Zhang Ying, Zhang Ai-Hua, Li Rong-Li, Li Wen-Jun, Liu Yun, Li Teng
Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Department of Hematology, Weifang People's Hospital, Shandong Second Medical University, Weifang, Shandong, China.
Front Med (Lausanne). 2024 Dec 10;11:1499524. doi: 10.3389/fmed.2024.1499524. eCollection 2024.
Inflammation is key to metabolic dysfunction-associated steatotic liver disease (MASLD) development. Nevertheless, the correlation between the inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), and the MASLD prognosis remains unclear. We aim to determine the link between NLR and mortality risk in MASLD.
The MASLD adult participants from the 1999-2018 National Health and Nutrition Examination Survey (NHANES) database were evaluated. Utilizing restricted cubic spline (RCS) analyses, as well as Cox proportional hazards (PH) models, the associations between NLR and all-cause mortality (ACM) and cardiovascular mortality (CVM) were analyzed in MASLD. Subgroup analyses and interaction tests were conducted to validate these associations. Moreover, we used sensitivity analyses to ascertain the robustness of the results.
Through 115 months of median follow-up, 2,307 of the 16,859 participants with MASLD died, including 650 deaths from cardiovascular causes. RCS analyses showed positive linear associations between NLR and both ACM and CVM. In the multivariable-adjusted Cox PH model, a one-unit elevation in NLR was related to a hazard ratio (HR) of 1.16 (95% confidence interval [CI]: 1.12-1.21) for ACM and 1.21 (95% CI: 1.15-1.27) for CVM. Participants were classified into higher (≥ 2.88) and lower (< 2.88) NLR groups employing the maximally selected rank statistics. The higher NLR group had a significantly elevated ACM (HR 1.38, 95% CI: 1.23-1.55) and CVM (HR 1.64, 95% CI: 1.32-2.03) risk compared to the lower NLR group. The associations were consistent in subgroup analyses based on age, gender, BMI, hypertension, and diabetes, with no significant interaction between NLR and these characteristics. Sensitivity analyses affirmed the main outcome's robustness.
A raised NLR independently predicts escalated ACM and CVM in MASLD.
炎症是代谢功能障碍相关脂肪性肝病（MASLD）发展的关键因素。然而，炎症标志物中性粒细胞与淋巴细胞比值（NLR）与MASLD预后之间的相关性仍不明确。我们旨在确定NLR与MASLD死亡风险之间的联系。
对1999 - 2018年国家健康与营养检查调查（NHANES）数据库中的成年MASLD参与者进行评估。利用受限立方样条（RCS）分析以及Cox比例风险（PH）模型，分析MASLD中NLR与全因死亡率（ACM）和心血管死亡率（CVM）之间的关联。进行亚组分析和交互检验以验证这些关联。此外，我们使用敏感性分析来确定结果的稳健性。
经过115个月的中位随访，16859名MASLD参与者中有2307人死亡，其中650人死于心血管原因。RCS分析显示NLR与ACM和CVM均呈正线性关联。在多变量调整的Cox PH模型中，NLR升高一个单位与ACM的风险比（HR）为1.16（95%置信区间[CI]：1.12 - 1.21），与CVM的风险比为1.21（95% CI：1.15 - 1.27）。采用最大选择秩统计将参与者分为NLR较高（≥2.88）和较低（<2.88）两组。与较低NLR组相比，较高NLR组的ACM（HR 1.38，95% CI：1.23 - 1.55）和CVM（HR 1.64，95% CI：1.32 - 2.03）风险显著升高。在基于年龄、性别、体重指数（BMI）、高血压和糖尿病的亚组分析中，这些关联是一致的，NLR与这些特征之间无显著交互作用。敏感性分析证实了主要结果的稳健性。
升高的NLR独立预测MASLD中ACM和CVM的升高。
