Predictive role of lactate dehydrogenase-to-albumin ratio (LAR) in nonalcoholic fatty liver disease and advanced liver fibrosis

Globally, nonalcoholic fatty liver disease (NAFLD) is recognized as one of the most prevalent chronic liver disease. Its progression to advanced liver fibrosis carries significant morbidity risks. However, noninvasive diagnostic tools remain limited. While chronic inflammation drives NAFLD pathogenesis, the lactate dehydrogenase-to-albumin ratio (LAR)—an easily accessible inflammatory biomarker from routine blood tests—has not been evaluated for its predictive value in NAFLD and associated advanced liver fibrosis. This study aims to assess LAR’s potential as a novel biomarker for predicting both conditions. Utilizing cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2017–2018, NAFLD was characterized by a controlled attention parameter of ≥285 dB/m, while advanced liver fibrosis was identified using vibration-controlled transient elastography with a threshold of ≥12 kPa. Weighted multivariate logistic regression and receiver operating characteristic analysis were employed to evaluate the associations and predictive performance of LAR in relation to NAFLD and advanced liver fibrosis. To elucidate nonlinear relationships, restricted cubic spline regression models and segmented regression models were applied. Additionally, subgroup analyses were performed to further investigate these associations. Among 3750 participants (48.1% men), LAR was significantly associated with both NAFLD and advanced liver fibrosis. Increased LAR was negatively associated with NAFLD (OR = 0.81, 95% CI: 0.69–0.96, P = .022) and positively associated with advanced liver fibrosis (OR = 1.30, 95% CI: 1.04–1.63, P = .029). LAR demonstrated moderate diagnostic accuracy for NAFLD (area under the curve = 0.795) and high accuracy for advanced fibrosis (area under the curve = 0.861). LAR is a promising noninvasive biomarker for predicting the occurrence of NAFLD and advanced liver fibrosis. This may assist clinicians in the early detection and monitoring of chronic liver disease.