms of NLR and PLR (p=0.02, p=0.007), respectively)(Table 2).


Inaddition, correlationanalyses revealed that PLR has a negative and significant relationship with both fibrosis and HAI ((r: -0,220, p:0,005), (r: -0,146, p:0,02), respectively).


In the meantime, correlation analyses revealed that NLR has a negative and significant relationship with fibrosis (r = -0.225, p:0,004). There isn’t correlation with HAI (r = -0.071, p = 0.363).


Correlation analyses revealed that HBV DNA has a positive and significant relationship with both fibrosis and HAI ((r: 0,159,  p:0,04), (r: 0,315, p:<0,001),respectively).




Diagnosis and follow-up of chronic liver diseases has long relied on liver biopsy, and only recently has its value as a method to assess the severity of liver diseases (or to follow-up disease progression) been questioned. Although biopsy is used to stage most cases of liver disease, it is well known that this procedure has several limitations [12,13].Liver biopsy is an invasive procedure with associated morbidity: pain occurs in 20% of patients and major complications (such as bleeding or hemobilia) in 0.5% [13]. Therefore, liver biopsy has poor tolerance, particularly if it needs to be repeated over time in an individual patient. For this reason, noninvasive diagnosis of liver fibrosis is one of the fields that has evolved most rapidly in recent years. Moreover, patients are now aware of the availability of noninvasive methods to assess the degree of liver damage and are thus reluctant to undergo an invasive procedure [4]. In addition, non-invasive tests can be repeated over time, and in cases of indeterminate results, two or more methods can be combined [4].


In the case of patients with CHB, the number of studies assessing noninvasive markers is smaller. As one of them, APRI score was developed by Wai et al. in 2003 [6]. APRI score, which is often used daily practice such as AST and platelet count and can be calculated from the two test affected in the liver fibrosis is easy and non-invasive method [6]. It is indicate that the development of liver fibrosis may impair thrombopoietin production and, therefore, contribute to the reduction of the platelet count [14]. Splenomegalycontributesto a decrease of the circulating platelet pool. Advanced liver fibrosis, causing an altered production of thrombopoietin, portal hypertension and, consequently, splenomegaly, plays the main role in the pathogenesis of thrombocytopenia in chronic viral hepatitis. Other factors may play a minor role in platelet reduction, such as anti-platelet antibodies and bone marrow inhibition by the viral infection, and/or metabolic or toxic events [15]. Progression of liver fibrosis may reduce the clearance of AST, leading to increased serum AST levels [16]. Inaddition, advancedliverdiseasemaybeassociatedwithmitochondrial injury, resultinginmoremarkedreleaseofAST,whichispresent in mitochondriaandcytoplasm, relativeto ALT[17]. The some authors suggested that, in their studies, APRI score, which issued to predict significant fibrosis and cirrhosis in CHC,was not suitable for patients with CHB. They explain this by the presence of a fluctuating course with acute attacks in CHB patients while the progression of fibrosis in CHC is more quiet[6,18,19]. In contrast, multiple studies had shown that it is of great value and has high accuracy in predicting advanced fibrosis in different forms of liver disease [20-22]. Shin et al. studied a large number of CHB patients and suggested a strong positive linear correlationbetween fibrosis and APRI [7]. Sebastiani et al. assessedthe utility of several noninvasive markers in a cohort of 110 patients with chronic hepatitis B who had undergone liver biopsy [23].They showed fibrotest and APRI achieved the highest diagnostic accuracy in identifying patients with significant fibrosis [23].


Celikbilek M et al. found that APRI score was higher in significant fibrosis but it was not statistically significant. However, in CHB patients with cirrhosis APRI score was significantly higher. They alsomentioned that their study results also showed a statisticalassociation between age and cirrhosis. Cirrhotic patients were found to be more elderly compared to the non-cirrhotic patients.They said this can be explained by the increased cirrhosis rates witholder age [24].


Although there are studies which suggest that lowplatelet counts are related to advanced hepatic fibrosis,other studies have shown opposite findings [18,25,26]. As consistent with above knowledge, in current research the platelet counts were significantly lower in the patients with CHB and significant fibrosis group than those of the control group and early-stage fibrosis, respectively. The AST values were higher in the patients with CHB and significant fibrosis group than those of the control group and early-stage fibrosis, respectively. As in that of Celikbilek M et al., although APRI score was significantly higher in patients group than control group, we did not find statistically significant relation with APRI score and significant fibrosis. However, one of our study limitations is we have not elderly patients so we have a few cirrhosis patient. For this reason, we didn’t create a different group whose compose of cirrhotic patients. We thought that the lack of statistically significant relation with APRI score and significant fibrosis can attribute to the small number of our cirrhotic. Additionally, our results can be asssessed as preliminary data for CHB started in childhood and used in comparison of studies for elderly population.


