Neutrophil to Lymphocyte Ratio as a new marker for predicting steatohepatitis in patients with Nonalcoholic Fatty Liver Disease

Background : Nonalcoholic fatty liver disease is associated with a state of chronic inflammation, which may play a role in disease progression to non alcoholic steatohepatitis (NASH) and fibrosis. A liver biopsy remains the only method to distinguish NASH from simple steatosis.However, this is an invasive and expensive modality with serious potential complications and sampling errors .Therefore, the development of noninvasive markers that can identify patients with NASH greatly needed. Objective: The aim of this study was to investigate the utility of neutrophil to lymphocyte (N/L) ratio as a simple, noninvasive and inexpensive new marker to predict the presence of NASH in patients with non alcoholic fatty liver disease (NAFLD) . Study Design: This is an observational case-controlled study conducted in AL-Azhar University hospital . In our study, 90 individuals were selected and divided into three groups ; Group A (n=30) (NASH group) , Group B (n=30) (Simple steatosis ) and Group C ( n= 30) ( healthy control group). All groups was subjected to the following , CBC with differential count and N/L ratio was calculated , Liver function tests , renal function tests , lipid profiles, C-reactive protein and abdominal ultrasound . Viral markers for HCV and HBV was measured in group A and group B only. Liver biopsy , Iron profiles ( serum iron , transferrin saturation and serum Ferritin) and Autoimmune markers ( ANA , ASMA , AMA) was performed in Group A only . Results : Our results showed that there was highly statistically significant difference between patients groups (A?,B) and control group(C) in relation to (N/L) ratio (P<0.001) and there was statistically significant difference between group A(NASH group) and group B(Simple steatosis) in relation to (N/L) ratio (P<0.001) indicating that (N/L) ratio was significantly higher in NASH group in comparison to both simple steatosis and normal control groups and also(N/L) ratio was higher in the patients with simple steatosis group than the normal control group with the mean of (N/L) ratio in group A (2.19±0.609) , group B (1.55±0.36) and in group C (1.19±0.23). In our study the median of N/L ratio in patients with NASH was (2.19), which was significantly higher than in patients without NASH (1.55) and the Cut-off value of (1.63) has the highest sensitivity (76.7 %) and specificity (86.7 %) for detecting patients with NASH . Conclusion : Neutrophil to Lymphocyte ratio can be used as a diagnostic noninvasive, a simple and inexpensive marker for detecting steatohepatitis in patients with NAFLD without the need for invasive liver biopsy and acut-off value of 1.63 can be used to identify patients with NASH. Abbreviations: non alcoholic fatty liver disease (NAFLD), Neutrophil to Lymphocyte ratio (N/L),non alcoholic steatohepatitis (NASH) ,anti nuclear antibody (ANA), anti smooth muscle antibody (ASMA), anti mitochondrial antibody (AMA).