Neutrophil-to-lymphocyte ratio is independently associated with inflammatory activity and fibrosis grade in nonalcoholic fatty liver disease

Abstract

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. This simple available laboratory tool may be incorporated into future diagnostic scores.

Dyslipidemic Diet Induces Mobilization of Peripheral Neutrophils and Monocytes That Exacerbate Hemorrhagic Brain Injury and Neuroinflammation

“…NAFLD patients were found to have a persistent increase of circulating neutrophils and monocytes (Zhang et al, 2018;Khoury et al, 2019). As an extension of these previous findings, we found that mobilization of neutrophils and monocytes in the periphery contributes to the aggravation of hemorrhagic injury in NAFLD mice.…”

“…Among factors that increase the risk of ICH, non-alcoholic fatty liver disease (NAFLD) is a common liver disease that affects up to 30% of the general population (Tsochatzis and Newsome, 2018). NAFLD is characterized by excessive deposition of lipids in liver parenchyma independent of heavy alcohol consumption (Kim et al, 2011;Younossi et al, 2018;Khoury et al, 2019). Accompanying the accumulation of hepatic fat, patients usually display insulin resistance, dyslipidemia, and escalated systemic inflammation (Gluchowski et al, 2017;Fiorucci et al, 2018).…”

Increased neutrophil-to-lymphocyte ratio predicts the development of post-stroke infections in patients with acute ischemic stroke

“…A large number of Fig. 1 Receiver operating characteristic curve analysis for NLR for prognostic value for PSI studies have shown that higher NLR might be an independent predictor of clinical outcome in a variety of diseases, including malignant tumors, acute respiratory distress syndrome, fibrotic liver disease and cardiovascular diseases [29][30][31][32]. At present, it has been paid more attention in the research of neurovascular diseases [33][34][35].…”

Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review

“…NLR was described to be a prognostic factor in many liver diseases. In non-alcoholic fatty liver disease, NLR was associated with inflammatory activity and different histological fibrotic grades[ 11 - 15 ]. In chronic viral hepatitis B and C, NLR predicted response to anti-viral therapy[ 16 - 21 ].…”