Unlike previous reports, to further evaluate the association betweeninflammatory markers and liver fibrosis, we did additional analyses in which both NLR and PLR levels were taken into account. In the meantime, our study was composed of the greater number of CHB patients and along with healthy subject. As the other non-invasive markers, NLR and PLR can be easily calculated and are cost-effective tests shows the body’s immune response [10].Recently,NLR has been recommended as a new marker for systemic inflammation [27].Celikbilek M et al. founded that in their study, NLR showed no difference in the CHB and control group, but negative and significant relationship between HAI with NLR. And they mentioned this negative relationship demonstrates the important role of lymphocytes in liver damage in CHB. According to their findings, fibrosis stage and cirrhosis were not associated with NLR. All the spectra of biopsies of patients with CHB give rise to the study of the relationship between histological findings with APRI score and NLR [24].In present study, NLR of the study group were significantly higher than those of the control group. NLR of the significant fibrosis were lower than those of the early-stage fibrosis. Although, there isn’t correlation with HAI, there is negative and significant correlation between fibrosis with NLR.


Lymphomononuclear cells play a fundamental role in inflammatory pathways during the development of cirrhosis [28].In our study, we noted that the lymphocyte count was markedly higher in patients with significant fibrosis compared with patients with no/minimal fibrosis. It can reflect the mononuclear inflammation occurring at the tissue level[28].Thus, it was found NLR of the significant fibrosis were lower.


Although most published studies assessing NLR have been made in patients with chronic hepatitis, to our knowledge, our study is the first to evaluate the PLR in CHB disease. In the literature, PLR has been studied in various inflammatory states and neoplastic diseases such as chronic calcific pancreatitis, gastric cancer, non-small cell lung cancer and hepatocellular carcinoma[29-32].Furthermore, it has been demonstrated that this ratio can be used as a prognostic factor for post-transplant HCC recurrence [33,34].Moreover, in the light of current reports, NLR is a good predictor for the risk of dropout, while PLR is a good predictor for the risk of post-liver transplant recurrence [34].Our current findings showed that PLR values were considerably lower both CHB patients according to control group and in cases with significant liver fibrosis.


One of our study limitations, all of our patients were male. However, Kekilli M et al. revealed that no significant difference between the two groups regarding sex in their study which is composed of 92 male and 37 female[35].




In conclusion, the present study has shown, for thefirst time, that in patients with childhood CHB, PLR is associated with histological severity and canbe used to identify patients with advanced disease. Ifour data are confirmed in future studies, we believethat a standardized cut-off value for PLRwould simplify the identification of advanced fibrosis inpatients with CHB. Thus, we suggest that PLR,a low-cost and useful test, provides a beneficial andspeedy evaluation of fibrosis in patients with CHB. Inlight of our findings, it is suggested that PLR,in combination with other noninvasive parameters such as APRI score and NLR,may assist in identifying individuals at high risk ofhaving advanced and progressive disease.Continued research in this area will give us the opportunity to offer our patients more precise and noninvasive diagnostic tools.




This article was not funded.


Declaration of interest


The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.



