The Role of Inflammatory Markers in the Diagnosis and Monitoring of Non-Alcoholic Fatty Liver Disease
DOI:
https://doi.org/10.56801/MME1201Keywords:
Non-Alcoholic Fatty Liver Disease (NAFLD), Systemic Inflammation Index (SII), Systemic Inflammation Response Index (SIRI).Abstract
Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a growing concern in chronic liver disorders, with a global prevalence of 32.4%. It is associated with metabolic dysfunctions, including insulin resistance, and may progress to severe liver complications, such as cirrhosis and liver cancer. Identifying reliable biomarkers for early diagnosis and monitoring of NAFLD is critical for effective management. Inflammatory markers like the Systemic Inflammation Index (SII) and the Systemic Inflammation Response Index (SIRI) have emerged as potential biomarkers for diagnosing and monitoring the progression of various diseases, including NAFLD. However, their role in NAFLD remains underexplored.
Methods: This cohort study analyzed data from 868 adult patients diagnosed or suspected of having NAFLD, .Inflammatory markers (SII and SIRI) were calculated from complete blood counts (CBC), and liver function was assessed through standard tests and imaging. The relationship between these inflammatory markers and NAFLD prevalence and severity was evaluated using correlation analysis, comparative tests, logistic regression, and receiver operating characteristic (ROC) curve analysis.
Results: Higher SII and SIRI values were significantly associated with an increased risk of NAFLD. The odds ratio for NAFLD prevalence was highest in the top quartile of the SII (OR = 3.45, 95% CI: 2.18–5.48, p < 0.001) and SIRI (OR = 3.13, 95% CI: 1.99–4.92, p < 0.001) indices, after adjusting for confounders like age, sex, comorbidities, and lifestyle factors. ROC curve analysis showed that both SII and SIRI had good diagnostic accuracy for predicting NAFLD.
Conclusion: This study demonstrates that both SII and SIRI are significantly associated with NAFLD prevalence and severity. These inflammatory markers may serve as useful tools for early diagnosis and monitoring of NAFLD. Incorporating these indices into routine clinical assessments could improve patient outcomes by facilitating early intervention and better management of NAFLD and related metabolic disorders. Further prospective studies with larger, more diverse populations are needed to confirm these findings.
References
Azab, B., Zaher, M., Weiserbs, K.F., Torbey, E., Lacossiere, K., Gaddam, S., Gobunsuy, R., Jadonath, S., Baldari, D., et al. (2010). The usefulness of the neutrophil-to-lymphocyte ratio in predicting both short- and long-term mortality following non-ST-elevation myocardial infarction. American Journal of Cardiology, 106, 470–476.
Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., & Tiribelli, C. (2006). The Fatty Liver Index: A simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterology, 6, 33.
Cosansu, N.C., Kara, R., Yaldiz, M., & Dikicier, B.S. (2022). New markers for predicting the response to omalizumab in chronic spontaneous urticaria. Dermatologic Therapy, 35, e15589.
Cosansu, N.C., Yuksekal, G., Turan, U., Umitfer, F., Yaldiz, M., & Sevimli Dikicier, B. (2022). Investigating the systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) as indicators of the anti-inflammatory effects of isotretinoin in patients with acne vulgaris. Cutaneous and Ocular Toxicology, 41, 174–218.
Hu, B., Yang, X.R., Xu, Y., Sun, Y.F., Sun, C., Guo, W., Zhang, X., Wang, W.M., Qiu, S.J., et al. (2014). The systemic immune-inflammation index predicts the prognosis of patients after curative resection for hepatocellular carcinoma. Clinical Cancer Research, 20, 6212–6222.
Jia, C.P., Chen, H., & Sun, B. (2019). Research advances on the predictive value of preoperative systemic inflammatory response index for prognosis in patients with resectable pancreatic cancer. Zhonghua Wai Ke Za Zhi (Chinese Journal of Surgery), 57, 862–885.
Jiang, H., Li, D., Xu, T., Chen, Z., Shan, Y., Zhao, L., Fu, G., Luan, Y., Xia, S., et al. (2022). The systemic immune-inflammation index predicts contrast-induced acute kidney injury in patients undergoing coronary angiography: A cross-sectional study. Frontiers in Medicine, 9, 841601.
