Assessment of Neutrophil to Lymphocyte Ratio as Predictor of NASH in Obese Patients

Background: Nonalcoholic fatty liver disease has a histological spectrum ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. This study aimed to study relationship of neutrophil lymphocyte ratio (NLR) with NASH in obese patients. Methods: This cross-sectional observational study included100 obese cases with diffuse fatty infiltration on ultrasound. Patients were categorized by fibroscan into two groups: Group 1 (NASH) (n=46): cases with both significant steatosis and fibrosis (CAP ≥ 248 dB/m and LSM ≥ 7.9 kPa). Group 2 (Non-NASH) (n=54): Patients with CAP < 248 dB/m and LSM < 7.9 kPa. Results: NLR presented a significantly positive correlation with body mass index (BMI) (r 0.205, P value 0.040), alanine transaminase (ALT) (r 0.532, P value <0.001), and aspartate transaminase (AST) (r 0.493, P value <0.001) while insignificant correlations between NLR and age, Hb, platelets, white blood cells, bilirubin, INR, albumin, total cholesterol, triglycerides, and HbA1c. NLR is significantly higher in moderate and severe steatosis/fibrosis (P <0.001), with no significant interstage difference. NLR can significantly identify NASH (area under the curve = 0.886, P value <0.001) at cut off >2.94, 89.13% sensitivity, 90.74% specificity, 89.1% positive predictive value and 90.7% negative predictive value. Conclusion: The study highlights NLR as a simple, non-invasive biomarker for identifying NASH and assessing steatosis/fibrosis severity in obese patients. Elevated NLR and BMI were significantly linked to NASH, supporting systemic inflammation role in its pathogenesis. Higher NLR in moderate and severe steatosis/fibrosis suggests it may also reflect disease severity.