Prognostic Role of Neutrophil to Lymphocyte Ratio in Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis

Abstract

Introduction. Nonalcoholic steatohepatitis (NASH) and liver fibrosis are the most common complications of nonalcoholic fatty liver disease (NAFLD). In this systematic review and meta-analysis, we aim to analyze the current literature to evaluate the association of neutrophil to lymphocyte ratio (NLR) with NASH and fibrosis in patients with NAFLD. Methods. PubMed, Web of Science, and Scopus were used to conduct a systematic search for relevant publications published before May 24, 2022. The Newcastle–Ottawa scale was used for quality assessment. Results. Thirteen studies were included in our study. The pooled results showed that NAFLD patients with significant NASH had elevated levels of NLR compared to those with nonsignificant or without NASH (SMD = 0.97, 95% CI = 0.59–1.39, p < 0.001 ). The pooled sensitivity and specificity of NLR were 78.16% (95% CI = 73.70%–82.04%), and 76.93% (95% CI = 70.22%–82.50%), respectively. In addition, NAFLD patients with significant liver fibrosis had elevated levels of NLR compared to those with nonsignificant or without fibrosis (SMD = 1.59, 95% CI = 0.76–2.43, p < 0.001 ). The pooled sensitivity and specificity of NLR were 82.62% (95% CI = 70.235%–90.55%) and 81.22% (95% CI = 75.62%–85.78%), respectively. Conclusion. Our findings support NLR to be a promising biomarker that can be readily integrated into clinical settings to aid in the prediction and prevention of NASH and fibrosis among patients with NAFLD.

Therapeutic targeting of PLK1 in TERT promoter‐mutant hepatocellular carcinoma

“…HCC commonly evolved from liver cirrhosis 29,30 . During the process, it involves genetic mutation, immune escapes and so on 7,31 .…”

“…HCC commonly evolved from liver cirrhosis. 29 , 30 During the process, it involves genetic mutation, immune escapes and so on. 7 , 31 The therapeutical strategies and drug development were decided by the drivers, suppressors and their regulator of HCC development.…”

Systemic immune-inflammatory biomarkers (SII, NLR, PLR and LMR) linked to non-alcoholic fatty liver disease risk

“…The “second hit” then involves the activation of systemic pro-inflammatory pathways, particularly the increase in inflammatory cytokines, chemokines, and signaling molecules. Among them, nuclear factor-kappa B (NF-κB) and c-Jun N-terminal kinase (JNK) as the key pro-inflammatory signal molecules increased in NASH, as these signaling pathways provide a link between hepatic inflammation and insulin resistance ( 48 ). There is evidence that fat accumulation causes inflammation in the liver, activating Kupffer cells and releasing inflammatory cytokines, which enter the bloodstream and trigger a systemic inflammatory response.…”

Low Lymphocyte-to-Monocyte Ratio as a Possible Predictor of an Unfavourable Clinical Outcome in Patients with Acute Ischemic Stroke after Mechanical Thrombectomy

“…The most well-established ratios, which serve as markers of inflammation, include the lymphocyte-to-monocyte ratio (LMR) (or reversely monocyte-to-lymphocyte ratio) and the neutrophil-to-lymphocyte ratio (NLR). The diagnostic and prognostic utilities of these ratios have been observed in several inflammation-related diseases, including cancer, type 2 diabetes mellitus (T2DM), diabetic kidney injury, nonalcoholic fatty liver disease, inflammatory bowel disease, epilepsy, Guillain-Barré syndrome, and COVID-2019 [9,[11][12][13][14][15][16][17]. Furthermore, according to recent studies, these parameters are predictive markers for the development of poststroke complications, including early neurological deterioration and poststroke depression [5,18].…”