Systemic immune-inflammatory biomarkers (SII, NLR, PLR and LMR) linked to non-alcoholic fatty liver disease risk

The association between nutritional-inflammatory status and chronic kidney disease prognosis: a population-based study

BACKGROUND

Chronic kidney disease (CKD) prognosis is closely tied to the interplay between nutrition and inflammation. However, comprehensive nutritional-inflammatory indices for prognostic evaluation are rare in CKD. This study explored the association of the advanced lung cancer inflammation index (ALI) with estimated glomerular filtration rate (eGFR) and all-cause mortality in CKD patients.

METHODS

A total of 1,982 CKD patients from the National Health and Nutrition Examination Survey (NHANES) database (2011-2018) were included in the analysis. Analytical methods included linear regression, cox regression, and restricted cubic spline (RCS) analysis. Subgroup and sensitivity analyses were performed, and further evaluation was conducted using the receiver operating characteristic (ROC) curve and C-index for all-cause mortality across different CKD stages.

RESULTS

Among CKD patients, 1,103 patients (55.7%) were classified as stage I-II, and 879 patients (44.3%) as stage III-V. After adjusting covariates, ALI was found to be positively correlated with eGFR (Beta = 0.11; 95% CI: 0.07-0.15), and negatively related with all-cause mortality (HR = 0.72; 95% CI: 0.63-0.83). Subgroup analysis showed that the positive correlation between ALI and eGFR was stronger in CKD stage III-V compared to stage I-II. However, ALI's protective effect on mortality was weaker in stage III-V. The C-index for ALI was 0.648 in stage I-II and 0.660 in stage III-V.

CONCLUSION

ALI was significantly associated with eGFR and all-cause mortality in CKD patients. Nutritional and anti-inflammatory interventions in early-stage CKD may improve prognosis, and ALI may have great potential as a multifaceted biomarker to influence the prognosis of CKD, particularly in stages III-V.

The prognostic value of systemic immune-inflammation index and lymphocyte-to-monocyte ratio in cases with profound sudden sensorineural hearing loss

OBJECTIVES

To evaluate the prognostic value of SII and LMR in predicting hearing recovery outcomes in profound SSHL cases.

METHODS

The relationships between inflammatory markers and hearing outcomes were assessed using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive accuracy of SII and LMR for recovery outcomes.

RESULTS

The study revealed that SII and LMR were linked to hearing recovery in profound SSHL. Cases in the complete recovery group had significantly lower SII (806.57 ± 217.26) and higher LMR (2.14 ± 0.94) compared to those in the partial and no recovery groups (P < 0.001 for both). Multivariate logistic regression identified Tbil, SII, and LMR as independent predictors of recovery outcomes. Higher SII and lower LMR were significantly associated with poor recovery, while lower SII and higher LMR predicted better recovery. ROC curve analysis showed that SII and LMR had moderate predictive power for partial recovery (AUC: 0.668 for SII, 0.696 for LMR) and excellent predictive power for no recovery (AUC: 0.804 for SII, 0.819 for LMR). The combination of SII and LMR further enhanced predictive accuracy (AUC: 0.879 for no recovery).

CONCLUSION

SII and LMR are valuable biomarkers for predicting recovery outcomes in cases with profound SSHL. Elevated SII and reduced LMR are associated with poor recovery, while lower SII and higher LMR suggest a favorable prognosis. The combined use of these markers improves the accuracy of prognosis prediction and could guide clinical management in SSHL cases.

Association of cardiovascular health with MAFLD and mortality in overweight and obese adults and mediation by inflammation and insulin resistance

MAFLD is highly prevalent among overweight and obese individuals. Recently, the American Heart Association proposed a new measure of cardiovascular health (Life's Essential 8). This study investigated the relationship between the Life's Essential 8 (LE8) and MAFLD, all-cause and cardiovascular mortality in these populations, exploring the mediating role of inflammation and insulin resistance. This retrospective study used data from the National Health and Nutrition Examination Survey (NHANES, 2007-2018), including 6,885 overweight and obese individuals. LE8 scores were categorized into low, medium, and high groups. Weighted logistic regression and Cox proportional hazards models assessed the relationships between LE8, MAFLD, and mortality. Mediation analyses explored the roles of inflammation and insulin resistance, and weighted restricted cubic spline (RCS) regression examined potential nonlinear associations. Kaplan-Meier survival analysis evaluated survival rates across LE8 groups, and subgroup analyses assessed interactions with demographic characteristics. Additionally, ROC curves were used to explore the predictive accuracy of various inflammation and insulin resistance biomarkers. In model 3, compared to the low LE8 group, the prevalence of MAFLD in the highest LE8 group was reduced by 89% (OR = 0.11; 95% CI: 0.06, 0.20). HOMA-IR mediated 72.26% of the mediation effect. Various inflammation markers, including CRP, hs-CRP, SII, and SIRI indices, mediated effects ranging from 3 to 12%. Compared to the low LE8 group, the highest LE8 group had a 58% reduction in all-cause mortality and a 90% reduction in cardiovascular mortality. Kaplan-Meier analysis showed that the higher LE8 groups had significantly higher survival rates than the low LE8 group. Inflammatory markers mediated 5-17% of the mediation effects. Restricted cubic spline (RCS) curves revealed a non-linear relationship between LE8 and MAFLD. Age interacted with LE8 in several subgroup analyses. ROC curves showed that HOMA-IR had strong predictive accuracy for MAFLD, while SIRI demonstrated potential advantages in predicting mortality risk. In overweight/obese populations, LE8 scores were negatively associated with the prevalence of MAFLD, and risk of mortality. These findings emphasize the importance of maintaining high levels of LE8 scores for primary prevention in overweight/obese populations.

Neutrophil Percentage-to-Albumin Ratio and Neutrophil-to-Albumin Ratio as novel biomarkers for non-alcoholic fatty liver disease: a systematic review and meta-analysis

BACKGROUND

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.

METHODS

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.

RESULTS

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%).

CONCLUSION

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.

CLINICAL TRIAL NUMBER

Not applicable.

Aggregate index of systemic inflammation tied to increased fatty liver disease risk: insights from NHANES data

BACKGROUND

Fatty liver disease (FLD), characterized by hepatic lipid accumulation, impairs quality of life and can progress to cirrhosis and hepatocellular carcinoma, imposing a healthcare burden. This study investigates the association between the aggregate index of systemic inflammation (AISI) and FLD prevalence, evaluating AISI's potential as an early biomarker for risk assessment.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) database, which encompasses the years 2017 through 2020. Participants were chosen based on the availability of controlled attenuation parameter (CAP) scores derived from transient elastography (TE), a technique utilized for assessing liver steatosis. The formula employed to compute the AISI is as follows: AISI = N × P × M / L, where N, P, M, and L refer to neutrophils, platelets, monocytes, and lymphocytes, respectively. Additionally, demographic, socioeconomic, dietary, and health-related information was gathered. Logistic regression models were utilized to pinpoint risk factors associated with FLD, and a nomogram was created to forecast FLD risk.

RESULTS

Of the 3,961 participants, 2,377 (60.0%) were diagnosed with FLD based on a CAP score ≥ 248 dB/m. Elevated AISI was significantly associated with FLD (P = 0.021). Other significant risk factors included sex, age, BMI, race, marital status, hypertension, and diabetes. The nomogram demonstrated excellent discriminatory performance with an AUC of 0.814 (95% CI: 0.800, 0.827) and good calibration.

