The Correlation Between hs CRP TG Triglycerides Glucose Index in NAFLD and Liver Fibrosis

Non-Alcoholic Fatty Liver Disease (NAFLD) is the most prevalent chronic liver disease in the world, affecting one-fourth of the global population, and represents a serious public health issue. NAFLD encompasses a broad spectrum of liver abnormalities, ranging from simple hepatic steatosis, which is thought to be benign, to non-Alcoholic Steatohepatitis (NASH) without fibrosis and progressing to fibrotic NASH. The evolution of liver fibrosis results in irreversible architectural changes of the liver and can progress to Hepatocellular Carcinoma (HCC) (Sheka et al., 2020; Zhou et al., 2025). NAFLD is associated with an increased risk of systemic metabolic disorders, such as hyperuricemia, hyperlipidemia, IR, and hyperglycemia. These metabolic disorders, in combination with NAFLD, contribute to the risk of developing extrahepatic malignancies and cardiovascular diseases, which are the main causes of extrahepatic mortality (Li et al., 2022).

High-sensitivity C-reactive protein (hs-CRP) is a widely used biomarker for measuring systemic inflammation and is readily available for measurement. It is especially useful for identifying low-grade inflammation and has been associated with adverse health outcomes, including cardiovascular disease, metabolic syndrome, insulin resistance, and decreased physical function (Banait et al., 2022; Son et al., 2022). In addition, hs-CRP is a marker of pro-inflammatory cytokines such as interleukin-6 (IL- 6) and tumor necrosis factor-alpha (TNF-α), and it has been used as a useful and valid marker of inflammation in large-scale epidemiological studies (Banait et al., 2022). In addition, the C-reactive protein-triglyceride glucose index (CTI) is a composite index that integrates the triglyceride and glucose (TyG) index with hs-CRP, thus reflecting both insulin resistance and systemic inflammation. Previous studies have found that the CTI is linked to various diseases, such as coronary heart disease, depression, stroke, NAFLD, and liver fibrosis (Ruan et al., 2022 Recent research has helped elucidate the pathogenic roles of insulin resistance (IR) and inflammation in NAFLD. Patients with non-alcoholic steatohepatitis (NASH) are likely to have higher levels of high-sensitivity C-reactive protein (hs-CRP) and pro-inflammatory cytokines, which could contribute to chronic inflammation and disease progression. Moreover, systemic inflammation is known to play a pivotal role in the pathogenesis of advanced cirrhosis (Ling et al., 2023). The triglyceride-glucose (TyG) index, a non-invasive surrogate marker of insulin resistance, is strongly linked with the development and progression of hepatic steatosis and fibrosis. The combined high-sensitivity C-reactive protein and triglyceride glucose index (CTI), which combines TyG and hs-CRP, offers a comprehensive estimate that reflects both insulin resistance and inflammation (Ruan et al., 2022; Xu et al., 2024). However, there are only a limited number of studies with a limited number of patients that have addressed the Correlation between the hs-CRP-triglyceride glucose index and NAFLD and liver fibrosis.

Inclusion criteria

• Adults ≥18 years
• Available fasting labs: TG, fasting glucose, hs-CRP
• Valid liver assessment by VCTE (FibroScan LSM) and CAP or ultrasound-based steatosis assessment

Exclusion criteria

• 1- Significant alcohol intake (define using your local standard; commonly sex-specific thresholds) 2- Viral hepatitis (HBsAg positive and/or HCV RNA positive) 3- Other chronic liver diseases (autoimmune hepatitis, hemochromatosis, Wilson's, etc.) 4- Pregnancy