A Study on Association between Neutrophil to Lymphocyte Ratio and Steatohepatitis and Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease

Abstract

BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is seen worldwide and is the most common liver disorder in industrialized countries. Non-alcoholic steatohepatitis (NASH) is the severest form of NAFLD and is associated with inflammation and oxidative stress. Human neutrophil peptides have the ability to enhance hepatic fibrosis. We wanted to study the association between neutrophil to lymphocyte ratio and steatohepatitis and fibrosis in patients with non-alcoholic fatty liver disease. METHODS This is an analytical cross-sectional study conducted among 50 cases and 50 controls attending the hospital attached to BMCRI. The neutrophil lymphocyte ratio was calculated and compared between cases and controls. RESULTS Our study results showed that 7 patients had grade 1, 19 had grade 2, 24 had grade 3 hepatic steatosis and 13 patients had fibrosis. The mean neutrophil lymphocyte ratio (NLR) was significantly higher in cases than controls (3.6 +/- 1.83 and 1.72 +/- 0.57, P - 0.00). However, there was no statistical significance (F: 2.06, P value: 0.14) in the utility of NLR in detecting higher grades of steatosis (grade 1:2.41 +/- 0.76, grade 2:4.01 +/- 2.46, grade 3:3.62 +/- 1.3). The mean NLR was significantly higher (P - 0.001) in patients with fibrosis (3.72 +/- 2.1) compared with controls (1.46 +/- 051). CONCLUSIONS The neutrophil lymphocyte ratio can be used to detect the presence of steatohepatitis and fibrosis in patients with NAFLD but cannot be used to predict the presence of higher grades of hepatic steatosis. KEY WORDS Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steatohepatitis, Fibrosis, Neutrophil-Lymphocyte Ratio