Hubungan Neutrofil Limfosit Rasio (NLR) dengan Mortalitas pada Pasien Hepatocellular Carcinoma (HCC) dengan Hepatitis B di RS Adam Malik Medan

Abstract

Background. Hepatocellular carcinoma (HCC) is a primary liver malignancy with a high mortality rate and is frequently associated with chronic hepatitis B infection. Systemic inflammation plays an important role in the progression of HCC, and one inflammatory marker that can be easily obtained is the neutrophil–lymphocyte ratio (NLR). Objective. To evaluate the accuracy of the neutrophil–lymphocyte ratio as a predictor of mortality in patients with HCC and hepatitis B. Methods. This was an analytical observational study with a cross-sectional design using medical record data from RSUP H. Adam Malik Medan. Results. A total of 139 patients with HCC and hepatitis B met the study criteria, consisting of 70 patients (50.4%) who died and 69 patients (49.6%) who survived. Most patients were aged 45–59 years (49.6%) and were predominantly male (87.8%). NLR values were compared between the mortality and non-mortality groups and analyzed using the Receiver Operating Characteristic (ROC) curve. The results showed that the median NLR was higher in the mortality group than in the survival group; however, the difference was not statistically significant (p = 0.363). ROC analysis demonstrated an area under the curve (AUC) of 0.585, indicating low predictive accuracy. An NLR cut-off value of 7.16 yielded a sensitivity of 52.9% and a specificity of 53.6% for predicting mortality. Other laboratory parameters that showed a significant association with mortality were leukocyte count (p = 0.016), prothrombin time (PT) (p < 0.001), and international normalized ratio (INR) (p = 0.008). Conclusion. The neutrophil–lymphocyte ratio has low accuracy as a predictor of mortality in patients with hepatocellular carcinoma and hepatitis B. Therefore, NLR is not recommended as a single prognostic parameter but may still be considered as part of a comprehensive clinical evaluation together with other clinical and laboratory parameters.