CONCLUSION

This study reveals a significant, independent association between elevated AISI and increased FLD risk in the U.S. population, even after adjusting for confounders. AISI demonstrated good discriminative performance for FLD, but its effect size suggests it should supplement, not replace, existing clinical risk assessment tools. AISI, a cost-effective biomarker, holds potential for enhancing FLD screening, particularly in resource-limited settings.

The role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patients

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is recognized as the predominant chronic liver disorder globally. Inflammation is integral to the onset and progression of NAFLD. The C-reactive protein to lymphocyte ratio (CLR), a novel inflammatory marker, has yet to be explored in the context of NAFLD.

METHOD

This investigation encompassed 4371 individuals from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015-2018. Weighted logistic regression was employed to examine the correlation between CLR and NAFLD. Weighted Cox proportional hazards models were utilized to evaluate the association between CLR and all-cause and Cardiovascular disease (CVD) mortality in patients with NAFLD. Restricted cubic spline (RCS) curves were employed to assess the dose-response relationship. Threshold effect analysis was used to determine the existence of an inflection point.

RESULT

After adjusting for all included covariates in Model 3, a positive correlation between lnCLR and NAFLD was identified (OR = 1.45, 95% CI = 1.16-1.81, P = 0.010). However, no significant association was observed between it and all-cause as well as CVD mortality among patients with NAFLD. The RCS curve illustrated a nonlinear association between CLR and NAFLD (P-nonlinear < 0.0001). Threshold effect analysis determined that the inflection point occurs at CLR = 1.667.

CONCLUSION

CLR exhibited a nonlinear positive association with NAFLD. Higher CLR levels may increase the risk of NAFLD. However, CLR does not affect all-cause and CVD mortality in patients with NAFLD.

The Impact of Non-Invasive Scores and Hemogram-Derived Ratios in Differentiating Chronic Liver Disease from Cirrhosis

Background: Chronic liver disease (CLD) is a major global health concern, contributing significantly to morbidity and mortality. Cirrhosis and liver cancer are the leading causes of liver-related deaths, with various etiological factors, such as metabolic disorders and alcohol-related and viral hepatitis, driving its global prevalence. Non-invasive biomarkers and scoring systems have emerged as key tools for assessing liver disease severity and differentiating CLD from cirrhosis. This study evaluates biomarkers and non-invasive scores and their utility in distinguishing CLD from cirrhosis. Methods: This retrospective observational study included 250 adult patients hospitalized between January 2021 and December 2023 at Cluj County Emergency Clinical Hospital, Romania. Patients were diagnosed with either cirrhosis or CLD of viral, autoimmune, or primary biliary cholangitis (PBC) etiology. Non-invasive biomarkers, scores, and various hemogram-derived ratios were evaluated. Statistical analysis involved descriptive statistics, comparative tests, and receiver operating characteristic (ROC) curve analysis. Results: Among the 250 patients, 137 had liver cirrhosis (54.8%) and 113 had CLD without cirrhosis (45.2%). Significant differences were observed in laboratory parameters, with cirrhosis patients showing lower hemoglobin, platelet count, and albumin levels alongside higher liver enzymes and INR values. Non-invasive scores such as APRI, FIB-4, and NFS demonstrated higher values in the cirrhosis group, indicating more advanced liver damage. Hemogram-derived ratios, particularly the neutrophil-to-lymphocyte ratio (NLR), were higher in cirrhosis patients. ROC analysis revealed that the Lok index had the highest discriminatory power (AUC 0.89), followed by the King score (AUC 0.864) and the Fibrosis index (AUC 0.856), which effectively distinguished cirrhosis from CLD. Conclusions: This study underscores the utility of non-invasive biomarkers and scoring systems in differentiating CLD from cirrhosis. The Lok index, King score, and Fibrosis index demonstrated excellent diagnostic accuracy, while hemogram-derived ratios, such as NLR, offer insights into systemic inflammation associated with liver disease progression. These findings support the integration of non-invasive markers into clinical practice for improved risk stratification and management of liver diseases.

Predictive value of inflammatory indexes in in-hospital mortality for patients with acute aortic dissection

BACKGROUND

The purpose of this study was to assess the relationship between admission inflammatory indexes neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammation index (SII), and the risk of in-hospital all-cause mortality in acute aortic dissection (AAD) patients.

METHODS

A retrospective analysis was conducted on 597 AAD patients (Stanford classification: Stanford type A 365 patients, Stanford type B 232 patients) at a single center. Outcomes were the incidence of in-hospital all-cause mortality. The risk of all-cause death was compared between the groups with low and high inflammatory indexes using the Kaplan-Meier curve. The association between admission inflammatory indexes and outcomes was evaluated using the Cox regression model and restricted cubic splines (RCS). Stratified analysis was performed based on AAD type, age (< 50 years or ≥ 50 years), and gender.

RESULTS

The Kaplan-Meier curves revealed statistically significant differences in outcomes among the low and high inflammatory indexes groups. Cox regression analysis revealed that the in-hospital mortality risk was significantly high in the high inflammatory index groups. MLR was the strongest associated with in-hospital mortality risk. The RCS curve revealed that NLR was non-linearly and J-shaped correlated with in-hospital mortality, and MLR and SII were linearly correlated with in-hospital mortality. Stratified analysis showed interactions between NLR, MLR, and SII and AAD type and age for the risk of in-hospital mortality.

CONCLUSION

Admission high inflammatory indexes were independently associated with an increased risk of in-hospital all-cause mortality in AAD patients. The inflammatory indexes NLR, MLR, and SII may be useful indicators for predicting in-hospital all-cause mortality in AAD patients.

The red blood cell distribution width is associated with all-cause and cardiovascular mortality among individuals with non-alcoholic fatty liver disease

BACKGROUND

Identifying reliable prognostic indicators is essential for the appropriate management of non-alcoholic fatty liver disease (NAFLD). Red blood cell distribution width (RDW) has been established as an inflammatory marker associated with cardiovascular outcomes. This study aimed to evaluate the association between RDW and both cardiovascular and all-cause mortality in individuals with NAFLD.

METHODS

Data from 7,438 participants with NAFLD were analyzed, collected between 2005 and 2016 through the National Health and Nutrition Examination Survey (NHANES). Mortality data were retrieved from the National Death Index (NDI). Restricted cubic spline (RCS) analysis was used to illustrate the relationship between RDW and mortality risk, Weighted Cox proportional hazards models were used to assess the independent relationship between RDW and mortality risk. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive ability of RDW for survival outcomes.

RESULTS

During a median follow-up period of 124 months, 1,269 deaths were recorded, including 335 from cardiovascular causes. RDW positively correlated with both cardiovascular and all-cause mortality according to the RCS analysis. Participants were categorized into quartiles based on RDW levels. Those in the highest RDW quartile (Q4) demonstrated a significantly higher risk of cardiovascular mortality (HR 3.61, 95% confidence interval [CI]:2.17-6.02, P=0.009) and all-cause mortality (HR 2.29, 95% CI:1.72-3.06, P < 0.0001), according to the weighted Cox hazards models. Additionally, the area under the curve (AUC) for all-cause mortality at 3, 5 and 10 years was, 0.69, 0.67, and 0.66, respectively. For cardiovascular mortality, the AUCs were 0.70, 0.68, and 0.68, respectively.

CONCLUSION

Among patients with NAFLD, RDW was identified as an independent predictor of increased cardiovascular and all-cause mortality risk.

