Neutrophil-Lymphocyte Ratio (NLR) Could Be Better Predictor than C-reactive Protein (CRP) for Liver Fibrosis in Non-alcoholic Steatohepatitis(NASH)

Non-alcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease worldwide. The aims of this study were to assess Neutrophil-Lymphocyte Ratio (NLR) and C-reactive protein (CRP), and their association with liver histology in patients with non-alcoholic steatohepatitis (NASH), chronic hepatitis B (HBV), and hepatitis C (HCV).We studied 38 consecutive patients with biopsy-proven NASH, 19 patients with HCV, 45 patients with HBV, and 35 healthy controls who were similar for age and gender. The stage of fibrosis was measured using a 6-point scale.NLR was significantly higher in NASH patients compared to controls, HBV, and HCV patients (p0.001, p0.001, and p0.001, respectively). NLR was positively associated with NAFLD activity scores (r=0.861, p0.001). NLR was associated with hepatocyte ballooning degeneration (r=0.426, p=0.024), lobular inflammation(r=0.694, p0.001), steatosis(r=0.498, p=0.007), and fibrosis stage(r=0.892, p0.001) in NASH patients. Univariate and multivariate analyses showed that NLR was significantly associated with liver fibrosis and NAS (β=0.631, p0.001 for liver fibrosis; β=0.753, p0.001 for NAS in the multivariate model); however, CRP had no association with liver fibrosis and NAS CONCLUSION: NLR is a promising and inexpensive inflammation marker that correlates with histological grade and fibrosis stage in NASH patients.