Published online Mar 27, 2026. doi: 10.4254/wjh.v18.i3.111569
Revised: August 20, 2025
Accepted: January 16, 2026
Published online: March 27, 2026
Processing time: 266 Days and 5.2 Hours
Inflammation is a central mechanism in the progression of metabolic dysfunction-associated steatotic liver disease. Because direct inflammatory biomarkers are not cost-effective for routine use in clinical health systems, indices derived from peripheral blood counts, such as the neutrophil-to-lymphocyte ratio (NLR), ag
To evaluate the predictive value of whole blood cell-based inflammatory indices for liver fibrosis in adults with hepatic steatosis.
This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 pre-pandemic cycle (n = 16427) and the 2021-2023 cycle (n = 11933). Participants were classified into a control group (n = 3281) or a liver fibrosis group (n = 950). The predictive performance of inflammatory indices was evaluated using the area under the receiver operating characteristic curve (AUROC) and multivariable binary logistic regression models.
C-reactive protein (CRP), NLR, and SIRI were independently associated with steatosis in multivariable logistic regression analyses [P = 0.001, Exp(B) = 1.01, 1.00, and 1.12, respectively]. However, none of the evaluated indices demonstrated clinically meaningful predictive performance. Receiver operating characteristic analyses showed statistically significant but modest discrimination, with AUCROC values ranging from 0.53 to 0.61.
Whole-blood cell-based inflammatory indices are not reliable predictors of liver fibrosis and were consistently outperformed by CRP. These findings suggest that alternative direct inflammatory biomarkers should be further evaluated as cost-effective tools for prognostic assessment in liver fibrosis.
Core Tip: This study evaluated low-cost inflammatory indices derived from whole blood cell counts - such as the neutrophil-to-lymphocyte ratio, aggregate index of systemic inflammation, and systemic inflammation response index - as potential noninvasive predictors of liver fibrosis in adults with metabolic dysfunction-associated steatotic liver disease using National Health and Nutrition Examination Survey data. Although these indices showed statistically significant associations with liver injury, their overall predictive performance was poor, with no meaningful positive predictive value and low area under the receiver operating characteristic curve. C-reactive protein consistently outperformed the cell-based indices. These findings suggest that, despite their ease of calculation, inflammatory ratios are insufficient as standalone markers for fibrosis prediction, underscoring the need for more accurate and cost-effective direct biomarkers.