The association of advanced lung cancer inflammation index with non-alcoholic fatty liver disease in NHANES 2017-2020

Background

The advanced lung cancer inflammation index (ALI) is a composite index that combines inflammation and nutritional status, and non-alcoholic fatty liver disease (NAFLD) is associated with inflammation, nutritional status, and obesity. This study aimed to investigate the possible relationship between ALI and NAFLD.

Methods

We extracted cohort datasets from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) for the study. Weighted analyses and multivariate linear regression models were applied to assess the association between ALI and NAFLD. Fitted curves and threshold effects analyses were used to characterize nonlinear relationships.

Results

A total of 6,595 adults aged 18-80 years were included in this study. In multivariate linear regression analysis, there was a significant positive association between ALI and NAFLD [OR: 1.02, 95% CI (1.01, 1.02)]. In subgroup analyses, this positive association was maintained in females [OR: 1.02, 95% CI (1.01, 1.02)] and not in males. In addition, we found that the association between ALI and NAFLD was nonlinear, with an L-shaped relationship and an inflection point of 32.47. ALI showed a U-shaped association with NAFLD in the male population, with an inflection point of 40.65, and an L-shaped association in the female population, with an inflection point of 30.61.

Conclusion

Our study suggests that there is a significant positive association between high ALI levels and NAFLD prevalence in the US adult population. However, more clinical cohort studies are needed to confirm this finding.

Inflammatory markers as predictors of liver fibrosis in type 2 diabetes patients with metabolic dysfunction-associated fatty liver disease

Objective

This study investigates the link between inflammatory markers and liver fibrosis in type 2 diabetes mellitus (T2DM) patients with metabolic dysfunction-associated fatty liver disease (MAFLD).

Methods

From Oct 2020 to Oct 2024, 769 hospitalized T2DM patients were studied. They were split into Control (n=389) and Experimental groups (T2DM with MAFLD, n=380). The Experimental group was further divided based on FIB-4 scores into non-fibrosis (FIB-4< 1.3, n=267), suspected fibrosis (1.3 ≤ FIB-4 ≤ 2.67, n=99), and advanced fibrosis (FIB-4 > 2.67, n=14). Logistic regression identified factors affecting liver fibrosis, while ROC analysis assessed the predictive value of NLR, SIRI, PLR, and PHR for liver fibrosis in T2DM-MAFLD patients.

Results

The Experimental group showed higher BMI, FPG, TG, TC, LDL-C, ALT, AST, ALB, GGT, and SUA, but lower age, diabetes duration, MPV, and HDL-C (P< 0.05). Compared to non-fibrosis, suspected fibrosis had higher age, diabetes duration, MPV, AST, and NLR, and lower LY, PLR, PHR. Advanced fibrosis featured higher age, AST, NLR, FPG, HbA1c, SIRI, and lower LY, RBC, LDL-C, PLR, PHR, Hb, PLT, and ALB (P< 0.05). Logistic regression identified NLR, SIRI, PLR, and PHR as significant factors for liver fibrosis. ROC analysis showed AUCs of 0.712 (NLR), 0.757 (SIRI), 0.703 (PLR), and 0.806 (PHR) with sensitivities and specificities varying among markers. Optimal cut-offs were 1.573 (NLR), 1.465 (SIRI), 110.819 (PLR), and 185.379 (PHR).

Conclusions

NLR, SIRI, PLR, and PHR significantly influence liver fibrosis in T2DM patients with MAFLD, aiding in its diagnosis and management.

Dynamic Status of Systemic Immune Inflammation Index Is Associated With Metabolic Dysfunction-Associated Steatotic Liver Disease: An Evidence From a Ten-Year Prospective Longitudinal Cohort Study

Objective

Previous research studies have linked the systemic immune inflammation index (SII), derived from a complete blood count, to metabolic dysfunction-associated steatotic liver disease (MASLD). However, evidence on the relationship between longitudinal changes in SII and MASLD remains limited. This study aimed to explore distinct SII trajectories and their association with MASLD incidence.

Methods

A longitudinal study analyzed 25,600 individuals who underwent periodic health assessments at a Dalian City hospital between 2014 and 2023. MASLD was diagnosed via ultrasound. The SII was calculated using the formula SII = (platelet count × neutrophil count) / lymphocyte count. Group-based trajectory modeling was used to identify SII trajectories, and restricted cubic spline (RCS) analysis was employed to assesse the dose-response relationship. Stratified analyses and sensitivity analyses were also conducted.

Results

Three SII trajectories were identified: "low stable" (50.6%), "moderate stable" (35.1%), and "high stable" (8.9%). After adjustments, the hazard ratios (HR) for MASLD incidence were 1.118 (95% CI: 1.057-1.182, P<0.001) for the "moderate stable" group and 1.284 (95% CI: 1.172-1.408, P<0.001) for the "high stable" group. These associations persisted after adjusting for lifestyle factors. A significant non-linear relationship between SII and MASLD risk was found in both the overall population and among different genders. Subgroup and sensitivity analyses consistently confirmed these findings.

Conclusion

Elevated SII levels are significantly associated with an increased risk of MASLD, particularly among individuals under 45 and women. Regular SII monitoring may improve risk stratification and facilitate targeted prevention strategies for those at higher risk of MASLD.

Inflammatory Indices in First Trimester as Predictors of Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes

OBJECTIVES

To explore the association between systemic inflammatory markers (systemic inflammation response index [SIRI], systemic immune inflammation index [SII], interleukin [IL]-33, and soluble tumorigenicity 2 [sST2]) and gestational diabetes mellitus (GDM), as well as adverse pregnancy outcomes (APOs), and to assess the impact of glycemic control on these relationships.

METHODS

A total of 777 participants were included, comprising 476 women with GDM and 301 without. Clinical characteristics, inflammatory markers, and pregnancy outcomes were analyzed. Logistic regression was employed to assess the risk of GDM and APOs associated with elevated inflammatory indices and glycemic control. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curves.

RESULTS

Women with GDM exhibited significantly higher levels of SII, SIRI, IL-33, and sST2. Multivariate logistic regression demonstrated that SII, SIRI, IL-33, and sST2 were independent predictors of GDM. Moreover, the highest tertiles of SII, SIRI, and IL-33 were strongly associated with APO risk. ROC analysis revealed that SII had the highest predictive value for GDM (AUC 0.763), while IL-33 had the greatest predictive accuracy for APOs (AUC 0.669). Effective glycemic control was associated with reduced inflammatory marker levels (SII, aOR 3.9; SIRI, aOR 3.7; IL-33, aOR 2.4) and a decreased risk of APOs and large-for-gestational-age (LGA) infants in women with GDM.

CONCLUSIONS

Elevated SII, SIRI, IL-33, and sST2 are significant predictors of GDM and APOs, with SII being the most robust predictor of GDM and IL-33 for APOs. Glycemic control reduces inflammation and may improve pregnancy outcomes in women with GDM.

Potential association of neutrophil-albumin ratio with non-alcoholic fatty liver disease: A cross-sectional study based on NHANES

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) has become a major public health problem in the world. Exploring objective biomarkers for the prevention, monitoring, and clinical evaluation of NAFLD is of guiding significance for clinical targeted prevention and treatment. There is a complex interaction between inflammation and NAFLD. Exploring NAFLD-related inflammatory markers is helpful for elucidating its pathogenic mechanism.

AIM

To explore the potential association between the inflamma-tory marker neutrophil to albumin ratio (NAR) and NAFLD based on the National Health and Nutrition Examination Survey (NHANES) database.

