title: A novel model using mean platelet volume and neutrophil to lymphocyte ratio as a marker of nonalcoholic steatohepatitis in NAFLD patients: multicentric study.
abstract: OBJECTIVE
  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).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of aTropical Medicine bGeneral Surgery cClinical Pathology dPathology eInternal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura fTropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig gEndemic Diseases and Gastroenterology Department hInternal Medicine Department, Aswan University, Aswan, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdel-Razik
authors.forename: Nasser
authors.initials: N
authors.lastname: Mousa
authors.forename: Walaa
authors.initials: W
authors.lastname: Shabana
authors.forename: Mohamed
authors.initials: M
authors.lastname: Refaey
authors.forename: Youssif
authors.initials: Y
authors.lastname: ElMahdy
authors.forename: Rania
authors.initials: R
authors.lastname: Elhelaly
authors.forename: Rasha
authors.initials: R
authors.lastname: Elzehery
authors.forename: Khaled
authors.initials: K
authors.lastname: Zalata
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arafa
authors.forename: Sherif
authors.initials: S
authors.lastname: Elbaz
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hafez
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Awad
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood* / Q000209:etiology / Q000473:pathology*; D016015:Logistic Models; D018655:Lymphocyte Count; D008297:Male; D063847:Mean Platelet Volume; D008875:Middle Aged; D009504:Neutrophils; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D000410:Alanine Transaminase