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The association between neutrophil to lymphocyte ratio (NLR) with mortality in patients with perforated peptic ulcer at Dr. Soetomo Hospital in Surabaya, Indonesia

  • Arifin Perdana Istimansyah ,
  • Denny Septarendra ,
  • Marjono Dwi Wibowo ,


Background: Perforated peptic ulcer is the most dangerous complication of peptic ulcer.  Neutrophils and lymphocytes are crucial in the inflammatory process. A simple and effective biomarker to assess systemic inflammation is the neutrophil-lymphocyte ratio (NLR). This study aims to ascertain the connection between NLR and mortality in peptic ulcer patients.

Methods: This study was a cross-sectional observational analytic study. Data were obtained from medical records in Dr. Soetomo General Hospital from January 2018 to December 2022. The dependent variable was patient mortality, while NLR value served as the independent variable. NLR cutoff value calculated using the Receiver Operating Characteristic (ROC) curve. The collected data was tested using the Chi-square test and the Spearman rank correlation test integrated in the SPSS software.

Results: There were 109 patients, consisting of 74 male and 35 female patients. There were 29 patients with the Boey Score category 1, 54 patients with the Boey score category 2, and 25 patients with the Boey score 3. Using a cutoff of 15.60, the NLR values were separated into low and high NLR groups. There were 56 patients with high scores and 53 patients with low scores. A significant relationship was found between NLR values and mortality (p <0.0001). The results of Spearman's analysis revealed a strong correlation between the incidence of mortality and an increase in the NLR value (p<0.0001; r = 0.500).

Conclusion: There is a significant relationship between NLR and mortality in patients with perforated peptic ulcers.


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How to Cite

Istimansyah, A. P., Septarendra, D. ., & Wibowo, M. D. . (2023). The association between neutrophil to lymphocyte ratio (NLR) with mortality in patients with perforated peptic ulcer at Dr. Soetomo Hospital in Surabaya, Indonesia . Bali Medical Journal, 12(1), 976–982.




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Arifin Perdana Istimansyah
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Denny Septarendra
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Marjono Dwi Wibowo
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