METHODS

The participant data set of the NHANES database from 2017 to 2018 was selected. They were divided into NAFLD group and non-NAFLD group according to the occurrence of NAFLD or not. The clinical data of the two groups were compared. Logistic regression analysis was used to analyze the relationship between NAR and NAFLD, and restricted cubic spline (RCS) and threshold effect analysis were performed to explore the potential turning point.

RESULTS

A total of 4526 participants were enrolled, including 1503 patients with NAFLD. The NAR level in the NAFLD group was significantly higher than that of the non-NAFLD group (P < 0.05). There were also significant differences in gender, age, body mass index, smoking status, hypertension, antihypertensive drugs, diabetes, hypoglycemic agents, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, uric acid, triglyceride, and total cholesterol between the two groups (P < 0.05 for), and these variables were therefore included in the adjusted model analyses. In model 1 without any adjustment, NAR levels were associated with the risk of NAFLD (OR = 2.154). In the model 2 (OR = 1.375), model 3 (OR = 1.693), and model 4 (OR = 1.817) adjusting for some variables, their independent association still existed. RCS curve analysis showed that there was a nonlinear relationship between NAR and NAFLD (P_{for overall} < 0.001, P_{for nonlinear} < 0.001). Threshold effect analysis showed that the inflection point of NAR influencing NAFLD risk was 1.436, and when NAR was lower than 1.436, the risk of NAFLD occurrence increased by 3.304 times for each additional unit of NAR (OR = 3.304; 95% confidence interval: 2.649-4.122; P < 0.001). However, this study did not found the potential value of NAR in distinguishing non-alcoholic steatohepatitis.

CONCLUSION

The levels of NAR show an independent association with NAFLD. When NAR is lower than 1.436, the risk of NAFLD increases with the increase of NAR level.

Association of Naples Prognostic Score with anemia in cancer survivors: a study based on NHANES database

Background

Anemia is a prevalent issue among cancer survivors, which greatly affects their quality of life and overall prognosis. The Naples Prognostic Score (NPS), an inflammation-based prognostic tool, is increasingly acknowledged for its potential in predicting clinical outcomes. This study aims to assess the correlation between anemia status, prognosis, and NPS in cancer survivors.

Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) database spanning from 2003 to 2018, along with death data from the National Death Index (NDI) up to December 31, 2019. A total of 80,312 participants were included, of whom 4,260 were identified as cancer survivors. After applying rigorous exclusion criteria for missing variables, 3,143 participants were retained in the final analysis. NPS was calculated using serum albumin (ALB), total cholesterol (TC), neutrophil to lymphocyte ratio (NLR), and lymphocyte to monocyte ratio (LMR). After adjusting relevant confounding factors, weighted univariable and multivariable logistic regression were utilized to calculate the odds ratios (OR) and 95% confidence intervals (CI). Kaplan-Meier (KM) curves and Log-rank test were employed to compare survival differences among the three patient groups, while Cox proportional regression was utilized to estimate hazard ratio (HR) and 95% CI. Additionally, subgroup analyses were performed to assess the consistency of the outcomes.

Results

Univariable and multivariable analyses indicated positive correlation between NPS and anemia in cancer survivors (P < 0.05). When NPS was treated as continuous variable, crude model showed that higher NPS scores were linked to higher likelihood of anemia in cancer survivors (OR: 1.77, 95% CI: 1.55 - 2.02; P < 0.001), and this association remained significant even after adjusting for all confounding variables (OR: 1.66, 95% CI: 1.45 - 1.90; P < 0.001). Moreover, with Q1 (score = 0) as the reference category, the analysis demonstrated positive association between NPS and the prevalence of anemia in cancer survivors, regardless of whether the model was crude or fully adjusted (P < 0.001). KM analysis indicated that the decline in overall survival from all causes and other causes was significantly more pronounced among anemic cancer survivors in the Q3 (score = 3 or 4) group (P < 0.05). After accounting for all confounding factors, individuals with the highest NPS had HR of 2.46 (95% CI: 1.81 - 3.34) for all-cause mortality. However, there were no significant differences in mortality trends related to cardiovascular or cancer causes (P > 0.05). Subgroup analyses and sensitivity analysis revealed no statistically significant interactions (P for interaction < 0.05).

Conclusions

The study highlights the correlation between higher NPS and an increased prevalence of anemia in cancer survivors, indicating that NPS may serve as a valuable tool for assessing the prognosis of cancer survivors in clinical practice and for guiding interventions aimed at mitigating anemia-related complications.

Inflammatory Indices and MAFLD Prevalence in Hypertensive Patients: A Large-Scale Cross-Sectional Analysis from China

Objective

Hypertension development and progression are largely influenced by inflammation, which plays a critical role by activating the immune system and causing damage to the vascular endothelium. Metabolic dysfunction-associated fatty liver disease (MAFLD) is also associated with chronic low-grade inflammation, which drives disease progression via metabolic imbalances and adipose tissue dysfunction. This study investigates the relationship between inflammatory indices and MAFLD in hypertensive patients and assesses the predictive accuracy of these indices for MAFLD.

Methods

We performed a cross-sectional analysis involving 34,303 hypertensive patients from a Chinese hospital-based registry. The diagnosis of MAFLD was established using metabolic dysfunction criteria alongside evidence of hepatic steatosis confirmed through imaging. Complete blood counts were used to calculate inflammatory indices, including the monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI). To assess the relationship between inflammatory indices and MAFLD, multivariable logistic regression was performed with adjustments for potential confounders. The diagnostic performance of these indices was analyzed using receiver operating characteristic (ROC) curves and area under the curve (AUC) calculations.

Results

Patients with MAFLD exhibited significantly elevated levels of all inflammatory indices compared to those without. After multivariable adjustment, each standard deviation increase in AISI, SIRI, and SII was associated with a 74%, 62%, and 58% increased odds of MAFLD, respectively. The AUC for AISI was 0.659, indicating moderate diagnostic accuracy. The AUCs for SIRI and SII were 0.626 and 0.619, respectively, while NLR, PLR, and MLR had lower AUCs of 0.593, 0.558, and 0.589, respectively.

Conclusion

In hypertensive patients, inflammatory indices, especially AISI, show a strong association with MAFLD, indicating their potential utility in risk stratification within clinical settings. Further research is needed to evaluate the effectiveness of these markers in the management of MAFLD.

Associations between systemic inflammatory biomarkers and metabolic dysfunction associated steatotic liver disease: a cross-sectional study of NHANES 2017-2020

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a primary cause of chronic liver disease, with potential progression to cirrhosis and hepatocellular carcinoma (HCC). Although systemic inflammatory biomarkers are associated with liver diseases, their specific role in MASLD remains unclear. This study examines the association between systemic inflammatory biomarkers and MASLD.

METHODS

This cross-sectional study enrolled 6613 adults aged 20 years or older from the National Health and Nutrition Examination Survey (NHANES) spanning from 2017 to March 2020. Among these participants,, 34.67% were aged 40-59 years, 50.85% were female, and 63.26% were Non-Hispanic White. We investigated 10 inflammatory biomarkers: ALI, SIRI, SII, SIPS, IBI, NLR, PLR, CAR, LMR, and PNI. Logistic regression models were performed to assess the linear association between systemic inflammatory biomarkers and MASLD. Restricted cubic spline (RCS) regression was employed to explore potential nonlinear relationships between biomarkers and MASLD risk. Additionally, subgroup analyses were conducted to examine the influence of various demographic and clinical characteristics on the observed associations.

