Predictive Role of Neutrophil-Percentage-to-Albumin Ratio (NPAR) in Nonalcoholic Fatty Liver Disease and Advanced Liver Fibrosis in Nondiabetic US Adults: Evidence from NHANES 2017–2018

Abstract

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent globally and includes chronic liver diseases ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). The neutrophil-to-albumin ratio (NPAR) is a cost-effective, readily available biomarker of inflammation used to assess cancer and cardiovascular disease prognosis, and it may be of predictive value in NAFLD. This study was to evaluate the associations between the NPAR, the neutrophil-to-lymphocyte ratio (NLR), and the presence of NAFLD or advanced liver fibrosis, and to assess the predictive value of the NPAR in NAFLD in a nationally representative database. This population-based, cross-sectional, retrospective study analyzed the secondary data of adults with NAFLD or advanced liver fibrosis extracted from the National Health and Nutrition Examination Survey (NHANES) database 2017–2018. NHANES participants with complete information of vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) were enrolled. A logistic regression analysis was used to determine the associations between the variables in the participants with and without NAFLD or advanced liver fibrosis. The mean values of the lymphocyte counts, neutrophil counts, NPAR, aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), total cholesterol, triglycerides, and HbA1c were significantly higher in the participants with NAFLD than in those without NAFLD or advanced liver fibrosis. The mean blood albumin levels of the subjects without NAFLD or advancing fibrosis were considerably greater than those of the individuals with these conditions. The mean values of the NLR, NPAR, AST, ALT, triglycerides, lymphocyte count, neutrophil count, and HbA1c were significantly higher in patients with advanced fibrosis than in those without advanced fibrosis. A multivariate analysis showed that per unit increases in both the NLR and NPAR were significantly associated with an increased risk of developing NAFLD, while neither the NLR nor NPAR was significantly associated with higher odds of advanced fibrosis. In conclusion, the novel biomarker NPAR demonstrates a good association with NAFLD, along with participants’ clinical characteristics, in a nationwide population. The NPAR may serve as a biomarker for NAFLD and help clinicians refine the diagnosis and treatment of chronic liver disease.

Neutrophil to albumin ratio: a biomarker in non-alcoholic fatty liver disease and with liver fibrosis

“…There was a study has also indicated that FIB-4 ≥ 1.3 results in false positives in 35% of patients ( 42 ). Another study reported an AUC of 0.810 (95% CI: 0.794–0.825) for NPAR in predicting NAFLD, and it was also associated with an increased risk of advanced fibrosis ( 43 ), which seems more superior predictive performance than NAR, as the AUC for NAR in our study was 0.701 (95% CI: 0.694–0.708). However, our study conducted a direct comparative analysis of the predictive capabilities of NAR and NPAR in forecasting NAFLD and NAFLD with liver fibrosis, highlighting the exceptional performance of NAR in these contexts.…”

Prognostic nutritional index (PNI) and risk of non-alcoholic fatty liver disease and advanced liver fibrosis in US adults: Evidence from NHANES 2017–2020

“…Evaluating the inflammatory and immune landscapes often mandates the quantification of peripheral white blood cells epitomised by lymphocytes in the PNI, a method used inexpensively and widely. A cohort study showed that individuals with NAFLD harbored a higher peripheral blood lymphocyte count than their healthy counterparts, with the obvious significance in statistic [ 43 ]. This observation is consistent with those of multiple clinical studies.…”

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

“…Still, there are also studies which failed to identify discrepancies in NLR values between subjects with hepatic steatosis and healthy counterparts, but which showed an inverse correlation between neutrophil-percentage-to-albumin ratio (NPAR) and liver attenuation values ( Cucoranu et al, 2023 ). As a matter of fact, NPAR might perform better than NLR in predicting advanced liver fibrosis, in light of the results of a nationwide US study enrolling non-diabetic adults ( Liu and Chien, 2023 ). Moreover, a Turkish study performed on adults proved that NLR does not correlate with severity of fibrosis and of hepatic inflammation, quantified through liver biopsy assessment ( Kara et al, 2015 ).…”