  1. Custer B, Sullivan SD, Hazlet TKet al. (2004)Global epidemiology of hepatitis B virus. J Clin Gastroenterol 38: 158-168.
  2. Corte CD, Nobili V, Comparcola D et al. (2014) Management of chronic hepatitis B in children: An unresolved issue. J Gastroenterol Hepatol29: 912-919.
  3. European Association for The Study of The Liver (2009) EASL Clinical Practice Guidelines: management of chronic hepatitis B. J Hepatol 50: 227-242.
  4. Martínez SM, Crespo G, Navasa M, Forns X (2011)NoninvasiveAssessment of Liver Fibrosis. Hepatology53: 325-335.
  5. Papastergiou V, Tsochatzis E, Burroughs AK (2012) Non-invasiveassessment of liverfibrosis. Ann Gastroenterol 25: 218-231.
  6. Wai CT, Greenson JK, Fontana RJet al. (2003) A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 38: 518-526.
  7. Shin WG, Park SH, Jang MK et al. (2008) Aspartate aminotransferase to platelet ratio index can predict liver fibrosis in chronic hepatitis B. DigLiver Dis 40: 267-274.
  8. Chen L, Zhang Q, Chang Wet al. (2012)Viral and host inflammation-related factors that can predict the prognosis of hepatocellular carcinoma. Eur J Cancer 48: 1977-1987.
  9. Halazun KJ, Hardy MA, Rana AA et al. (2009)Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma. Ann Surg 250: 141-151.
  10. Alkhouri N, Morris-Stiff G, Campbell Cet al. (2012)Neutrophil to lymphocyte ratio: a new marker for predicting steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease. Liver Int 32:297-302.
  11. Ishak K, Baptista A, Bianchi Let al. (1995)Histologicalgradingandstaging of chronic hepatitis. J Hepatol 22: 696-9.
  12. BedossaP, Dargere D, Paradis V (2003) Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology38: 1449-1457.
  13. CadranelJF, Rufat P, Degos F (2000) Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF).Hepatology32: 477-481.
  14. Adinolfi LE, Giordano MG, Andreana A et al. (2001)Hepaticfibrosisplays a central role in thepathogenesis of thromcytopenia in patientswithchronicviralhepatitis. Br J Haematol113:590-595.
  15. Floreani A, Biasin MR, Marchelle G et al. (1996) Are human platelets a site of HCV replication? Hepatology24: 1539.
  16. Kamimoto Y, Horiuchi S, Tanase S, Morino Y (1985) Plasma clearance of intravenously injected aspartate aminotransferase isozymes: evidence for preferential uptake by sinusoidal liver cells. Hepatology5: 367-375.
  17. Okuda M, Li K, Beard MR et al. (2002) Mitochondrialinjury, oxidativestress, andantioxidant gene expressionareinducedbyhepatitis C virus core protein. Gastroenterology 122: 366-375.
  18. Kim BK, Kim SA, Park YN et al. (2007) Noninvasive models to predict liver cirrhosis in patients with chronic hepatitis B. Liver Int27: 969-976.
  19. Yilmaz Y, Yonal O, Kurt R et al. (2011)Noninvasive assessment of liver fibrosis with the aspartate transaminase to platelet ratio index (APRI): Usefulness in patients with chronic liver disease: APRI in chronic liver disease. HepatMon11:103-106.
  20. Sebastiani G, Vario A, Guido M et al. (2006) Stepwise combination algorithms of non-invasive markers to diagnose significant fibrosis in chronic hepatitis C. J Hepatol44:686-93.
  21. Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cárdenas Eet al. (2008) AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol 7: 350-357.
  22. Snyder N, Gajula L, Xiao SYet al. (2006)APRI: an easy and validated predictor of hepatic fibrosis in chronic hepatitis C. J ClinGastroenterol 40: 535-542.
  23. SebastianiG, Vario A, Guido M, Alberti A (2007) Sequential algorithms combining non-invasive markers and biopsy for the assessment of liver fibrosis in chronic hepatitis B. World J Gastroenterol13: 525-531.
  24. Celikbilek M, Dogan S, Gursoy S et al. (2013) Noninvasive assessment of liver damage in chronic hepatitis B. World J Hepatol 27: 439-45.
  25. Mohamadnejad M, Montazeri G, Fazlollahi Aet al. (2006)Noninvasive markers of liver fibrosis and inflammation in chronic hepatitis B-virus related liver disease. Am J Gastroenterol101: 2537-45.
  26. Pan JJ, Yang CF, Chu CJ et al. (2007) Prediction of liver fibrosis in patients with chronic hepatitis B by serum markers. Hepatogastroenterology54: 1503-1506.
  27. AtanD, Ikinciogulları A, Koseoğlu Set al. (2015) New Predictive Parameters of Bell’s Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio. Balkan Med J32: 167-170.
  28. Calvaruso V and Craxì A (2011) Fibrosis in chronic viral hepatitis. Best Pract Res Clin Gastroenterol 25: 219-230.
  29. Rammohan ACherukuri SDPalaniappan Ret al. (2015)Preoperative Platelet-Lymphocyte Ratio Augments CA 19-9 as a Predictor of Malignancy in Chronic Calcific Pancreatitis.39:2323-8.
  30. Tian XCZeng FRWu DH (2015)Platelet-to-lymphocyte ratio: a prognostic factor for patients with advanced hepatocellular carcinoma?Tumour Biol 36:4935-4936.
  31. Wu G, Yao Y, Bai C et al. (2015) Combination of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio is a useful prognostic factor in advanced non-small cell lung cancer patients.Thorac Cancer6:275-287.
  32. Lian L, Xia YY, Zhou C et al. (2015) Application of platelet/lymphocyte and neutrophil/lymphocyte ratios in early diagnosis and prognostic prediction in patients with resectable gastric cancer.Cancer Biomark 15:899-907.
  33. Xia W, Ke Q, Wang Yet al. (2015) Predictive value of pre-transplant platelet to lymphocyte ratio for hepatocellular carcinoma recurrence after liver transplantation.World J Surg Oncol13: 160.
  34. Lai Q, Castro Santa E, Rico Juri JMet al. (2014)Neutrophil and platelet-to-lymphocyte ratio as new predictors of dropout and recurrence after liver transplantation for hepatocellular cancer. Transpl Int 27:32-41.
  35. Kekilli M, Tanoglu A, Sakin YS et al. (2015) Is the neutrophil to lymphocyte ratio associated with liver fibrosis in patients with chronic hepatitis B? World J Gastroenterol21: 5575-5581.


