S2353 Evaluating CBC-Derived Indices as Predictors of Liver Fibrosis in Metabolic Dysfunction and Alcohol-Related Liver Disease (MetALD): Insights From the NHANES 2021-2023 Dataset

Introduction: CBC-derived indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-high-density lipoprotein ratio (MHR), and red cell distribution width (RDW) have been studied as potential non-invasive markers for liver fibrosis. However, their predictive value in patients with MetALD remains unclear. This study aimed to evaluate the diagnostic utility of these indices for liver fibrosis using data from the NHANES 2021–2023 dataset. Methods: A cross-sectional analysis was performed on adult patients with MetALD. Liver fibrosis was assessed using liver stiffness measurement (LSM), and patients were categorized into 2 groups: non-significant fibrosis (F0-F1) and significant fibrosis (F2-F4). Univariate and multivariate logistic regression analyses were used to determine the association between CBC-derived indices and fibrosis. Generative AI tools (ChatGPT models O1, O3) were used to assist with code development, data visualization, and proofreading. Results: Among the indices evaluated, RDW was the only marker that showed a significant association with liver fibrosis in the univariate analysis (P = 0.03). However, after adjusting for potential confounders (age, sex, race, BMI, and waist circumference), RDW lost statistical significance (P > 0.05). NLR, PLR, and MHR did not demonstrate significant associations with liver fibrosis in either univariate or multivariate analyses. Conclusion: The findings indicate that CBC-derived indices, including RDW, NLR, PLR, and MHR, are not reliable predictors of liver fibrosis in patients with MetALD. These results highlight the need for identifying novel blood-based, non-invasive biomarkers specifically tailored to the pathophysiology of MetALD.