The Predictive Role of the Platelet-to-lymphocyte Ratio for the Risk of Non-alcoholic Fatty Liver Disease and Cirrhosis: a Nationwide Cross-sectional Study

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2024 Jul 23

PMID 39040676

Authors

Cheng Yan

Weichang Zhang

Yangyan Xiao

Yuxin Sun

Xinke Peng

Wenwu Cai

Affiliations

Soon will be listed here.

Abstract

Background: The associations between platelet-to-lymphocyte ratio (PLR) and non-alcoholic fatty liver disease (NAFLD) and cirrhosis are unclear, and there are still no effective means for diagnosing or monitoring disease progression.

Methods: Data from the National Health and Nutrition Examination Surveys were collected for analysis. Logistic regression and restricted cubic splines were used to evaluate the associations between PLR and NAFLD and cirrhosis in different populations. The Area Under Curve Receiver Operating Characteristic (AUCROC) was used to distinguish the models. Threshold analysis was performed by constructing a two-piecewise linear regression. Correlation analysis was performed separately on either side of the inflection point.

Results: A total of 5724 adults were included. Logistic regression analysis revealed that the PLR was associated with NAFLD and cirrhosis (AUCROC of NAFLD: 0.803; AUCROC of cirrhosis: 0.851). The AUCROC of the PLR for predicting NAFLD incidence was 0.762 in the diabetic population and 0.804 in the nondiabetic population. High PLR predicted cirrhosis in the diabetic population, with an AUCROC of 0.824, whereas a high PLR was not associated with cirrhosis in the nondiabetic population. The restricted cubic spline revealed a negative linear correlation between the PLR and NAFLD incidence. The inflection point of the PLR for NAFLD was 180.74. A PLR ≤180.74 was statistically significant (odds ratio=0.997, 95% confidence interval=0.995-0.999). In the NAFLD population, the PLR was negatively correlated with cirrhosis at a PLR ≤130.5 (odds ratio=0.987, 95% confidence interval=0.977-0.996) and positively correlated with cirrhosis at a PLR > 130.5 (odds ratio=1.006, 95% confidence interval=1.001-1.012).

Conclusions: The PLR and NAFLD were negatively correlated in the U.S. population. The PLR had a U-shaped relationship with cirrhosis in the NAFLD population. The PLR has potential value in monitoring NAFLD patient progression to cirrhosis.

Citing Articles

Residual HCV-RNA and Elevated Platelet-to-Lymphocyte Ratio Predict Poor Long-Term Outcomes in Patients with Chronic Hepatitis C After Treatment.

Wroblewska A, Gliwinski M, Rybicka M, Cheba M, Lorenc B, Trzonkowski P Infect Dis Ther. 2024; 14(1):305-315.

PMID: 39725828 PMC: 11782785. DOI: 10.1007/s40121-024-01101-2.

References

Tiniakos D, Vos M, Brunt E . Nonalcoholic fatty liver disease: pathology and pathogenesis. Annu Rev Pathol. 2010; 5:145-71. DOI: 10.1146/annurev-pathol-121808-102132. View

Simental-Mendia L, Rodriguez-Moran M, Guerrero-Romero F . The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects. Metab Syndr Relat Disord. 2008; 6(4):299-304. DOI: 10.1089/met.2008.0034. View

Chen M, Wang B, Huang J, Zhao J, Chen J, Chen G . The role of platelet-related parameters for the prediction of NAFLD in OSAHS patients. BMC Pulm Med. 2022; 22(1):487. PMC: 9790114. DOI: 10.1186/s12890-022-02291-6. View

Jou J, Choi S, Diehl A . Mechanisms of disease progression in nonalcoholic fatty liver disease. Semin Liver Dis. 2008; 28(4):370-9. DOI: 10.1055/s-0028-1091981. View

Meng X, Wei G, Chang Q, Peng R, Shi G, Zheng P . The platelet-to-lymphocyte ratio, superior to the neutrophil-to-lymphocyte ratio, correlates with hepatitis C virus infection. Int J Infect Dis. 2016; 45:72-7. DOI: 10.1016/j.ijid.2016.02.025. View

