Background and aim The progression of nonalcoholic fatty liver disease (NAFLD) to nonalcoholic steatohepatitis (NASH) is believed to be the driver for future development of fibrosis and cirrhosis. Nevertheless, there remains a lack of noninvasive methods for the diagnosis of NASH. The aim of the present study was to determine the role of neutrophil-to-lymphocyte ratio (NLR) in predicting histological severity in NAFLD. Patients and methods We performed a single-center retrospective study in EMMS Nazareth Hospital from July 2014 to May 2017. Liver biopsies were evaluated using the steatosis, activity, and fibrosis scoring system, which includes three components: (i) steatosis (0–3), (ii) activity grade (0–4), and (iii) fibrosis (0–4). Patients were divided into two groups. The first group was considered to have NAFLD when fibrosis grade was 0–1 and inflammatory activity was 0–1, whereas the second group included patients with fibrosis grade of 2–4 and inflammatory activity grade of 2–3, considered to have NASH. Results Ninety-one (91) patients with biopsy-proven fatty liver were included. The average age was 42.13±11.5 (18–74) years. Fifty-seven (62.6%) patients were male. Univariate analysis revealed several factors to be associated with advanced fibrosis and inflammatory activity, including NLR, C-reactive protein, and HOMA-IR, which correlated with fibrosis [odds ratio (OR): 1.405, 95% confidence interval (CI): 1.21–1.63, P<0.0001; OR: 1.329, 95% CI: 1.05–1.68, P=0.016; and OR: 1.922, 95% CI: 1.18–3.11, P=0.007, respectively], and NLR, triglycerides, and HOMA-IR, which correlated with hepatocyte inflammation (OR: 1.210, 95% CI: 1.08–1.35, P=0.0009; OR: 0.984, 95% CI: 0.97–0.99, P=0.01; and OR: 2.069, 95% CI: 1.28–3.34, P=0.003, respectively). On multivariate logistic regression analysis, NLR remains independently associated with advanced fibrosis grade and inflammatory activity (OR: 0.734, 95% CI: 0.631–0.854, P<0.0001, area under the curve: 0.8622 and OR: 0.836, 95% CI: 0.74–0.95, P=0.006, area under the curve: 0.7845, respectively). Our second major finding was defining an NLR cut-off point that was associated with inflammatory activity and fibrosis grade using receiver operating characteristic analysis based on the Youden index (J), which is defined by the maximal sensitivity and specificity. Conclusion NLR showed significant independent correlation with advanced inflammation and fibrosis in patients with NAFLD.
|Number of pages||1006|
|Journal||European Journal of Gastroenterology and Hepatology|
|State||Published - 1 Sep 2019|
Bibliographical noteFunding Information:
Authors’ contributions: Tawfik Khoury, Amir Mari, Wisam Sbeit, and Mahmud Mahamid contributed to study concept and design. All authors contributed to data acquisition, interpretation, and analysis. Tawfik Khoury, Amir Mari, Wisam Sbeit, and Mahmud Mahamid contributed to writing the manuscript draft, and all authors approved the final manuscript version to be published.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
- Fatty liver