Predictive Biomarker Signatures in Non-Alcoholic Fatty Liver Disease: Hs-CRP, Monocyte to High-Density Lipoprotein Cholesterol Ratio and Neutrophil Percentage to Albumin Ratio

Background: NAFLD (Non-Alcoholic Fatty Liver Disease) is liver fat buildup unrelated to alcohol, linked to obesity, diabetes, and metabolic syndrome. It ranges from simple steatosis to NASH (inflammation/fibrosis). Often asymptomatic, detected via blood tests or imaging. Managed with weight loss, diet, exercise, and controlling metabolic risks to prevent cirrhosis or liver cancer. The present study aims to investigate the association between human serum C-Reactive protein (hs-CRP), monocyte to high-density lipoprotein cholesterol ratio (MHR) and neutrophil percentage to albumin ratio (NPR) with non-alcoholic fatty liver disease (NAFLD) in the South-Indian population. Methods: A cross-sectional study included 102 patients (51 case and 51 control) aged above 18 years who visited the outpatient ward of a tertiary care hospital in Tamil Nadu, India. The diagnosis for NAFLD was done using ultrasonographic findings. Results: NAFLD patients exhibited slightly higher NPAR levels compared to non-NAFLD individuals, though the difference was not statistically significant (p = 0.2064). However, both MHR and HsCRP were significantly elevated in NAFLD (p < 0.001). ROC analysis revealed that HsCRP had near-perfect discriminatory power for NAFLD (AUC = 0.9942), with a cutoff of ≥1.0 mg/L correctly classifying 95.2% of cases. MHR showed moderate predictive ability (AUC = 0.6935), while NPAR performed poorly (AUC = 0.5592). Conclusion: Our findings highlight HsCRP as a highly sensitive marker for NAFLD, though further validation is needed to confirm its diagnostic utility in broader populations.