Abstract
INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a leading cause of chronic liver disease worldwide, yet simple and reliable non-invasive markers for fibrosis assessment remain limited. Accessible blood-based indicators could aid early detection of significant fibrosis. This cross-sectional study evaluated the diagnostic performance of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) as non-invasive predictors of liver fibrosis severity in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: This cross-sectional study analyzed data extracted from medical records collected between 2020 and 2023. MASLD diagnosis was based on clinical, laboratory, and imaging findings. Liver fibrosis stage was assessed using transient elastography. Statistical analyses included comparative tests between fibrosis groups and ROC curve analysis to identify optimal cut-off values and evaluate diagnostic performance. RESULTS: A total of 140 patients were included. Patients were divided into two groups: non-significant fibrosis (F < F2; n = 95, 68.6%) and significant fibrosis (F ≥ F2; n = 45, 31.4%). Mean NLR was 1.77 in F < F2 versus 2.57 in F ≥ F2 (p < 0.0001). ROC analysis identified an optimal NLR cut-off of 1.79, showing 90% sensitivity, 68.7% specificity, and an AUC of 0.812 (95% CI 0.74-0.88). Mean MPV was 8.84 fL in F < F2 versus 9.95 fL in F ≥ F2 (p < 0.0001). The optimal MPV threshold was 9.05 fL, yielding 66% sensitivity, 65.7% specificity, and an AUC of 0.71 (95% CI: 0.62-0.81). NLR demonstrated excellent accuracy for identifying significant fibrosis, while MPV showed moderate discriminatory ability. CONCLUSION: NLR and MPV correlate significantly with fibrosis severity and may serve as accessible, low-cost adjunctive biomarkers for early risk stratification of MASLD patients, especially in primary care or resource-limited settings.