title: Neutrophil-Lymphocyte Ratio (NLR) Could Be Better Predictor than C-reactive Protein (CRP) for Liver Fibrosis in Non-alcoholic Steatohepatitis(NASH).
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  NLR was significantly higher in NASH patients compared to controls, HBV, and HCV patients (p<0.001, p<0.001, and p<0.001, respectively). NLR was positively associated with NAFLD activity scores (r=0.861, p<0.001). NLR was associated with hepatocyte ballooning degeneration (r=0.426, p=0.024), lobular inflammation(r=0.694, p<0.001), steatosis(r=0.498, p=0.007), and fibrosis stage(r=0.892, p<0.001) in NASH patients. Univariate and multivariate analyses showed that NLR was significantly associated with liver fibrosis and NAS (β=0.631, p<0.001 for liver fibrosis; β=0.753, p<0.001 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.
authors.affiliation: Dr. A. Y. Ankara Oncology Training and Research Hospital, Department of Internal Medicine, Section of Nephrology, Yenimahalle, Ankara, Turkey drhakkiyilmaz@yahoo.com.
authors.forename: Hakki
authors.initials: H
authors.lastname: Yilmaz
authors.affiliation: Turgut Ozal University, School of Medicine, Department of Internal Medicine, Ankara, Turkey.
authors.forename: Kadir Serkan
authors.initials: KS
authors.lastname: Yalcin
authors.affiliation: Turgut Ozal University, School of Medicine, Department of Biochemistry, Beştepe, Ankara, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Namuslu
authors.affiliation: Turgut Ozal University, School of Medicine, Department of Biochemistry, Beştepe, Ankara, Turkey.
authors.forename: Huseyin Tugrul
authors.initials: HT
authors.lastname: Celik
authors.affiliation: Turgut Ozal University, School of Medicine, Department of Gastroenterology, Beştepe, Ankara, Turkey.
authors.forename: Meral
authors.initials: M
authors.lastname: Sozen
authors.affiliation: Yenimahelle Training and Research Hospital, Department of Internal Medicine, Ankara, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Inan
authors.affiliation: Turgut Ozal University, School of Medicine, Department of Gastroenterology, Beştepe, Ankara, Turkey.
authors.forename: Isılay
authors.initials: I
authors.lastname: Nadir
authors.affiliation: Turgut Ozal University, School of Medicine, Department of Gastroenterology, Beştepe, Ankara, Turkey.
authors.forename: Cansel
authors.initials: C
authors.lastname: Turkay
authors.affiliation: Turgut Ozal University, School of Medicine, Department of Internal Medicine, Section of Nephrology, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Akcay
authors.affiliation: Turgut Ozal University, School of Medicine, Department of Internal Medicine, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Kosar
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D002452:Cell Count; D005260:Female; D006509:Hepatitis B / Q000097:blood; D006526:Hepatitis C / Q000097:blood; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood*; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000378:metabolism*; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood*; D012044:Regression Analysis
chemical_list: D002097:C-Reactive Protein
keywords: Fibrosis; Inflammation; Liver pathology; NASH; Neutrophil-Lymphocyte Ratio