Correlation of Simple Laboratory Result Parameters to CTP and MELD Scores, and the Diagnostic Role of Simple Laboratory Indexes to Cirrhosis Decompensation

Ni Nyoman Gita Kharisma Dewi(1), Ni Luh Putu Yunia Dewi(2), Putu Itta Sandi Lesmana Dewi(3), Kadek Mercu Narapati Pamungkas(4), Dwijo Anargha Sindhughosa(5), I Ketut Mariadi(6),

(1) Udayana University
(2) Udayana University
(3) Udayana University
(4) Udayana University
(5) Division of Gastroenterology and Hepatology, Department of Internal Medicine, Udayana University/ Prof. dr. IGNG Ngoerah General Hospital, Bali
(6) Division of Gastroenterology and Hepatology, Department of Internal Medicine, Udayana University/ Prof. dr. IGNG Ngoerah General Hospital, Bali
Corresponding Author



Cirrhosis of the liver is a final condition of all chronic liver diseases. Liver cirrhosis is the leading cause of increasing morbidity and mortality in adults worldwide. Systemic inflammation has been suggested to play an important role in causing progressive liver damage and is one of the leading causes of compensated and decompensated liver cirrhosis.

Aim of Study

Evaluate the correlation of neutrophil-lymphocyte ratio (NLR), albumin-bilirubin ratio (ABR), albumin-bilirubin score (ALBI), aspartate aminotransferase to platelet ratio (APRI), albumin-creatinine ratio (ACR), lymphocyte-monocyte ratio (LMR), de ritis ratio to the severity of liver cirrhosis as assessed by CTP score and MELD score. In addition, this study also evaluated the diagnostic ability of NLR, ABR, ALBI, APRI, ACR, LMR, de ritis ratio, and CTP and MELD scores in predicting decompensated liver cirrhosis.


We conducted a cross-sectional study involving patients diagnosed with liver cirrhosis at Prof DR IGNG Ngoerah General Hospital. All patients were diagnosed based on clinical history, physical examination, and investigations. This study enrolled 96 cirrhotic patients regardless of etiology. Laboratory examination results recorded platelets, neutrophils, lymphocytes, monocytes, AST, ALT, albumin, and creatinine. Then NLR, ACR, APRI, LMR, de raitis, ALBI, and ABR are calculated. CTP and MELD scores were calculated by taking data from the patient's medical record


Of the 96 patients tested in our study, the majority were male (66). The study found a significant moderate to very strong relationship to the MELD score between ACR, APRI, ALBI, ABR, LMR, WBC, sodium, and albumin. Neutrophil to lymphocyte ratio, ACR, De ritis, APRI, LMR, ALBI, ABR, sodium levels, and albumin have a moderate to very strong significant relationship to CTP score. ACR, De ritis, APRI, LMR, ALBI, ABR, WBC, sodium, and albumin levels with respective cut-offs £ 3.6; ≥ 1.5; ≥ 0.3; £ 2.8; ≥ 0.7; £1.6; ≥ 6.7, £ 136.50, and £ 3.0 can be used to help predict decompensated cirrhosis


In addition to using the CTP score and MELD score as a tool to predict the severity of liver cirrhosis, data from laboratory examination results in the form of albumin and ABR levels can help establish the diagnosis of decompensated cirrhosis. The sensitivity and specificity of ABR were 96.8% and 75.4% with a cut-off of £  1.6, while albumin levels were 93.5% and 81.5% with an amount off of £  3.0.



Sharma B, John S. Hepatic Cirrhosis. 2023. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from:

Tapper EB, Parikh ND. 2023. Diagnosis and Management of Cirrhosis and Its Complications: A Review. JAMA. 329(18):1589–1602. doi:10.1001/jama.2023.5997

Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. 2021. Liver cirrhosis. Lancet. 398(10308):1359-1376. doi: 10.1016/S0140-6736(21)01374-X.

Huang, D.Q., Terrault, N.A., Tacke, F. et al. 2023. Global epidemiology of cirrhosis — etiology, trends, and predictions. Nat Rev Gastroenterol Hepatol 20, 388–398.

Hasan I, Putra RP, Yunihastuti E, Kurniawan J. 2022. The Validity and Reliability of the Indonesian Version of the Chronic Liver Disease Questionnaire (CLDQ) in Measuring Quality of Life in Patients with Liver Cirrhosis. Acta Med Indones. 54(1):10-18. PMID: 35398821.

