Association of hsCAR With MAFLD and Liver Fibrosis: A Cross-sectional Study

Study Overview
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Brief Summary
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The goal of this observational study is to investigate the associations between a novel inflammatory marker, high sensitivity C-reactiveprotein to albumin ratio (hsCAR), and steatosis and fibrosis of metabolic dysfunction-associated fatty liver disease (MAFLD). The main question[s] it aims to answer are: [question 1] Can hsCAR serve as a clinical indicator to determine whether a patient has MAFD? [question 2] Can hsCAR determine whether MAFLD patients are complicated with liver fibrosis?

Detailed Description
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Background Inflammation is related to the occurrence and development of fatty liver. Our research aimed to investigate the link between an inflammatory indicator, high-sensitivity C-reactive protein to albumin ratio (hsCAR), and metabolic dysfunction-associated fatty liver disease (MAFLD). Methods Ultrasonic indices were used to evaluate the severity of liver steatosis and fibrosis of participants from the NHANES database, respectively. The relationship between hsCAR and MAFLD was explored using multivariate logistic regression analysis, restricted cubic splines (RCS) as well as threshold analysis. Finally, subgroup analyses were performed using the same methodology.

Official Title
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Association of High-sensitivity C-reactive Protein to Albumin Ratio With Metabolic Dysfunction-associated Fatty Liver Disease and Liver Fibrosis: A Cross-sectional Study

Conditions
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Metabolic Dysfunction-associated Fatty Liver Disease, Hepatic Steatosis, Liver Fibrosis

Intervention / Treatment
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* Other: high-sensitivity C-reactive protein to albumin ratio


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Total participants from NHANES 2017-2020 Participants diagnosed with MAFLD. Metabolic dysfunction-associated fatty liver disease (MAFLD) is the term used to describe hepatic steatosis in the presence of metabolic abnormalities, excess weight, obesity, or type 2 diabetic mellitus. Diagnosis of diabetes mellitus: (1) taking glucose-lowering drugs; (2) HbA1c ≥ 6.5% (48 mmol/mol); (3) fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL); (4) 2-hour plasma glucose (2hPG) ≥ 11.1 mmol/L (200 mg/dL). Overweight or obesity: defined as BMI≥25 kg/m2 in Caucasians or BMI≥23 kg/m2 in Asians If presence of at least two metabolic risk abnormalities: Waist circumference≥102/88 cm in Caucasian men and women (or≥90/80 cm in Asian men and women) Blood pressure≥130/85 mmHg or specific drug treatment Plasma triglycerides≥150 mg/dl (≥1.70 mmol/L) or specific drug treatment Plasma HDL-cholesterol <40 mg/dl (<1.0 mmol/L) for men and <50 mg/dl (<1.3 mmol/L) for women or specific drug treatment Prediabetes (i.e., fasting glucose levels 100 to 125 mg/dl [5.6 to 6.9 mmol/L], or 2-hour post-load glucose levels 140 to 199 mg/dl [7.8 to 11.0 mmol] or HbA1c 5.7% to 6.4% [39 to 47 mmol/mol]) Homeostasis model assessment of insulin resistance score≥2.5 Plasma high-sensitivity C-reactive protein level >2 mg/L Exclusion Criteria: Liver ultrasound data not available participants without complete clinical data participants under 18 years old participants with cancer.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Non-MAFLD group<br>controlled attenuation parameter<274 dB/m | |
| MAFLD group<br>controlled attenuation parameter ≥ 274 dB/m | Other: high-sensitivity C-reactive protein to albumin ratio<br>* High-sensitivity C-reactive protein to albumin ratio is an inflammatory indicator which can make a determination of disease severity.<br>|
| Non-fibrosis group<br>liver stiffness measurement < 8.2 kPa | |
| Fibrosis group<br>liver stiffness measurement ≥ 8.2 kPa | Other: high-sensitivity C-reactive protein to albumin ratio<br>* High-sensitivity C-reactive protein to albumin ratio is an inflammatory indicator which can make a determination of disease severity.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Controlled attenuation parameter | Controlled attenuation parameter is an ultrasound indicator measured by FibroScan to evaluate the degree of liver steatosis | at baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Liver stiffness measurement | Liver stiffness measurement is an ultrasound indicator measured by FibroScan to evaluate the degree of liver stiffness | at baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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National Health and Nutrition Examination Survey, control attenuation parameter, liver stiffness measurement, inflammation, high-sensitivity C-reactive protein to albumin ratio, metabolic dysfunction-associated fatty liver disease