Association of the Platelet-to-Neutrophil Ratio With Metabolic Dysfunction-Associated Steatotic Liver Disease and Liver Fibrosis in U.S. Adults: NHANES 2017-March 2020

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic liver disease that is not related to alcohol and is characterized by excessive accumulation of fat within liver cells. As one of the most common chronic liver diseases worldwide, MASLD affects about a quarter of the world's population and is expected to become a leading indication for liver transplantation by 2030. The disease not only increases the risk of cirrhosis and hepatocellular carcinoma, but also is closely associated with a variety of extra-hepatic complications such as type 2 diabetes and cardiovascular disease. Although many biomarkers such as N-terminal type III collagen propeptide (PRO-C3), enhanced liver fibrosis (ELF), and Fibrosis-4 Score (FIB-4) have been used to identify and predict MASLD and metabolic dysfunction-associated steatohepatitis (MASH), their clinical utility remains limited. Recent studies have shown that neutrophils and platelets play a crucial role in the progression of MASLD. The platelet-to-neutrophil ratio (PNR), a novel biomarker, has shown predictive value in ovarian cancer and myocardial infarction. However, PNR has not been fully studied in MASLD. The aim of this study was to investigate the association between PNR and MASLD and to explore its relationship with hepatic steatosis and fibrosis.