RESULTS

After adjusting for key confounders, NLR and PLR exhibited negative association with MASLD risk, while ALI, CAR, and PNI exhibited the opposite association (P < 0.05). Most biomarkers, including ALI, SIRI, IBI, CAR, LMR, and PNI, exhibited significant non-linear correlations with MASLD (P < 0.05). Subgroup analyses revealed substantial age-related differences in the association between ALI and MASLD risk, as well as varying relationships between PNI and MASLD risk across various cardiovascular outcomes (P < 0.05).

CONCLUSION

Systemic inflammatory biomarkers are significantly associated with MASLD risk. Large-scale prospective studies are warranted to confirm these findings and elucidate the underlying mechanisms.

Development and validation of machine learning models for MASLD: based on multiple potential screening indicators

Background

Multifaceted factors play a crucial role in the prevention and treatment of metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to utilize multifaceted indicators to construct MASLD risk prediction machine learning models and explore the core factors within these models.

Methods

MASLD risk prediction models were constructed based on seven machine learning algorithms using all variables, insulin-related variables, demographic characteristics variables, and other indicators, respectively. Subsequently, the partial dependence plot(PDP) method and SHapley Additive exPlanations (SHAP) were utilized to explain the roles of important variables in the model to filter out the optimal indicators for constructing the MASLD risk model.

Results

Ranking the feature importance of the Random Forest (RF) model and eXtreme Gradient Boosting (XGBoost) model constructed using all variables found that both homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride glucose-waist circumference (TyG-WC) were the first and second most important variables. The MASLD risk prediction model constructed using the variables with top 10 importance was superior to the previous model. The PDP and SHAP methods were further utilized to screen the best indicators (including HOMA-IR, TyG-WC, age, aspartate aminotransferase (AST), and ethnicity) for constructing the model, and the mean area under the curve value of the models was 0.960.

Conclusions

HOMA-IR and TyG-WC are core factors in predicting MASLD risk. Ultimately, our study constructed the optimal MASLD risk prediction model using HOMA-IR, TyG-WC, age, AST, and ethnicity.

miRNAs and Hematological Markers in Non-Alcoholic Fatty Liver Disease-A New Diagnostic Path?

Background: Asymptomatic liver steatosis constitutes an emerging issue worldwide. Therefore, we decided to explore relationships between selected types of microRNAs (miRNAs), serological markers of liver fibrosis and hematological parameters in the course of non-alcoholic fatty liver disease (NAFLD). Methods: Two hundred and seven persons were included in the survey: 97 with NAFLD and 110 healthy controls. Serological concentrations of miR-126-3p, miR-197-3p, and miR-1-3p were measured in all participants. Direct indices of liver fibrosis [procollagen I carboxyterminal propeptide (PICP), procollagen III aminoterminal propeptide (PIIINP), platelet-derived growth factor AB (PDGF-AB), transforming growth factor-α (TGF-α) and laminin] together with indirect markers (AAR, APRI, FIB-4 and GPR) were also evaluated. The assessment of hematological parameters concerned: mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), red blood cell distribution width (RDW), MPV to platelet (PLT) ratio (MPR), RDW to PLT ratio (RPR), neutrophil to lymphocyte (LYM) ratio (NLR), PLT to LYM ratio (PLR) and RDW to LYM ratio (RLR). Additionally, the NAFLD fibrosis score and BARD score were applied. Results: The concentration of miR-126-3p and miR-1-3p was higher, and miR-197-3p was lower in the NAFLD group (p < 0.0001). miR-197-3p correlated notably with hematological indices: negatively with PDW (p < 0.05) and positively with PLR (p < 0.05). Conclusions: Significant correlations between miRNA molecules and hematological markers in the course of NAFLD indicate inflammation as a potential background and create new possibilities for a diagnostic approach.

Association between neutrophil-albumin ratio and ultrasound-defined metabolic dysfunction-associated fatty liver disease in U.S. adults: evidence from NHANES 2017-2018

BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) is increasingly prevalent, and systemic inflammation markers may play a role in its pathogenesis. This study aimed to investigate the relationship between neutrophil-albumin ratio (NAR) and MAFLD.

METHODS

This population-based study was performed using data from NHANES 2017-2018 and included 4526 individuals with a median age of 44 years old, and the males account for 46.13% (n = 2088). Ultrasound-defined MAFLD was diagnosed using a controlled attenuation parameter (CAP) threshold of ≥ 285 dB/m. Differences in baseline characteristics between patients with CAP ≥ 285 dB/m and < 285 dB/m were analyzed. A generalized additive model (GAM) and restricted cubic splines (RCS) were applied to explore the nonlinear relationship between NAR and CAP, followed by generalized linear models (GLMs). Threshold effect analysis was performed to identify the inflection point in the nonlinear relationship. CAP-related variables were ranked using XG Boost and random forest algorithms, and predictive models were developed and evaluated.

RESULTS

The study population included 1,503 patients with CAP ≥ 285 dB/m. NAR was significantly elevated in subjects with CAP ≥ 285 dB/m (P < 0.001), and nonlinear relationships between NAR and CAP were observed. NAR was positively associated with CAP in three GLMs, and this relationship remained after adjusting for confounding factors or dividing NAR into tertiles. Additionally, when NAR < 1.436, a one-unit rise in NAR was linked to a 3.304-fold increase in the risk of NAFLD (OR = 3.304, 95% CI: 2.649-4.122). The NAR-based random forest model showed the best predictive performance with AUC values of 0.978 (training) and 0.813 (validation).

CONCLUSION

NAR is positively associated with CAP, and the NAR-based random forest model is optimal for predicting MAFLD risk, highlighting the importance of NAR in predicting MAFLD.

The association between immunoinflammatory biomarkers NLR, PLR, LMR and nonalcoholic fatty liver disease: a systematic review and meta-analysis

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disorder closely linked to metabolic syndrome. Identifying novel, easily measurable biomarkers could significantly enhance the diagnosis and management of NAFLD in clinical settings. Recent studies suggest that immunoinflammatory biomarkers-specifically, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-may offer diagnostic value for NAFLD. However, the effectiveness of these biomarkers has not been comprehensively assessed in this patient population. This systematic review and meta-analysis aimed to evaluate the association between these immunoinflammatory biomarkers and NAFLD. As of August 8, 2024, databases including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus were systematically searched to compare NLR, PLR, and LMR levels in NAFLD patients and healthy controls. Study quality was assessed using the Newcastle-Ottawa Scale, and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated (PROSPERO registry number: CRD42024580812). A total of 20 studies were included in the meta-analysis. Results indicated that NAFLD patients had significantly higher NLR levels (SMD = 0.43; 95% CI 0.28-0.58; p < 0.001) and lower PLR levels (SMD = - 0.29; 95% CI - 0.41 to - 0.17; p < 0.001) compared to controls. However, no significant difference in LMR was observed between NAFLD patients and controls(SMD = 0.08; 95% CI - 0.00 to 0.17; p = 0.051). These findings suggest that NLR and PLR may hold promise as diagnostic markers for NAFLD, while LMR appears to have limited diagnostic utility. Further research is warranted to explore the potential role of these biomarkers in tracking disease progression.

