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

Abstract 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...

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Main Authors: Jianxin Xi, Shengnan Wang, Jie Chen, Jason Chi Shing Law, Zhongqi Fan, Guoyue Lv
Format: Article
Language:English
Published: BMC 2025-05-01
Series:BMC Gastroenterology
Subjects:
Online Access:https://doi.org/10.1186/s12876-025-03924-w
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author Jianxin Xi
Shengnan Wang
Jie Chen
Jason Chi Shing Law
Zhongqi Fan
Guoyue Lv
author_facet Jianxin Xi
Shengnan Wang
Jie Chen
Jason Chi Shing Law
Zhongqi Fan
Guoyue Lv
author_sort Jianxin Xi
collection DOAJ
description Abstract 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.
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spelling doaj-art-2bbd71593a9d47e497c7f90dab280dff2025-08-20T02:55:27ZengBMCBMC Gastroenterology1471-230X2025-05-0125111210.1186/s12876-025-03924-wThe role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patientsJianxin Xi0Shengnan Wang1Jie Chen2Jason Chi Shing Law3Zhongqi Fan4Guoyue Lv5Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin UniversityDepartment of Neurology, The First Hospital of Jilin UniversityDepartment of Radiology, The First Hospital of Jilin UniversityFaculty of Medicine, The University of Hong KongDepartment of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin UniversityDepartment of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin UniversityAbstract 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.https://doi.org/10.1186/s12876-025-03924-wNAFLDCLRNHANESAll-Cause MortalityCVD mortality
spellingShingle Jianxin Xi
Shengnan Wang
Jie Chen
Jason Chi Shing Law
Zhongqi Fan
Guoyue Lv
The role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patients
BMC Gastroenterology
NAFLD
CLR
NHANES
All-Cause Mortality
CVD mortality
title The role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patients
title_full The role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patients
title_fullStr The role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patients
title_full_unstemmed The role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patients
title_short The role of C-reactive protein to lymphocyte ratio in NAFLD and mortality among NAFLD patients
title_sort role of c reactive protein to lymphocyte ratio in nafld and mortality among nafld patients
topic NAFLD
CLR
NHANES
All-Cause Mortality
CVD mortality
url https://doi.org/10.1186/s12876-025-03924-w
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