A novel model using mean platelet volume and neutrophil to lymphocyte ratio as a marker of nonalcoholic steatohepatitis in NAFLD patients: Multicentric study

Background and aim Nonalcoholic fatty liver disease (NAFLD) is a leading cause of progressive and chronic liver injury. Mean platelet volume (MPV) and the neutrophil-lymphocyte ratio (N/L ratio) may be considered cheap and simple markers of inflammation in many disorders. We aimed to investigate the clinical utility of MPV and the N/L ratio to predict fibrosis in NAFLD patients and the presence of nonalcoholic steatohepatitis (NASH). Materials and methods A total of 873 patients with biopsy-proven NAFLD and 150 healthy controls were included. Patients were divided into two groups: non-NASH group (n= 753) and NASH group (n=120). Liver biopsy, MPV, lymphocyte, and neutrophil counts were registered; the N/L ratio was calculated. Proinflammatory cytokines (tumor necrosis factor-α and interleukin-6) were measured by an ELISA. Results NASH patients had higher MPV compared with non-NASH patients (10.9 ± 1.8 and 9.5 ± 1.6 fl, respectively, P<0.001). MPV correlated positively with the NAFLD activity score, proinflammatory cytokines, and C-reactive protein (CRP) (P< 0.001). Patients with advanced fibrosis (F3-4) had increased MPV (11.3 ± 0.9 fl) compared with patients with early fibrosis (F1-2) (10.2 ± 0.8 fl, P< 0.001). NASH patients had an increased N/L ratio compared with non-NASH cases (2.6 ± 1.1 and 1.9 ± 0.7 fl, respectively, P<0.001). The N/L ratio correlated positively with NAFLD activity score, proinflammatory cytokines, and CRP (P <0.001). In addition, patients with advanced fibrosis (F3-4) had an N/L ratio (2.5 ± 1.1) comparable with that of patients with early fibrosis (F1-2) (1.8 ± 0.9) (P< 0.001). Conclusion MPV and the N/L ratio were elevated in NASH patients versus non-NASH cases, and in patients with advanced fibrosis (F3-4) versus early fibrosis (F1-2). They can be used as noninvasive novel markers to predict advanced disease. Eur J Gastroenterol Hepatol 28:e1-e9.