Chronic hepatitis B infection biochemical, virological and tissue treatment response in correlation with platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) in Egyptian patients infected with chronic hepatitis B virus
Authors: Elkilany Hesham H , Ghaly Sameh M , Abdullah Karim S , Wassfy Wesam E , Said Nouran M 
Published: February 2024

Abstract

Background
Hepatitis B virus (HBV) is considered one of the most significant public health challenges due to its chronicity and complications that happen after several years of infection. The main event in HBV effect is its recognition as a foreign antigen which activates the immunity to target and destroy infected cells, hence HBV is not a cytotoxic virus. This destruction happens intermittently through the course of chronic infection leading to inflammation and necrosis of the liver tissue. The repetition of these periods of liver injury yields liver fibrosis and hepatocellular carcinoma. For disease prognostication, assessment of treatment of treatment indications and management in HBV chronic infected patients, assessment of liver fibrosis and cirrhosis status is crucial. Liver biopsy is an accurate but invasive method, while transient elastography and different serum biomarkers are considered non-invasive modalities. The platelet-lymphocyte ratio (PLR) is a novel inflammatory marker, which can be used for predicting inflammation and mortality in many diseases. While NLR has been recommended as a new marker for systemic inflammation as Lymphomononuclear cells play a fundamental role in inflammatory pathways during the development of cirrhosis. PLR values were considerably lower in chronic Hepatitis B (CHB) patients with significant liver fibrosis and it is suggested that combining noninvasive parameters such as PLR and NLR may help identifying patients at high risk of developing advanced and progressive disease.

Aim
To correlate hepatitis B viral replication, liver biochemical tests and liver fibrosis to platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) and follow up treatment response of HBV with PLR and NLR.

Patients and methods
This prospective study was conducted on 60 patients with HBV eligible for antiviral treatment with NAs, agreeable to regular follow-up, recruited from Ain Shams University Virology Center in Cairo during the period from January 2022 to January 2023 after informed consents were taken from the patients and agreement for follow up. All patients were investigated by laboratory tests (CBC, AST, ALT, Total bilirubin, serum albumin, INR, serum creatinine, alpha fetoprotein, HBsAg, HBV DNA PCR, HBeAg), Pelviabdominal ultrasound and Fibroscan followed by calculation of PLR and NLR before and six months after initiating treatment.

Results
Our study shows a negative and a statistically significant correlation between PLR and Fibroscan in patients before treatment (P value <0.001) and 6 months after treatment initiation (P value <0.001) Also PLR statistically correlated in a positive way to HBV DNA in patients before treatment (P value <0.001). While there was no statistically significant correlation between NLR and neither the Fibroscan nor HBV DNA PCR in both study periods.

Conclusions
PLR partially correlates with HBV DNA PCR but strongly correlated with fibrosis stage in fibroscan with an inverse correlation and can be used as a marker of fibrosis. While NLR neither reflects HBV DNA nor fibrosis stage in fibroscan and cannot be used as a marker of fibrosis