Association between Neutrophil-to-Lymphocyte Ratio and High Hepatitis B Virus DNA Load in Patients with Hepatitis B

Objective: To investigate the association between peripheral blood neutrophil-to-lymphocyte ratio (NLR) and the levels of viral replication and hepatocyte injury in patients with hepatitis B, and to preliminarily explore the potential application of NLR as an auxiliary indicator for assessing hepatic inflammatory activity. Methods: A retrospective study was conducted on 383 patients with hepatitis B who attended Nanning Third People’s Hospital from January 2023 to December 2024 and completed simultaneous testing of hepatitis B virus (HBV) DNA quantification, liver function (ALT, AST), hepatitis B surface antigen, and complete blood count. NLR was calculated, and its correlation with HBV-DNA load and transaminase (ALT, AST) levels was analyzed. Patients were divided into low, medium, and high viral load groups according to HBV-DNA load. Differences in NLR, ALT, and AST levels among groups were compared. Spearman correlation analysis, ROC curve analysis, and multivariate logistic regression analysis were used to evaluate the predictive efficacy of NLR for high HBV-DNA load and the associations among various indicators. Results: NLR levels showed a gradual increasing trend with increasing HBV-DNA load (low → medium → high), and NLR in the high viral load group was significantly higher than that in the non-high viral load group (P < 0.0001). NLR was significantly positively correlated with ALT and AST levels (both P < 0.001). ROC curve analysis showed that the area under the curve (AUC) of NLR for predicting high HBV-DNA load was 0.737, with an optimal cut-off value of 4.088, a sensitivity of 70.19%, and a specificity of 70.97%. Multivariate logistic regression analysis showed that with high viral load as the outcome variable, after adjusting for confounding factors such as sex, age, ALT, and AST, NLR remained an independent predictor of high viral load in patients with hepatitis B (OR = 1.08, 95% CI: 1.01 - 1.15, P = 0.017). Conclusion: NLR is significantly correlated with HBV-DNA load and liver injury indicators in patients with hepatitis B, and it maintains independent predictive value after adjusting for relevant confounding factors. As a convenient and readily available inflammatory marker, NLR can be used in combination with traditional virological and biochemical indicators to facilitate a more comprehensive assessment of hepatic inflammatory status and viral replication activity in patients with hepatitis B. It has certain application potential in clinical settings with limited medical resources or