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

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.