The role of platelet-related parameters for the prediction of NAFLD in OSAHS patients

Abstract

Purpose As the detection of non-alcoholic fatty liver disease (NAFLD) is imperative for the prevention of its complications, we aimed to explore the predictive value of platelet to lymphocyte count ratio (PLR) and white blood cell count to mean platelet volume ratio (WBC/MPV) in relation to the occurrence of NAFLD among patients with obstructive sleep apnea–hypopnea syndrome (OSAHS). Methods This was a cross-sectional study consisting of 351 patients with OSAHS (279 with and 72 without NAFLD). The logistic regression analysis was performed to estimate associations between PLR, WBC/MPV, and NAFLD. Finally, the receiver operating characteristic curve (ROC curve) was used to analyze the efficacy of PLR and WBC/MPV in NAFLD prediction. Results Compared to the OSAHS-only group, there was a rising trend in AHI and TS90% in the OSAHS + NAFLD group. And the logistic regression analysis identified average oxygen saturation (MaSO2), WBC/MPV and PLR as predicted factors (odds ratio [OR] = 1.134, P = 0.031; OR = 7.559, P = 0.018, OR = 0.980, P < 0.001, respectively) for NAFLD in OSAHS patients. Moreover, compared with WBC/MPV, PLR, FLI, and APRI, a combination of WBC/MPV and PLR presented the largest AUC for the detection of NAFLD in BMI < 28 kg/m2 (0.753, 95% CI 0.684–0.822), and in age ≥ 60 years subgroup (0.786, 95% CI 0.692–0.880) in ROC analysis. Meanwhile, a combination of WBC/MPV and PLR presented the second largest AUC for the detection of NAFLD in all subjects (0.743, 95% CI 0.708–0.831), as well as in the age < 60 years subgroup (0.729, 95% CI 0.652–0.806), only ranked after FLI, suggesting the combination of WBC/MPV and PLR has a good predictive value for NAFLD in OSAHS patients. Conclusion We confirmed that the levels of WBC/MPV, PLR, and MaSO2 were closely related to the occurrence of NAFLD among OSAHS patients. Furthermore, our results highlighted the clinical combination of WBC/MPV and PLR levels could act as a simple and effective biomarker for screening NAFLD in patients with OSAHS.

The association between platelet-related parameters and nonalcoholic fatty liver disease in a metabolically healthy nonobese population

“…Several studies have shown conflicting results on platelet-related parameters and NAFLD. Previously, Chen et al revealed that PLR and WBC/MPV were closely related to the occurrence of NAFLD among obstructive sleep apnea–hypopnea syndrome patients, and in the subgroup analysis, WBC/MPV and PLR had good performance in NAFLD prediction in the subgroup with BMI < 28 kg/m 2 , but not in BMI ≥ 28 kg/m 2 21 . However, Duan et al showed that platelet-related parameters such as PLR and MPV are not associated with NAFLD in obese children, but inflammatory cytokines such as IL-1β, IL-6, and IL-17 levels were significantly associated with NAFLD 22 .…”

“…Cut-off values that optimized both sensitivity and specificity were selected. One hundred iterations were performed to split the train-test set in a 7:3 ratio 19 , 21 . The results tailored to the new MASLD definition were also appended to the supplementary figures and tables.…”

“…However, the association between inflammatory markers and NAFLD remains uncertain. Many studies have demonstrated that WBC count, MPV and PLR are associated with NAFLD 18 – 21 . On the other hand, Duan et al showed that PLR, MPV and platelet distribution width are not associated with NAFLD in obese children 22 .…”

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

“…On the other hand, platelets can cause liver inflammation by enhancing the recruitment of white blood cells in the sinusoidal endothelium, and can further activate effector cells, thereby amplifying liver injury. Various long-term studies have shown that platelets induce the progression of NAFLD primarily by generating a pro-inflammatory and pro-fibrotic environment in the liver ( 51 , 52 ). In the presence of inflammatory diseases, circulating lymphocytes are often reduced ( 48 ).…”

Association of systemic inflammatory indices with anthropometric measures, metabolic factors, and liver function in non-alcoholic fatty liver disease

“…Regarding PLR, several studies similarly suggested that PLR may be more useful as a marker in determining the increased thrombotic state and inflammatory response in morbid obesity, obstructive sleep apnea–hypopnea syndrome, overall survival in patients with NAFLD-related hepatocellular carcinoma 5 , 36 , 41 , 42 . Taken together, it seems that PLR has relatively higher diagnostic accuracy for liver fibrosis 35 .…”