Sungkar T, Rozi MF, Dairi LB, Zain LH. 2019.The neutrophil-to-lymphocyte ratio (NLR) and its correlation with severity of decompensated liver cirrhosis based on Child-Turcotte Pugh (CTP) score. Journal of Clinical and Diagnostic Research. 2019 Feb, Vol-13(2): OC29-OC31. DOI: 10.7860/JCDR/2019/39895.12618.

Peng Y, Qi X, Guo X. 2016. Child-Pugh Versus MELD Score for Evaluating Prognosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis of Observational Studies. Medicine (Baltimore). 95(8):e2877. doi 10.1097/MD.0000000000002877.

Metawea MI, Moteleub HNAE. 2022. Diagnostic role of simple indices in HCV-related liver cirrhosis outcomes: a prospective cross-sectional study. Clin Exp Hepatol. (1):29-35. doi 10.5114/ceh.2022.114169.

Bhandari S, Gulati S, Sharma N, Kumar A, Singh A. 2021. Evaluation of Neutrophil to Lymphocyte ratio (NLR) and its utility as a prognostic marker in COVID-19 patients. Authorea Preprints. 35(8):2349-2562. DOI: 10.18410/jebmh/2021/616

Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cárdenas E, Sánchez-Avila F, Vargas-Vorácková F. 2008. AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol. 7(4):350-7. PMID: 19034235.

Kurniawan WD, Widodo B, Agustina B. AST to Platelet Ratio Index (APRI) and Degree of Severity based on Child-Pugh Classification among Cirrhosis Patients at Internal Medicine Ward in a Tertiary Hospital. 2(32):46-51. Available from:

Anju R, Shah K. 2017. Significance of SGOT & SGPT ratio (De Ritis Ratio) & GGT levels in patients of liver cirrhosis with and without a history of alcoholism. Int J Research Med. 6(2):1-3.

Abdelghani, A., Ibrahim, M.H.ED., Mohamed, O.M. et al. 2021. Urinary albumin-to-creatinine ratio in decompensated liver cirrhosis among elderly Egyptian patients: a single-center experience. Egypt J Intern Med 33, 32. Available from:

Zhang J, Feng G, Zhao Y, Zhang J, Feng L, Yang J. 2015. Association between lymphocyte-to-monocyte ratio (LMR) and the mortality of HBV-related liver cirrhosis: a retrospective cohort study. BMJ Open. 5(8):e008033. doi: 10.1136/bmjopen-2015-008033.

Emenena I, Emenena B, Kweki AG, Aiwuyo HO, Osarenkhoe JO, Iloeje UN, Ilerhunmwuwa N, Torere BE, Akinti O, Akere A, Casimir OE. 2023. Model for End-Stage Liver Disease (MELD) Score: A Tool for Prognosis and Prediction of Mortality in Patients With Decompensated Liver Cirrhosis. Cureus. 15(5). DOI: 10.7759/cureus.39267

Llovet, J.M., Kelley, R.K., Villanueva, A. et al. 2021. Hepatocellular carcinoma. Nat Rev Dis Primers 7, 6. Available from:

Zhou WC, Zhang QB, Qiao L. 2014. Pathogenesis of liver cirrhosis. World J Gastroenterol. 20(23):7312-24. doi: 10.3748/wjg.v20.i23.7312. PMID: 24966602; PMCID: PMC4064077.

Geong GY, Kang SH, Lee CM. 2019. An updated review on the epidemiology, pathophysiology, etiology, and diagnosis of liver cirrhosis.ResearchGate. Available from:

Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM. 2008. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 359(10):1018-26. doi: 10.1056/NEJMoa0801209.

Vyas, D. 2021. Study The Relation Between Serum Sodium And The Model For End-Stage Liver Disease Score In Patients With Liver Cirrhosis. International Journal of Medical and Biomedical Studies, 5(3).

Bernardi M, Angeli P, Claria J, Moreau R, Gines P, Jalan R, Caraceni P, Fernandez J, Gerbes AL, O'Brien AJ, Trebicka J.2020. Albumin in decompensated cirrhosis: new concepts and perspectives. Gut. 69(6):1127-38. DOI: 10.1136/gutjnl-2019-318843

Full Text: PDF

Article Metrics

Abstract View : 118 times
PDF Download : 45 times

DOI: 10.24871/251202427-33


  • There are currently no refbacks.