Prognostic Value of Neutrophil-to-lymphocyte Ratio in Patients with Acute-on-chronic Liver Failure in Comparison with Standard Scores: A Cross-sectional Observational Study from a Tertiary Care Hospital in South India

Background/aims: Acute-on-chronic liver failure (ACLF) is a clinical entity that denotes deteriorates liver function in patients with underlying liver disease. Most studies indicate that the neutrophil-to-lymphocyte ratio (NLR). Neutrophil-to-lymphocyte ratio is a valuable prognostic marker in patients with ACLF. This study aims to assess the role of NLR ratio and evaluate the accuracy of NLR as a prognostic marker in ACLF and to compare the NLR with other standard scores. Materials and methods: This study was conducted among patients with ACLF. Neutrophil-to-lymphocyte ratio was calculated by dividing the neutrophil count by the lymphocyte count. Neutrophil-to-lymphocyte ratio was compared with AARC score, CLIF-C ACLF score, MELD-Na score, and Child-Pugh classification as a prognostic marker in ACLF. Results: = 0.005). The receiver operating characteristic (ROC) analysis showed that NLR had good predictive accuracy for mortality (AUC = 0.84), supporting its utility as a simple, cost-effective tool in early risk stratification. Conclusion: With increased NLR suggesting a higher probability of death, the study emphasizes the importance of NLR as a useful prognostic biomarker in patients with ACLF. Clinical significance: Neutrophil-to-lymphocyte ratio is a prognostic marker to identify the risk of mortality in ACLF patients and helps in timely clinical decisions. Elevated NLR can help clinicians in prioritizing patients for liver transplantation. How to cite this article: . Prognostic Value of Neutrophil-to-lymphocyte Ratio in Patients with Acute-on-chronic Liver Failure in Comparison with Standard Scores: A Cross-sectional Observational Study from a Tertiary Care Hospital in South India. Euroasian J Hepato-Gastroenterol 2025;15(2):118-122.