Uncorrected Proof Shiraz E-Med J. 2023 August; 24(8):e138859. Published online 2023 September 24. https://doi.org/10.5812/semj-138859. Research Article The Association Between Peripheral Blood Neutrophil-to-Lymphocyte Ratio and Cirrhosis Complications in Adults with Compensated Liver Cirrhosis in Ahvaz, Iran Seyed Jalal Hashemi 1 , Mohsen Shokrian Tosi 1, * , Eskandar Hajiani 1 , Abazar Parsi 1 and Pezhman Alavinejad 1 1 Alimentary Tract Reseach Center, Clinical Research Institute, Imam Khomeini Hospital , Ahvaz University of Medical Sciences, Ahvaz, Iran * Corresponding author: Alimentary Tract Reseach Center, Clinical Research Institute, Imam Khomeini Hospital , Ahvaz University of Medical Sciences, Ahvaz, Iran. Email: msh2220@gmail.com Received 2023 August 01; Revised 2023 August 19; Accepted 2023 August 28. Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) is an inflammation biomarker in patients with liver cirrhosis. While increased NLR is linked to poor clinical outcomes and mortality in diseases like cancers, its association with cirrhosis complications has been sparsely examined. Objectives: This study aimed to evaluate the association between NLR and cirrhosis complications in patients with compensated liver cirrhosis. Methods: This retrospective cohort study was conducted on 256 patients with compensated liver cirrhosis visiting the Gastroenterology Clinic of Imam Khomeini Hospital, Ahvaz, Iran, in 2020. The peripheral blood lymphocyte and neutrophil counts were evaluated, and the NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Cirrhosis complications were assessed based on clinical and laboratory evaluation during 1 year of follow-up. Results: During the retrospective follow-up period, 59 patients (23.05%) experienced cirrhosis complications such as spontaneous bacterial peritonitis (n = 23), gastrointestinal bleeding (n = 22), and hepatic encephalopathy (n = 14). The baseline NLR, Model for End-Stage Liver Disease (MELD) score and Child-Pugh score were significantly higher in patients who later developed complications than in those who did not (P < 0.0001). The NLR with an optimal cut-off of > 1.95 had a sensitivity of 84.75% and specificity of 93.91% in predicting complications during the 1-year follow-up (AUC = 0.905, P < 0.0001). Conclusions: Our results indicated that the NLR is a simple, non-invasive, and cost-effective marker for predicting short-term complications in patients with compensated liver cirrhosis. Keywords: Neutrophil-to-Lymphocyte Ratio, Liver Cirrhosis, Inflammation, Complications 1. Background Liver cirrhosis is the fibrosis of hepatocytes, ultimately leading to portal hypertension and synthetic liver dysfunction (1, 2). This complex chronic disease causes over 1 million deaths yearly and is recognized as the primary risk factor for hepatocellular carcinoma (HCC) (2, 3). Compensated cirrhosis is often asymptomatic, while decompensated cirrhosis is characterized by complications including portal hypertension, ascites, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and bleeding from gastrointestinal varices (4, 5). Disease progression and complications are the leading causes of mortality in these patients (2, 6), with infections such as SBP causing many deaths (7). Hence, identifying markers for predicting cirrhosis complications and prognosis is crucial and contributes to better management strategies (8, 9). Systemic inflammation commonly occurs in patients with advanced liver cirrhosis (10) and is associated with adverse outcomes (11). The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and highlights the association between two immune pathways. The neutrophil count indicates ongoing (or progressive) inflammation, while the lymphocyte count reflects the activity of immunoregulatory pathways (8, 12). The NLR independently predicts outcomes and mortality Copyright © 2023, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.