Evaluating body roundness index and systemic immune inflammation index for mortality prediction in MAFLD patients

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a major cause of liver-related morbidity and mortality, contributing to both cardiovascular and non-cardiovascular deaths. The Body Roundness Index (BRI) and Systemic Immune-Inflammation Index (SII) have emerged as predictors of adverse outcomes in metabolic diseases. This study investigates the association between BRI, SII, and mortality risk in MAFLD patients. A nationwide retrospective cohort study was conducted using data from the NHANES database (January 1999-December 2018), including patients diagnosed with MAFLD. BRI and SII were calculated at baseline. Cox proportional hazards models assessed the association between these indices and all-cause, cardiovascular, and non-cardiovascular mortality, adjusting for confounders. Among 12,435 participants diagnosed with MAFLD, 3,381 (27.2%) were classified into the low BRI and low SII group, 2,889 (23.2%) into the low BRI and high SII group, 2,802 (22.5%) into the high BRI and low SII group, and 3,363 (27.1%) into the high BRI and high SII group. Compared to the low BRI and low SII group, the high BRI and high SII group demonstrated significantly higher all-cause mortality, with an adjusted hazard ratio (HR) of 1.89. For cardiovascular mortality, the HR was 2.31, while for non-cardiovascular mortality, the HR was 1.78. The high BRI and high SII cohort exhibited the highest risk of all-cause mortality, cardiovascular mortality, and non-cardiovascular mortality. BRI and SII are independent predictors of mortality in MAFLD patients, and their combined use enhances risk stratification. Integrating these indices into clinical practice could improve personalized management strategies and outcomes in this high-risk population.

Differential effects of systemic immune inflammation indices on hepatic steatosis and hepatic fibrosis: evidence from NHANES 1999-2018

BACKGROUND

Several studies have demonstrated that systemic immune inflammation index (SII) has a positive relationship with hepatic steatosis. However, it is lack of system evidence for the correlation between SII and hepatic fibrosis. The objective of this study was to evaluate the relationships between SII and hepatic steatosis or hepatic fibrosis.

METHODS

A cross-sectional analysis was performed from the National Health and Nutrition Examination Survey (NHANES). Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS) and hepamet fibrosis score (HFS) were the indicators for hepatic fibrosis; fatty liver index (FLI), NAFLD liver fat score (LFS) and Framingham steatosis index (FSI) were the indicators for hepatic steatosis. Pearson's test, generalized linear model (GLM) and restricted cubic splines (RCS) were used to analyze associations of SII with hepatic fibrosis and hepatic steatosis.

RESULTS

A total of 21,833 participants were enrolled in the study. Pearson's test and GLM revealed that there were negative relationships between SII and hepatic fibrosis (FIB-4, NFS and HFS), while positive relationships between SII and hepatic steatosis (FLI, LFS and FSI). The corresponding β (95%CI) of SII and hepatic fibrosis were - 0.35(-0.46, -0.24), -0.67(-0.71, -0.63) and - 0.10(-0.12, -0.09), respectively. The corresponding β (95%CI) of SII and hepatic steatosis were 6.12(4.75, 7.50), 0.22(0.12, 0.31) and 0.27(0.20, 0.34), respectively. Statistically significant non-linear association were found in SII with hepatic fibrosis and hepatic steatosis in RCS model (all P < 0.001).

CONCLUSION

There was a negative significant association between SII and hepatic fibrosis, while a positive significant association between SII and hepatic steatosis.

Inflammatory indexes and anemia in chronic kidney disease: correlation and survival analysis of the National Health and Nutrition Examination Survey 2005-2018

BACKGROUND

There is currently no research on the correlation between novel inflammatory indexes systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the risk of anemia in chronic kidney disease (CKD) population, as well as survival analysis in CKD with anemia.

METHODS

This investigation encompassed 4444 adult subjects out of the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The study utilized multi-variable logistic regression to assess the relationship between SII, NLR, PLR, and anemia risk occurrence in CKD population. Survival differences in CKD patients with anemia, based on varying levels of SII, NLR, and PLR were evaluated employing Kaplan-Meier and Cox proportional hazards models.

RESULTS

The adjusted logistic regression model demonstrates that SII, NLR, and PLR are associated with the risk of anemia occurrence in CKD population. Kaplan-Meier's analysis reveals significant differences in survival rates among CKD patients with anemia stratified by NLR levels. The adjusted Cox proportional hazards model shows that the higher NLR group has a 30% elevated risk of all-cause mortality contrasted with lower group (hazard ratio, HR: 1.30, confidence interval (CI) [1.01, 1.66], p value <.04). Restricted cubic spline (RCS) demonstrates no nonlinear relationship between NLR and all-cause mortality. Lastly, sub-cohort analysis indicates that in populations with diabetes, hypertension, and hyperuricemia, NLR levels have a greater impact on all-cause mortality.

CONCLUSIONS

Controlling inflammation may reduce the occurrence of anemia in CKD populations, with NLR serving to be a potential prognostic indicator for survival results within CKD patients suffering from co-morbid anemia.

Relevance of combined influence of nutritional and inflammatory status on non-alcoholic fatty liver disease and advanced fibrosis: A mediation analysis of lipid biomarkers

BACKGROUND AND AIM

This study aimed to investigate the relationship between advanced lung cancer inflammation index (ALI) and non-alcoholic fatty liver disease (NAFLD) and advanced liver fibrosis (AF).

METHODS

A total of 5642 individuals from the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2020 were examined. Limited cubic spline regression model, and weighted logistic regression were employed to determine if ALI levels were related to the prevalence of NAFLD and AF. Additionally, a mediating analysis was conducted to investigate the role of lipid biomarkers, such as total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C), in the effects of ALI on the prevalence of NAFLD and AF.

RESULTS

After adjusting for potential confounders, a significant positive association was found between ALI with NAFLD and AF prevalence. Compared with those in ALI Tertile 1, participants in Tertile 3 had higher odds of NAFLD prevalence (odds ratio [OR]: 3.16; 95% confidence interval [CI]: 2.52-3.97) and AF (OR: 3.17; 95% CI: 2.30-4.36). Participants in both Tertile 2 and Tertile 3 had lower odds of developing AF (P for trend = 0.005). Moreover, we discovered a nonlinear association between ALI and NAFLD. An inflection point of 74.25 for NAFLD was identified through a two-segment linear regression model. Moreover, TC and HDL-C levels mediated the association between ALI and NAFLD by 10.2% and 4.2%, respectively (both P < 0.001).

CONCLUSION

Our findings suggest that higher ALI levels are positively associated with an increased prevalence of NAFLD and AF, partly mediated by lipid biomarkers.

Association between the systemic immune-inflammation index and the outcome of liver fibrosis in patients with chronic hepatitis C

Background

Risk factors that influence the outcome of patients with chronic hepatitis C (CHC) are not fully understood. The systemic immune-inflammatory index (SII) is an independent prognostic factor for multiple diseases. However, the impact of the SII on the outcome of liver fibrosis is unclear.

Methods

This prospective real-world study enrolled patients with CHC treated with sofosbuvir/velpatasvir. Logistic regression models were used to investigate the relationship between the SII and the outcome of liver fibrosis in treatment-naive patients. Liver fibrosis was assessed using aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4).