Kobyliak, N., Abenavoli, L., Mykhalchyshyn, G., Kononenko, L., Boccuto, L., Kyriienko, D., & Dynnyk, O. (2018). A multi-strain probiotic reduces the Fatty Liver Index, cytokines, and aminotransferase levels in NAFLD patients: Evidence from a randomized clinical trial. Journal of Gastrointestinal and Liver Diseases, 27, 41–49.
Kurtul, A., & Ornek, E. (2019). Platelet to lymphocyte ratio in cardiovascular diseases: A systematic review. Angiology, 70, 802–818.
Li, S., Lan, X., Gao, H., Li, Z., Chen, L., Wang, W., Song, S., Wang, Y., Li, C., et al. (2017). Systemic Inflammation Response Index (SIRI), cancer stem cells, and survival outcomes in localized gastric adenocarcinoma after curative resection. Journal of Cancer Research and Clinical Oncology, 143, 2455–2468.
Ma, S.J., Yu, H., Khan, M., Gill, J., Santhosh, S., Chatterjee, U., Iovoli, A., Farrugia, M., Mohammadpour, H., et al. (2022). Evaluation of optimal thresholds for the neutrophil-lymphocyte ratio and its association with survival outcomes among patients with head and neck cancer. JAMA Network Open, 5, e227567.
Qi, Q., Zhuang, L., Shen, Y., Geng, Y., Yu, S., Chen, H., Liu, L., Meng, Z., Wang, P., et al. (2016). A novel systemic inflammation response index (SIRI) for predicting survival in pancreatic cancer patients after chemotherapy. Cancer, 122, 2158–2167.
Rensen, S.S., Slaats, Y., Nijhuis, J., Jans, A., Bieghs, V., Driessen, A., Malle, E., Greve, J.W., & Buurman, W.A. (2009). Increased hepatic myeloperoxidase activity in obese subjects with nonalcoholic steatohepatitis. American Journal of Pathology, 175, 1473–1482.
Riazi, K., Swain, M.G., Congly, S.E., Kaplan, G.G., & Shaheen, A.A. (2022). Race and ethnicity in non-alcoholic fatty liver disease (NAFLD): A narrative review. Nutrients, 14.
Ruhl, C.E., & Everhart, J.E. (2015). Fatty liver indices in the multiethnic United States National Health and Nutrition Examination Survey. Alimentary Pharmacology & Therapeutics, 41, 65–76.
Song, Y., Guo, W., Li, Z., Guo, D., Li, Z., & Li, Y. (2022). The systemic immune-inflammation index is associated with hepatic steatosis: Evidence from NHANES 2015–2018. Frontiers in Immunology, 13, 1058779.
Tang, Y., Zeng, X., Feng, Y., Chen, Q., Liu, Z., Luo, H., Zha, L., & Yu, Z. (2021). Association of the systemic immune-inflammation index with short-term mortality in congestive heart failure: A retrospective cohort study. Frontiers in Cardiovascular Medicine, 8, 753133.
Tilg, H., Adolph, T.E., Dudek, M., & Knolle, P. (2021). Non-alcoholic fatty liver disease: The interplay between metabolism, microbes, and immunity. Nature Metabolism, 3, 1596–1607.
Tong, Y.S., Tan, J., Zhou, X.L., Song, Y.Q., & Song, Y.J. (2017). The systemic immune-inflammation index predicts chemoradiation resistance and poor outcomes in patients with stage III non-small cell lung cancer. Journal of Translational Medicine, 15, 221.
Xiao, S., Wang, X., Zhang, G., Tong, M., Chen, J., Zhou, Y., Ji, Q., Liu, N., 2023a. The association between the Systemic Immune Inflammation Index (SIII) and cardiovascular disease, including estimated Pulse Wave Velocity, Atherogenic Index of Plasma, and Triglyceride-Glucose Index: Results from a large cross-sectional study. Mediators of Inflammation, 2023, Article ID 1966680.
Xiao, S., Wang, Z., Zuo, R., Zhou, Y., Yang, Y., Chen, T., Liu, N., 2023b. Association of Systemic Immune Inflammation Index with mortality due to all causes, cardiovascular disease, and cancer in patients with cardiovascular disease: A cross-sectional study. Journal of Inflammation Research, 16, 941–961.
