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Usefulness of neutrophil to lymphocyte ratio in fatty liver disease: authors' reply

To the Editor: We read with great interest the article recently published in Liver International by Alkhouri et al. (1), presenting that the neutrophil/lymphocyte (N/L) ratio is higher in patients with nonalcoholic steatohepatitis (NASH) and advanced fibrosis. They mentioned that N/L integrates information on the inflammatory milieu and physiological stress. They found higher N/L ratio in NASH patients compared with controls. Also they implicated that this ratio is correlated with the individual histological features of NASH, especially inflammation and fibrosis. We want to add some points which may take into consideration. In a recent study, diet and physical exercise intervention significantly reduces the N/L ratio in a population of overweight, male adolescents (2). They also conclude that weight loss was associated with a significant decrease of pro-inflammatory cytokine levels. Although various medical treatment strategies are under evaluation, we know that the current management of NAFLD relies on weight loss and exercise (3). The N/L ratio a novel noninvasive, inexpensive and simple accessible marker can be used to predict advanced disease. Also according to our opinion, the N/L ratio can be used for following patients and also can be used for evaluating the affectivity of novel treatment strategies in NASH.