Angulo P, Bugianesi E, Bjornsson E, Charatcharoenwitthaya P, Mills P, Barrera F . Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2013; 145(4):782-9.e4. PMC: 3931256. DOI: 10.1053/j.gastro.2013.06.057. View

Cucoranu D, Pop M, Niculescu R, Kosovski I, Toganel R, Licu R . The Association of Nonalcoholic Fatty Liver Disease With Neutrophil-to-Lymphocyte Ratio and Neutrophil-Percentage-to-Albumin Ratio. Cureus. 2023; 15(6):e41197. PMC: 10387286. DOI: 10.7759/cureus.41197. View

Bosch J, Gomis R, Kravetz D, Casamitjana R, Teres J, Rivera F . Role of spontaneous portal-systemic shunting in hyperinsulinism of cirrhosis. Am J Physiol. 1984; 247(3 Pt 1):G206-12. DOI: 10.1152/ajpgi.1984.247.3.G206. View

Zou X, Zhou X, Zhu Z, Ji L . Novel subgroups of patients with adult-onset diabetes in Chinese and US populations. Lancet Diabetes Endocrinol. 2018; 7(1):9-11. DOI: 10.1016/S2213-8587(18)30316-4. View

10.

Kjaergaard M, Lindvig K, Thorhauge K, Andersen P, Hansen J, Kastrup N . Using the ELF test, FIB-4 and NAFLD fibrosis score to screen the population for liver disease. J Hepatol. 2023; 79(2):277-286. DOI: 10.1016/j.jhep.2023.04.002. View

11.

Hagstrom H, Nasr P, Ekstedt M, Hammar U, Stal P, Hultcrantz R . Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017; 67(6):1265-1273. DOI: 10.1016/j.jhep.2017.07.027. View

12.

Sterling R, King W, Wahed A, Kleiner D, Khalili M, Sulkowski M . Evaluating Noninvasive Markers to Identify Advanced Fibrosis by Liver Biopsy in HBV/HIV Co-infected Adults. Hepatology. 2019; 71(2):411-421. PMC: 6923615. DOI: 10.1002/hep.30825. View

13.

Arguello G, Balboa E, Arrese M, Zanlungo S . Recent insights on the role of cholesterol in non-alcoholic fatty liver disease. Biochim Biophys Acta. 2015; 1852(9):1765-78. DOI: 10.1016/j.bbadis.2015.05.015. View

14.

Caligiuri A, Gentilini A, Marra F . Molecular Pathogenesis of NASH. Int J Mol Sci. 2016; 17(9). PMC: 5037841. DOI: 10.3390/ijms17091575. View

15.

Schobert I, Savic L, Chapiro J, Bousabarah K, Chen E, Laage-Gaupp F . Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE. Eur Radiol. 2020; 30(10):5663-5673. PMC: 7483919. DOI: 10.1007/s00330-020-06931-5. View

16.

Younossi Z, Koenig A, Abdelatif D, Fazel Y, Henry L, Wymer M . Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2015; 64(1):73-84. DOI: 10.1002/hep.28431. View

17.

Kim D, Kim W, Kim H, Therneau T . Association between noninvasive fibrosis markers and mortality among adults with nonalcoholic fatty liver disease in the United States. Hepatology. 2012; 57(4):1357-65. PMC: 3622816. DOI: 10.1002/hep.26156. View

18.

Michalak A, Cichoz-Lach H, Guz M, Kozicka J, Cybulski M, Jeleniewicz W . Towards an evaluation of alcoholic liver cirrhosis and nonalcoholic fatty liver disease patients with hematological scales. World J Gastroenterol. 2021; 26(47):7538-7549. PMC: 7754555. DOI: 10.3748/wjg.v26.i47.7538. View

19.

. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016; 64(6):1388-402. DOI: 10.1016/j.jhep.2015.11.004. View

20.

Shah A, Lydecker A, Murray K, Tetri B, Contos M, Sanyal A . Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009; 7(10):1104-12. PMC: 3079239. DOI: 10.1016/j.cgh.2009.05.033. View