Neutrophil to lymphocyte ratio: a new marker for predicting steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease

Liver Int. 2012 Feb;32(2):297-302. doi: 10.1111/j.1478-3231.2011.02639.x. Epub 2011 Sep 8.


Background: Nonalcoholic steatohepatitis (NASH), the most severe form of nonalcoholic fatty liver disease (NAFLD), is associated with inflammation and increased oxidative stress. The neutrophil/lymphocyte ratio (N/L) integrates information on the inflammatory milieu and physiological stress.

Aims: The aim of this study was to determine the utility of N/L ratio to predict the presence of NASH in patients with NAFLD.

Methods: Our cohort consisted of 101 consecutive patients undergoing liver biopsy for clinical suspicion of NAFLD. Patients were divided into two groups: NASH group (n = 50) and not NASH group (n = 51). The stage of fibrosis was measured using a 4-point scale. The total white cell count, neutrophil and lymphocyte counts were recorded, and the N/L ratio was calculated.

Results: The mean age was 49.5 (± 10.8) years and the mean BMI was 31.4 (± 4.9) kg/m(2) . Patients with NASH had a higher N/L ratio compared with patients with not NASH [2.5 (1.9-3.3) and 1.6 (1.2-2.0), respectively, P < 0.001]. The N/L ratio correlated with the NAFLD activity score and its individual components (steatosis, inflammation and ballooning P < 0.001). Patients with advanced fibrosis (F3-4) had an elevated N/L ratio [2.9 (2.0-3.9)] compared with patients with fibrosis stage 1-2 [1.8 (1.2-2.2)], P < 0.001. For each one-unit increase in N/L ratio, the likelihood of having NASH increased by 70% and the likelihood of having fibrosis increased by 50%.

Conclusion: The N/L ratio is higher in patients with NASH and advanced fibrosis. This ratio can be used as a novel noninvasive marker to predict advanced disease.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Biopsy
  • Cohort Studies
  • Fatty Liver / complications
  • Fatty Liver / diagnosis*
  • Fatty Liver / etiology
  • Female
  • Humans
  • Leukocyte Count
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / etiology
  • Lymphocytes / pathology*
  • Male
  • Middle Aged
  • Neutrophils / pathology*
  • Non-alcoholic Fatty Liver Disease
  • Predictive Value of Tests
  • Prognosis
  • ROC Curve