Results

Of the 288 participants, the SII was 238.2 (153.0-358.2). The non-improved outcomes of liver fibrosis assessed with APRI (non-improved APRI) and FIB-4 (non-improved FIB-4) were 83.0 and 87.5%, respectively. Adjusted models showed that the SII was positively associated with non-improved APRI (adjusted OR (95% CI): 1.013 (1.009-1.017), p < 0.001) and FIB-4 (adjusted OR (95% CI): 1.004 (1.001-1.007), p = 0.012). Similarly, a higher SII was associated with a higher risk of non-improved APRI (adjusted OR (95% CI): 13.53 (5.60-32.68), p < 0.001) and FIB-4 (adjusted OR (95% CI): 5.69 (2.17-14.90), p < 0.001). The association with non-improved APRI was much more remarkable in patients with alanine aminotransferase <2 ULN, and the association with non-improved FIB-4 was remarkable in patients aged <50 years. Multiple imputation analyses confirmed the robustness of these results.

Conclusion

Our findings suggested that the SII was positively associated with non-improved outcomes of liver fibrosis in patients with CHC. These results need to be validated in large-scale prospective cohorts.

Interaction between the systemic immune-inflammation index and trouble sleeping in nonalcoholic fatty liver disease: a cross-sectional study of the NHANES 2005-2018 data

BACKGROUND

The systemic immune-inflammation index (SII) and trouble sleeping are independent risk factors for nonalcoholic fatty liver disease (NAFLD). Nevertheless, studies investigating the combined effects of the SII and troubled sleeping on NAFLD are lacking. In this study, we investigated the independent relationships and interactions between trouble sleeping and the SII among patients with NAFLD.

METHODS

Data from seven survey cycles of the National Health and Nutrition Examination Survey (NHANES) (2005-2018) were analyzed. The SII was obtained by counting platelets, neutrophils, and lymphocytes. NAFLD was diagnosed using the US fatty liver index. Trouble sleeping was diagnosed using a sleep disorder questionnaire. The correlation between trouble sleeping and the SII in NAFLD was investigated using multiple regression analysis, subgroup stratification, interaction tests, and restricted cubic spline, and the presence or absence of additive or multiplicative interactions was determined. Additionally, mediation analyses were performed to explore the role of the SII in mediating the effects of trouble sleeping on NAFLD.

RESULTS

The survey included 10 963 participants. Multivariate logistic regression revealed that SII (OR: 1.21, 95% CI 1.08-1.35) and trouble sleeping (OR: 1.24, 95% CI 1.05-1.47) were positively correlated with NAFLD. For NAFLD, an additive but not multiplicative interaction was noted between the SII and trouble sleeping. The SII partially mediated the association between trouble sleeping and NAFLD, accounting for approximately 3.11% of the total effect (95% CI 0.01-0.05).

CONCLUSION

The SII and trouble sleeping were independently correlated with NAFLD risk. Furthermore, a combined effect may exist between SII and trouble sleeping, which increases the risk of NAFLD.

Analysis of risk factors affecting the prognosis of angiosarcoma patients: a retrospective study

This study aimed to identify prognostic factors influencing the survival of angiosarcoma patients and to explore the relationship between peripheral blood indicators and patient prognosis. A retrospective analysis was conducted on the clinical data collected from 105 angiosarcoma patients treated at China-Japan Union Hospital of Jilin University from January 2004 to April 2019, with an additional 50 patients included as external validation cohort. The median survival time for the study cohort was 1395 days, with 66.7% of patients (n=70) dying during the follow-up period. Significant differences were observed between the survival and death groups in age (P=0.022), primary tumor site (P=0.013), tumor size (P=0.008), and metastasis (P=0.018). Analysis of peripheral blood indicators showed that white blood cell (WBC) (P=0.006), platelet (PLT) (P=0.019), platelet-to-lymphocyte ratio (PLR) (P<0.001), and systemic immune-inflammation index (SII) (P=0.036) were significantly lower in the survival group, while lymphocyte (LYM) (P<0.001), albumin (ALB) (P<0.001), and prognostic nutritional index (PIN) (P<0.001) were significantly higher in the survival group. Multivariate Cox regression analysis identified SII (P=0.049, HR=0.551, 95% CI: 0.304-0.998), primary tumor site (P=0.001, HR=0.405, 95% CI: 0.235-0.699), metastasis (P=0.029, HR=1.864, 95% CI: 1.066-3.26), and chemotherapy (P=0.004, HR=0.434, 95% CI: 0.245-0.768) as independent prognostic factors affecting patients' 5-year survival. A nomogram model constructed based on these factors demonstrated high accuracy and stability in predicting 1-year, 3-year, and 5-year survival rates, with area under the curve (AUC) values of 0.836, 0.837, and 0.803, respectively, as validated by calibration curves and receiver operating characteristic (ROC) analysis. External validation further confirmed the model's reliability. Additionally, significant interactions were found between SII and primary tumor site (P=0.005) as well as chemotherapy (P=0.045). In conclusion, SII, primary tumor site, metastasis, and chemotherapy are crucial prognostic factors for angiosarcoma, and the developed nomogram provides a reliable tool for predicting survival outcomes.

Neutrophil-to-lymphocyte ratio and its association with latent tuberculosis infection and all-cause mortality in the US adult population: a cohort study from NHANES 2011-2012

Background

There has been little study done on the possible connection between all-cause mortality and the neutrophil-to-lymphocyte ratio (NLR), particularly in individuals with latent tuberculosis infection (LTBI). The objective of this research was to examine the correlation between the NLR and LTBI, along with their effects on all-cause mortality in a cohort of individuals who had either LTBI or not.

Methods

This research incorporated data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, with a total of 4938 subjects involved. To investigate the connection between LTBI and variables, multivariable logistic regression models were used. Multivariable Cox proportional hazards models and Kaplan-Meier (KM) survival curves were employed to examine the association between NLR and all-cause death in individuals with and without LTBI.

Results

When analyzed as a continuous variable, The calculated odds ratios (ORs) for the different models-Model 1, Model 2, and Model 3 were 0.86, 0.83, and 0.84 (P < 0.005). NLR was evaluated as a categorical parameter, revealing that individuals in the tertile T3 had a notably lower rate of LTBI in comparison to those in the T1 group. After adjusting for different confounders, the odds ratio for T3 varied in the various models, being 0.75 (0.60∼0.95), 0.69 (0.54∼0.89), and 0.71 (0.56∼0.92), respectively. Additionally, higher NLR was significantly link to a greater risk of all-cause mortality in individuals with or without LTBI. Following multivariate adjustment, an 8% (Model 3, HR 1.08, 95% CI 1.05-1.12, P < 0.001) greater risk of mortality from all-cause was linked to every unit rise in NLR.

Conclusion

Results from the study revealed a negative correlation between NLR and the likelihood of LTBI as well as a higher risk of death from all causes. Therefore, NLR may be a helpful technique for risk categorization in the adult LTBI in the United States. To clarify the underlying mechanisms and any therapeutic implications of these findings, more investigation is necessary.

Systemic Inflammatory Indicators and Risk of Incident Metabolically Unhealthy Phenotype

Objective

This retrospective cohort study was designed to evaluate the association between eight systemic inflammation indicators at baseline and the metabolically unhealthy (MU) phenotype after two years of follow-up.

Methods

Participants were defined as metabolically healthy (MH) if they met 0-2 of the criteria and metabolically unhealthy (MU) if they met ≥ 3 of the criteria. A many of 4175 subjects aged 20-80 years with a metabolically healthy (MH) phenotype at baseline were enrolled in the study. We compared the clinical characteristics between women and men enrolled at baseline according to the metabolic phenotype at follow-up. The associations between baseline inflammation indicators and MU status at follow-up were evaluated using logistic regression analysis.

