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Association of C-reactive protein-to-lymphocyte ratio (CLR) with liver stiffness measurement (LSM): Findings from NHANES 2017 to 2018

Junxi Liu,Q. Qiao,Mocun Yang,Xue Wang,Boda Zhou

Published 2025 in Medicine

ABSTRACT

The progression of nonalcoholic fatty liver disease may lead to liver fibrosis, with liver stiffness measurement (LSM) as an important noninvasive measurement for liver stiffness, indirectly reflecting the degree of liver fibrosis. C-reactive protein-to-lymphocyte ratio (CLR) is an important inflammatory marker which has potential diagnostic value in nonalcoholic fatty liver disease. This study investigates the association between the CLR and LSM. Utilizing data from the National Health and Nutrition Examination Survey 2017 to 2018, we included participants completed the liver transient elastography exam with complete CLR value. We excluded participants lacking ultrasound data on essential covariates. Our study implemented multi-model linear regression analysis, subgroup analysis, to investigate the independent relationship between CLR and LSM. We enrolled a total of 3399 participants (51.3% male and 48.7% female). Participants were divided into 2 groups based on LSM cutoff value of 12.5 kPa, indicating severe liver fibrosis or cirrhosis. We found after adjusting every potential covariates, CLR was significantly associated with LSM (odd ratios = 0.38, 95% confidence interval: 0.28–0.48, P < .001). Subgroup analysis suggested the relationship between CLR and LSM remained consistent, a significant interaction was noted between CLR and LSM accross different race groups. The restricted cubic spline model indicated a significant nonlinear relationship between CLR and LSM. In the adult population above 20 year old of National Health and Nutrition Examination Survey in U.S., lower CLR level was associated with higher prevalence of LSM above 12.5 kPa, which may be influenced by race. These findings indicate CLR as an independent protective factor for clinically significant liver fibrosis.

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