The Association of Nonalcoholic Fatty Liver Disease With Neutrophil-to-Lymphocyte Ratio and Neutrophil-Percentage-to-Albumin Ratio

The predictive role of the platelet-to-lymphocyte ratio for the risk of non-alcoholic fatty liver disease and cirrhosis: a nationwide cross-sectional study

Background

The associations between platelet-to-lymphocyte ratio (PLR) and non-alcoholic fatty liver disease (NAFLD) and cirrhosis are unclear, and there are still no effective means for diagnosing or monitoring disease progression.

Methods

Data from the National Health and Nutrition Examination Surveys were collected for analysis. Logistic regression and restricted cubic splines were used to evaluate the associations between PLR and NAFLD and cirrhosis in different populations. The Area Under Curve Receiver Operating Characteristic (AUCROC) was used to distinguish the models. Threshold analysis was performed by constructing a two-piecewise linear regression. Correlation analysis was performed separately on either side of the inflection point.

Results

A total of 5724 adults were included. Logistic regression analysis revealed that the PLR was associated with NAFLD and cirrhosis (AUCROC of NAFLD: 0.803; AUCROC of cirrhosis: 0.851). The AUCROC of the PLR for predicting NAFLD incidence was 0.762 in the diabetic population and 0.804 in the nondiabetic population. High PLR predicted cirrhosis in the diabetic population, with an AUCROC of 0.824, whereas a high PLR was not associated with cirrhosis in the nondiabetic population. The restricted cubic spline revealed a negative linear correlation between the PLR and NAFLD incidence. The inflection point of the PLR for NAFLD was 180.74. A PLR ≤180.74 was statistically significant (odds ratio=0.997, 95% confidence interval=0.995-0.999). In the NAFLD population, the PLR was negatively correlated with cirrhosis at a PLR ≤130.5 (odds ratio=0.987, 95% confidence interval=0.977-0.996) and positively correlated with cirrhosis at a PLR > 130.5 (odds ratio=1.006, 95% confidence interval=1.001-1.012).

Conclusions

The PLR and NAFLD were negatively correlated in the U.S. population. The PLR had a U-shaped relationship with cirrhosis in the NAFLD population. The PLR has potential value in monitoring NAFLD patient progression to cirrhosis.

Neutrophils: tissue and circulating signatures of pediatric non-alcoholic fatty liver disease

The recent rise in non-alcoholic fatty liver disease (NAFLD) among children and adolescents led to a thorough investigation of the peculiarities of the cellular infiltrate which characterize the disease at young ages. This review aims to highlight the key involvement of neutrophils in the pathogenesis of pediatric NAFLD and the potential biomarker role of neutrophil-to-lymphocyte ratio (NLR) in the same pediatric disorder. Neutrophils, which are first responders to inflammation, constitute an abundant component of an infiltrate which is particularly disposed within the portal area of children with NAFLD. The involvement of neutrophils in triggering liver fibrosis has been related amongst others to reactive oxygen species (ROS) production, to the stimulation of hepatic stellate cells, and to their synthesis of neutrophil elastase. As immune imbalance characterizes NAFLD, potentially emerging non-invasive biomarkers such as NLR have been proposed for the detection and prognosis of NAFLD. In adults, several studies asserted the role of NLR in the prediction of advancing liver fibrosis and mortality in subjects with NAFLD. In children, data is scarce with contradicting findings, as some studies failed to identify significant shifting in NLR values in children with NAFLD when compared with obese controls without liver impairment. However, NLR seems to significantly increase in children with obesity and different degrees of NAFLD when compared to healthy counterparts and their changes seem to be reversible with weight loss. Still, paucity of pediatric studies calls for future research addressing the role of NLR in predicting NAFLD development and progression in children with obesity.

Correlation between Coronary Artery Disease and Non-Alcoholic Fatty Liver Disease Using Computed Tomography Coronary Calcium Scans

INTRODUCTION

Concerns about how non-alcoholic fatty liver disease (NAFLD) might contribute to the development of cardiovascular disease (CVD) have grown as the importance of NAFLD and its relationship to the metabolic syndrome has grown. The purpose of this cross-sectional retrospective is to investigate potential correlations between hepatic steatosis in liver segments seen when measuring calcium score and the presence of atherosclerotic CAD (coronary artery disease).

METHODS

Two hundred patients (mean age, 57 years±10) who underwent coronary cardiac computed tomography (CT) scans were included. CT scans were analysed to assess the attenuation of liver parenchyma and the coronary artery calcification (CAC).

RESULTS

Age, gender, body mass index (BMI) and CAC score were significantly associated with hepatic steatosis. Among all patients, CAC score (r=-0.31, p<0.0001), and BMI (r=-0.40, p<0.0001) had a moderate negative correlation with the values of liver attenuation. BMI (OR: 1.109, p=0.001), CAC score (OR: 1.629, p<0.001), and age (OR: 1.050, p<0.001) were found to be independent predictors of hepatic steatosis through logistic regression.

CONCLUSIONS

A statistically significant correlation between CAC score and the presence of NAFLD as evaluated by non-contrast-enhanced CT was demonstrated. BMI, CAC score, and age were identified as independent predictors of hepatic steatosis.