# Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio as Biomarkers for the Prediction of Activity and Recurrence of Hepatic Echinococcosis: A Retrospective Observational Cohort Study

## TL;DR

This study shows that blood cell ratios can predict the activity and recurrence of liver echinococcosis, a parasitic disease.

## Contribution

The study identifies platelet-to-lymphocyte ratio (PLR) as an independent predictor of disease recurrence in hepatic echinococcosis.

## Key findings

- PLR and NLR were significantly higher in patients with hepatic cysts compared to healthy individuals.
- PLR was the only independent predictor of recurrence after treatment for hepatic echinococcosis.
- Both PLR and NLR showed strong ability to distinguish between active and inactive disease stages.

## Abstract

Background: Hydatid disease remains a significant health burden in endemic regions, and recurrence after treatment is a major challenge. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are emerging inflammatory biomarkers, but their role in predicting disease activity and recurrence in hepatic echinococcosis has not been clearly defined.

Objective: This study aimed to evaluate the diagnostic value of PLR and NLR in determining disease activity and predicting recurrence of hepatic hydatid cysts.

Methods: This retrospective observational cohort study was conducted at Al-Kindi Teaching Hospital, Baghdad, and included 187 patients diagnosed with hepatic hydatid cyst (2016-2020) and 190 age-, sex-, and BMI-matched healthy subjects. Only isolated hepatic cases were included, while patients with concomitant organ involvement, ruptured cysts, comorbid diseases, or incomplete records were excluded. Cysts were classified according to the WHO 2001 classification into active (CE1-CE2), transitional (CE3), and inactive (CE4-CE5) stages. All patients were followed for two years post-treatment with serology and ultrasound every six months to detect recurrence, confirmed by CT when indicated. Complete blood counts were obtained at presentation to calculate platelet-to-lymphocyte (PLR) and neutrophil-to-lymphocyte (NLR) ratios.

Results: PLR and NLR were significantly higher among HC patients compared to healthy individuals (p < 0.001). Both markers increased with disease activity, reaching their highest levels in active cysts (PLR median 246.1 vs. 92.8 in inactive, p < 0.0001). During follow-up, recurrence occurred in 27.2% of patients. Recurrent cases showed lower lymphocyte counts and higher neutrophil, platelet, PLR, and NLR values. On multivariate analysis, PLR emerged as the only independent predictor of recurrence (p = 0.033). ROC analysis demonstrated strong discriminative ability for disease activity (PLR AUC = 0.915; NLR AUC = 0.860) and recurrence (PLR AUC = 0.869; NLR AUC = 0.812).

Conclusion: PLR and NLR are significantly elevated in hepatic hydatid cysts, especially in active stages. PLR independently predicts recurrence, highlighting the role of systemic inflammation in cyst persistence. Further studies should validate its prognostic value and optimal cutoffs.