Results

922 (22.08%) developed new-onset MU symptoms during follow-up. Logistic regression analysis found that most inflammation indicators were significantly associated with MU phenotype at follow-up, aside from the LMR and SII. After adjusting for potential confounders, only the correlations between CRP level, neutrophil count, and MU phenotype reached significance. In comparison to the control group with a CRP of <0.50 mg/L, the odds ratios (ORs) and 95% confidence intervals (CIs) were 1.61 (1.25-2.09), 1.49 (1.15-1.94), and 1.68 (1.30-2.18) for individuals with CRP levels of 0.50-0.90 mg/L, 0.91-1.72 mg/L, and above 1.72 mg/L, respectively. In the population with a neutrophil count <5.00 ×109 cells/L, the neutrophil count correlated positively and significantly with the MU phenotype. In comparison to the control group with a neutrophil count of <2.75 × 109 cells/L, the ORs and 95% CIs were 1.65 (1.30-2.09) in the population with neutrophil count >4.17 × 109 cells/L.

Conclusion

CRP and neutrophil counts positively correlated with the risk of MU phenotype in Chinese subjects. These composite inflammatory markers (NLR, PLR, LMR, and SII) provide limited advantages for predicting MU risks compared to CRP.

The Role of Paraclinical Investigations in Detecting Inflammation in Children and Adolescents with Obesity and Metabolic Syndrome

Obesity is linked to the increasing prevalence of metabolic syndrome (MetS), even among the pediatric population. Some inflammatory and cardioembolic indexes derived from routine laboratory tests have captivated the attention of the medical community.

OBJECTIVES

The aim of our study was to evaluate whether these markers are effective in distinguishing varying degrees of obesity and MetS in children and adolescents.

METHODS

We conducted a retrospective study. A total of 71 children and adolescents, aged between 6 and 16, were included in the study. Among them, 5 were overweight, 35 had obesity, and 31 had severe obesity. According to the NCEP ATP III criteria, 32 individuals had Metabolic Syndrome (MetS), while 39 did not have MetS.

RESULTS

The MetS positive group had higher values of TG/HDL-C (p < 0.001), TC/HDL-C (p < 0.001), MHR (p = 0.015), LHR (p = 0.001), NHR (p = 0.001), atherogenic index of plasma (p < 0.001), and PHR (p < 0.001). ESR, NLR, PLR, and SII did not progressively increase with the number of MetS criteria. The ROC curve analysis demonstrated that markers such as TG/HDL-C, the atherogenic index of plasma, TC/HDL-C, LHR, NHR, and PHR were effective in identifying MetS in children and adolescents with obesity.

CONCLUSIONS

In conclusion, we determined that some novel inflammatory and cardioembolic indexes are useful in assessing MetS and obesity in children and adolescents.

Genetically predicted metabolites mediate the association between immune cells and metabolic dysfunction-associated steatotic liver disease: a mendelian randomization study

BACKGROUND

Existing studies have presented limited and disparate findings on the nexus between immune cells, plasma metabolites, and metabolic dysfunction-associated steatotic liver disease (MASLD). The aim of this study was to investigate the causal relationship between immune cells and MASLD. Additionally, we aimed to identify and quantify the potential mediating role of metabolites.

METHODS

A Mendelian randomization (MR) analysis was conducted using two samples of pooled data from genome-wide association studies on MASLD that included 2568 patients and 409,613 control individuals. Additionally, a mediated MR study was employed to quantify the metabolite-mediated immune cell effects on MASLD.

RESULTS

In this study, eight immunophenotypes were linked to the risk of MASLD, and thirty-five metabolites/metabolite ratios were linked to the occurrence of MASLD. Furthermore, a total of six combinations of immunophenotypic and metabolic factors demonstrated effects on the occurrence of MASLD, although the mediating effects of metabolites were not significant.

CONCLUSION

Our study demonstrated that certain immunophenotypes and metabolite/metabolite ratios have independent causal relationships with MASLD. Furthermore, we identified specific metabolites/metabolite ratios that are associated with an increased risk of MASLD. However, their mediating role in the causal association between immunophenotypes and MASLD was not significant. It is important to consider immune and metabolic disorders among patients with MASLD in clinical practice.

Association between lymphocyte-to-monocyte ratio and prostate cancer in men: A population-based study

Using the novel inflammatory biomarker lymphocyte-to-monocyte ratio (LMR), this work aimed to look into any potential connections between LMR and prostate cancer (PCa). A cross-sectional research investigation was conducted on 7706 male participants involved in the National Health and Nutrition Examination Survey from 2001 to 2010. Multivariate logistic regression modeling investigated the relationship between LMR levels and PCa risk. Furthermore, threshold analysis, subgroup analysis, interaction testing, and smoothed curve fitting were carried out. A significant negative correlation was seen between LMR and PCa risk (OR = 0.79, 95% CI: 0.65-0.97, P = .0002), even after controlling for potential confounding factors. A significant nonlinear negative correlation with a threshold effect and a breakpoint of 4.86 was found by smooth curve fitting between LMR and PCa. Subgroup analysis revealed a significant interaction (P for interaction = 0.0448) between the negative correlation between PCa and LMR about hypertension. Moreover, additional stratified smoothed curve fitting demonstrated a statistically significant inverse relationship between PCa risk and LMR. According to our findings, there is a substantial inverse relationship between PCa risk and LMR level. The inflammatory response-related index is quick, easy to use, and offers some clinical references. However, more extensive prospective investigations are required to confirm the involvement of LMR levels in PCa.

Systemic immune-inflammation index mediates the association between metabolic dysfunction-associated fatty liver disease and sub-clinical carotid atherosclerosis: a mediation analysis

Background

Limited research has been conducted to quantitatively assess the impact of systemic inflammation in metabolic dysfunction-associated fatty liver disease (MAFLD) and sub-clinical carotid atherosclerosis (SCAS). The systemic immune-inflammation index (SII), which integrates inflammatory cells, has emerged as a reliable measure of local immune response and systemic inflammation Therefore, this study aims to assess the mediating role of SII in the association between MAFLD and SCAS in type 2 diabetes mellitus (T2DM).

Method

This study prospectively recruited 830 participants with T2DM from two centers. Unenhanced abdominal CT scans were conducted to evaluate MAFLD, while B-mode carotid ultrasonography was performed to assess SCAS. Weighted binomial logistic regression analysis and restricted cubic splines (RCS) analyses were employed to analyze the association between the SII and the risk of MAFLD and SCAS. Mediation analysis was further carried out to explore the potential mediating effect of the SII on the association between MAFLD and SCAS.

Results

The prevalence of both MAFLD and SCAS significantly increased as the SII quartiles increased (P<0.05). MAFLD emerged as an independent factor for SCAS risk across three adjusted models, exhibiting odds ratios of 2.15 (95%CI: 1.31-3.53, P < 0.001). Additionally, increased SII quartiles and Ln (SII) displayed positive associations with the risk of MAFLD and SCAS (P < 0.05). Furthermore, a significant dose-response relationship was observed (P for trend <0.001). The RCS analyses revealed a linear correlation of Ln (SII) with SCAS and MAFLD risk (P for nonlinearity<0.05). Importantly, SII and ln (SII) acted as the mediators in the association between MAFLD and SCAS following adjustments for shared risk factors, demonstrating a proportion-mediated effect of 7.8% and 10.9%.

Conclusion

SII was independently correlated with MAFLD and SCAS risk, while also acting as a mediator in the relationship between MAFLD and SCAS.