  Patients (n = 164) Controls (n = 164) p value
Sex (M/F)           164/0 164/0
Age (years) 21(20-34) 21 (20-32) < 0.80
AST (IU/L) 43 (23-351) 22 (13-199) < 0.001
ALT (IU/L) 77 (44-826) 22 (7-82) < 0.001
Neutrophil count (103μL) 3.8 (0.7-8.3) 3.5 (1.6-7.2) 0.03
Lymphocyte count (103μL) 2.03 (0.7-4.1) 2.07 (1.09-3.97) 0.48
Platelet count (103μL) 230 (95-394) 253 (144-372) < 0.001
APRI score 0,5 (0,2-4,1) 0,2 (0,1-2,1) < 0.001
NLR 1.8 (0.3-6.2) 1.6 (0.7-4.2) 0.02
PLR 109 (57-253) 118 (56-279) 0.01


Values are expressed as n (%), median (minimum-maximum). AST: Aspartate amino transferase; ALT: Alanine amino transferase; NLR: Neutrophil lymphocyte ratio; PLR: Platelet lymphocyte ratio; APRI: Aspartate amino transferase/platelet ratio index. Mann-Whitney U


Table 1. Comparison of demographic and laboratory parameters in the groups


  No/mild fibrosis Significant fibrosis pvalue
(n = 71) (n = 93)
Sex (M/F)   71/0 93/0
1Age (years) 21(20-30) 21 (20-34) 0,77
1AST (IU/L) 40 (25-166) 45 (23-351) 0,10
1ALT (IU/L) 76 (44-553) 89 (45-826) 0,06
1Neutrophil count (103μL) 4 (1,89-7,3) 3,76 (0,76-8,32) 0,23
1Lymphocyte count (103μL) 1,87 (0,74-3,56) 2,1 (1,21-4,14) 0,02
1Platelet count (103μL) 233 (137-394) 229 (95-357) 0,66
1APRI score 0,5 (0,2-4,1) 0,5 (0,2-2,5) 0.29
1NLR 2,01 (0,95-6,28) 1,83 (0.37-4,12) 0.02
1PLR 120 (65,7-253,4) 107 (58-182) 0.007
2HbeAg (negative/positive) 40/31 48/45 0,54
1HBV DNA (103copy/mL) 3300 (0-9900000) 55000 (0-9900000) 0,11


Values are expressed as n (%), median (minimum-maximum). AST: Aspartate amino transferase; ALT: Alanine amino transferase; HBV: Hepatitis B virus; HBeAg: Hepatitis B e antigen; NLR: Neutrophil lymphocyte ratio; PLR: Platelet lymphocyte ratio; APRI: Aspartate amino transferase/ platelet ratio index. 1Mann-Whitney U, 2Pearson qui-square test (x2).


Table 2. Between group comparisons in CHB patients according to fibrosis stage


Suggested Citation


Citation: Altun D, Karacaer Z, Okur G, UmitSarici S (2017) Platelet to Lymphocyte Ratio in Hepatitis B. Arch Pedia 2017: APDT-109

Leave a Reply