El-Sehrawy Amr Ali Mohamed Abdelgawwad, Jafari Maryam, Zwamel Ahmed Hussein, Rashidian Pegah, Ballal Suhas, Kalia Rishiv, Nanda Anima, Maharana Laxmidhar, Javankiani Sepide, Hashemi Mohammad, Amini-Salehi Ehsan
Department of Internal Medicine, Diabetes, Endocrinology and Metabolism, Mansoura University, Mansoura, Egypt.
Student Research Committee, Anzali International Campus, Guilan University of Medical Sciences, Rasht, Iran.
J Health Popul Nutr. 2025 May 24;44(1):167. doi: 10.1186/s41043-025-00926-y.
Non-alcoholic fatty liver disease (NAFLD) is a major global health concern, with rising prevalence linked to obesity, insulin resistance, and metabolic syndrome. Timely and accurate identification of individuals at risk is crucial for improving outcomes. Recently, systemic inflammatory and nutritional markers such as the Neutrophil Percentage-to-Albumin Ratio (NPAR) and the Neutrophil-to-Albumin Ratio (NAR) have emerged as promising non-invasive biomarkers for NAFLD. Both ratios reflect inflammation and hepatic nutritional status, offering potential utility in predicting disease presence and progression. This systematic review and meta-analysis aimed to evaluate the diagnostic value of NPAR and NAR in patients with NAFLD.
A comprehensive search was performed across databases including PubMed, Embase, Scopus, and Web of Science from inception to December 28, 2024. Data extraction was carried out using a standardized form, and the methodological quality of included studies was assessed using the Newcastle-Ottawa Scale. Statistical analyses were performed using STATA version 18, employing a random-effects model.
The meta-analysis demonstrated that both the Neutrophil Percentage-to-Albumin Ratio (NPAR) and the Neutrophil-to-Albumin Ratio (NAR) were significantly higher in patients with NAFLD compared to healthy individuals. NPAR showed a standardized mean difference (SMD) of 0.28 (95% CI: 0.22-0.35, P < 0.01), while NAR had a higher effect size with an SMD of 0.69 (95% CI: 0.44-0.93, P < 0.01). The pooled diagnostic performance of NPAR yielded a sensitivity of 69.5% (95% CI: 56.3-82.6%), specificity of 63.1% (95% CI: 46.6-70.0%), and an area under the curve (AUC) of 76.05% (95% CI: 66.3-85.7%). For NAR, the pooled sensitivity was 65.0% (95% CI: 49.0-82.0%), specificity was 63.0% (95% CI: 47.0-79.0%), and AUC was 69.0% (95% CI: 48.0-89.0%).
In conclusion, both NPAR and NAR were found to be elevated in individuals with NAFLD, supporting their potential as non-invasive and accessible biomarkers. These ratios reflect key aspects of systemic inflammation and nutritional status, offering clinical value in early detection and risk stratification. However, given the limited number of studies available-particularly for NAR-further research is needed to confirm these findings, establish standardized thresholds, and assess their performance across diverse populations and clinical settings.
Not applicable.
非酒精性脂肪性肝病（NAFLD）是一个主要的全球健康问题，其患病率上升与肥胖、胰岛素抵抗和代谢综合征有关。及时准确地识别高危个体对于改善预后至关重要。最近，中性粒细胞百分比与白蛋白比值（NPAR）和中性粒细胞与白蛋白比值（NAR）等全身炎症和营养标志物已成为有前景的NAFLD非侵入性生物标志物。这两个比值都反映了炎症和肝脏营养状况，在预测疾病的存在和进展方面具有潜在效用。本系统评价和荟萃分析旨在评估NPAR和NAR在NAFLD患者中的诊断价值。
从数据库建立至2024年12月28日，在包括PubMed、Embase、Scopus和Web of Science在内的数据库中进行了全面检索。使用标准化表格进行数据提取，并使用纽卡斯尔-渥太华量表评估纳入研究的方法学质量。使用STATA 18版软件进行统计分析，采用随机效应模型。
荟萃分析表明，与健康个体相比，NAFLD患者的中性粒细胞百分比与白蛋白比值（NPAR）和中性粒细胞与白蛋白比值（NAR）均显著更高。NPAR的标准化均差（SMD）为0.28（95%CI：0.22 - 0.35，P < 0.01），而NAR的效应量更高，SMD为0.69（95%CI：0.44 - 0.93，P < 0.01）。NPAR的合并诊断性能显示敏感性为69.5%（95%CI：56.3 - 82.6%），特异性为63.1%（95%CI：46.6 - 70.0%），曲线下面积（AUC）为76.05%（95%CI：66.3 - 85.7%）。对于NAR，合并敏感性为65.0%（95%CI：49.0 - 82.0%），特异性为63.0%（95%CI：47.0 - 79.0%），AUC为69.0%（95%CI：48.0 - 89.0%）。
总之，发现NAFLD个体的NPAR和NAR均升高，支持它们作为非侵入性且易于获取的生物标志物的潜力。这些比值反映了全身炎症和营养状况的关键方面，在早期检测和风险分层中具有临床价值。然而，鉴于现有研究数量有限——特别是关于NAR的研究——需要进一步研究以证实这些发现，建立标准化阈值，并评估它们在不同人群和临床环境中的性能。
不适用。
