Premium
Neutrophil to lymphocyte ratio: a new marker for predicting steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease
Author(s) -
Alkhouri Naim,
MorrisStiff Gareth,
Campbell Carla,
Lopez Rocio,
Tamimi Tarek AbuRajab,
Yerian Lisa,
Zein Nizar N.,
Feldstein Ariel E.
Publication year - 2012
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2011.02639.x
Subject(s) - nonalcoholic fatty liver disease , gastroenterology , medicine , neutrophil to lymphocyte ratio , steatosis , fibrosis , liver biopsy , fatty liver , lymphocyte , biopsy , disease
Background Nonalcoholic steatohepatitis ( NASH ), the most severe form of nonalcoholic fatty liver disease ( NAFLD ), is associated with inflammation and increased oxidative stress. The neutrophil/lymphocyte ratio ( N/L ) integrates information on the inflammatory milieu and physiological stress. Aims The aim of this study was to determine the utility of N/L ratio to predict the presence of NASH in patients with NAFLD . Methods Our cohort consisted of 101 consecutive patients undergoing liver biopsy for clinical suspicion of NAFLD . Patients were divided into two groups: NASH group ( n = 50) and not NASH group ( n = 51). The stage of fibrosis was measured using a 4‐point scale. The total white cell count, neutrophil and lymphocyte counts were recorded, and the N/L ratio was calculated. Results The mean age was 49.5 (±10.8) years and the mean BMI was 31.4 (±4.9) kg/m 2 . Patients with NASH had a higher N/L ratio compared with patients with not NASH [2.5 (1.9–3.3) and 1.6 (1.2–2.0), respectively, P < 0.001]. The N/L ratio correlated with the NAFLD activity score and its individual components (steatosis, inflammation and ballooning P < 0.001). Patients with advanced fibrosis (F3‐4) had an elevated N/L ratio [2.9 (2.0–3.9)] compared with patients with fibrosis stage 1–2 [1.8 (1.2–2.2)], P < 0.001. For each one‐unit increase in N/L ratio, the likelihood of having NASH increased by 70% and the likelihood of having fibrosis increased by 50%. Conclusion The N/L ratio is higher in patients with NASH and advanced fibrosis. This ratio can be used as a novel noninvasive marker to predict advanced disease.