Xie, Y., Zhuang, T., Ping, Y., Zhang, Y., Wang, X., Yu, P., Duan, X., 2021. Elevated levels of the Systemic Immune Inflammation Index are associated with disease activity in patients with ulcerative colitis. Clinical Chemistry and Laboratory Medicine, 517, 122–216.
Yan, M., Man, S., Ma, L., Gao, W., 2022. Molecular mechanisms and current clinical therapy in nonalcoholic steatohepatitis: An overview and perspectives. Metabolism, 134, Article ID 155264.
Yang, R., Chang, Q., Meng, X., Gao, N., Wang, W., 2018. Prognostic value of the Systemic Immune Inflammation Index in cancer: A meta-analysis. Journal of Cancer, 9, 3295–3302.
Ye, C., Yuan, L., Wu, K., Shen, B., Zhu, C., 2023. Association between the Systemic Immune Inflammation Index and chronic obstructive pulmonary disease: A population-based study. BMC Pulmonary Medicine, 23, Article 295.
Zafrani, E.S., 2004. Non-alcoholic fatty liver disease: An emerging pathological spectrum. Virchows Archiv, 444, 3–12.
Zhang, Y., Xing, Z., Zhou, K., Jiang, S., 2021. The predictive role of the Systemic Inflammation Response Index (SIRI) in the prognosis of stroke patients. Clinical Interventions in Aging, 16, 1997–2007.
Zhang, X., Zuo, R., Xiao, S., Wang, L., 2022. Association between iron metabolism and non-alcoholic fatty liver disease: Evidence from the National Health and Nutrition Examination Survey (NHANES 2017–2018) and a controlled animal study. Nutrition & Metabolism, 19, Article 81.
Zhao, E., Cheng, Y., Yu, C., Li, H., Fan, X., 2023. The systemic immune-inflammation index's non-linear association with all-cause mortality in individuals with nonalcoholic fatty liver disease. Annals of Medicine, 55, Article 2197652.
Zhao, S., Dong, S., Qin, Y., Wang, Y., Zhang, B., Liu, A., 2022. Inflammation index SIRI is linked to increased all-cause and cardiovascular mortality in patients with hypertension. Frontiers in Cardiovascular Medicine, 9, Article 1066219.
Zhou, Y.X., Li, W.C., Xia, S.H., Xiang, T., Tang, C., Luo, J.L., Lin, M.J., Xia, X.W., Wang, W.B., 2022. The predictive value of the Systemic Immune Inflammation Index for adverse outcomes in patients with acute ischemic stroke. Frontiers in Neurology, 13, Article 836595.
Zhou, Z., Xu, M.J., Cai, Y., Wang, W., Jiang, J.X., Varga, Z.V., Feng, D., Pacher, P., Kunos, G., et al., 2018. Neutrophil-Hepatic Stellate Cell interactions promote fibrosis in experimental steatohepatitis. Cellular and Molecular Gastroenterology & Hepatology, 5, 399–413.
Zipf, G., Chiappa, M., Porter, K.S., Ostchega, Y., Lewis, B.G., Dostal, J., 2013. National Health and Nutrition Examination Survey: Plan and operations from 1999–2010. Vital and Health Statistics. Series 1, Programs and Collection Procedures, 1-37.
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2024 Moamen Abdelfadil Ismail, Muqrin Mulfi Owaidh Almutairi, Feras Alnufaily, Abdulrahman Atallah Aldughaylibi, Rashed Hassan Ali Almalki, Nawaf Mohsen Mubarak Alsuhaymi, Norah Turki M Aljuaid, Rahaf Sawan, Rahaf Abdullah Alshahrani, Asayil Soliman Alqurashi, Ahmed Abdullah M. Alshehri, Ohud Ghulayyim Alghamdi, Amina Jaafar Abdulla Ali Alsaffar, Intesar Saleh Almahdi, Fatima Mohsen Ibrahim Ali

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their published articles online (e.g., in institutional repositories or on their website, social networks like ResearchGate or Academia), as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
Except where otherwise noted, the content on this site is licensed under a Creative Commons Attribution 4.0 International License.