The Relation of Neutrophil Lymphocyte Ratio to the Steatosis and Fibrosis Stage in Patient with Non-Alcoholic Fatty Liver Disease Using Fibroscan with Controlled Attenuation Parameter and FIB-4 and FIB-5 Scores

Abstract

Abstract Background Non-alcoholic fatty liver disease (NAFLD) is a chronic inflammatory disease with excessive fat accumulation in the liver. Fibroscan with controlled attenuation parameter (CAP), a noninvasive imaging procedure in diagnosis of NAFLD patients. Also Neutrophil / lymphocyte ratio (NLR) is a simple marker for inflammation, may be used to predict disease outcome. Objectives Is to determine whether there is a correlation between NLR and the degree of steatosis and fibrosis measured by fibroscan with CAP, FIB-4 and FIB-5 score. Patients and Methods This was a cross sectional study involving 2 groups, group (1): included 115 patients of NAFLD and group (2): included 30 healthy controls. All participants were supjected to complete personal and medical history (history of other comorbidities as DM, Hypertension syndrome and drug/herb intake). Complete physical examination including anthropometric measurements, vital signs, local examination and general examination of any signs of liver dysfunction as hepatomegaly, Jaundice, ascites, splenomegaly and varices. Laboratory tests including (alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), Bilirubin, hemoglobin A1c, fasting glucose level, Lipid profile, Antinuclear antibody (ANA) test (to exclude autoimmune hepatitis), serum Uric acid and viral markers (HBsAg & Hcv Ab), Abdominal ultrasound, Fibroscan with CAP and FIB-4 and FIB -5 scoring, complete blood count with calculation of neutrophils /lymphocytes ratio(NLR). Results Both studied groups were comparable in age and sex distribution. Out of NAFLD cases (group 1), more than half (53.9%) had comorbidities (manifested as DM in 37.4%, hypertension in 36.5%, CVD in 8.7% and hypothyroidism in 1.7% of patients), there was no statistically significant difference between the studied groups regarding anthropometric measurements, NAFLD cases (group 1) had significantly lower Hb, HDL level and PLT p value <0.001 and higher NLR, ALT, AST, GGT, cholesterol, triglycerides and LDL levels p < 0.001,there was a significant positive correlation between NLR and each of steatosis and fibrosis p < 0.001,NLR was significantly positively correlated with FIB-4 (r = 0.667, P < 0.001) and FIB-5 (r = 0.361, P < 0.001), NLR was a significant predictor of hepatic steatosis (AUC= 0.816, P = 0.011) and fibrosis (AUC=0.739, P < 0.001) in NAFLD cases. Conclusion The study conducted on NAFLD patients at Ain Shams University Hospital found significant associations between NLR and liver steatosis/fibrosis. NLR proved to be a valuable predictor, with optimal cutoff values for steatosis and fibrosis, aiding in noninvasive assessment and management of NAFLD patients.