Abstract: Objective To analyze the relationship between the modified caudate-right lobe ratio (C/RL-r), aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), and the development of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Methods A total of 153 patients diagnosed with NAFLD treated at Baoding First Central Hospital between February 2021 and December 2022 were included in this study. The patients were divided into non-hepatic fibrosis group (81 cases) and hepatic fibrosis group (72 cases) based on liver puncture and pathology result. MRI scanning was performed to detect C/RL-r and laboratory tests were conducted to calculate the APRI and FIB-4. The analysis aimed to investigate the the correlation between laboratory indices, C/RL-r, APRI, FIB-4 and the presence of liver fibrosis in patients with NAFLD, as well as to identify independent risk factors for liver fibrosis. Additionally, the study sought to evaluate the predictive value of C/RL-r, APRI, FIB-4 for liver fibrosis in NAFLD patients. Results Significant differences were observed in the levels of alanine aminotransferase (ALT) [(42.32±10.21) U/L vs (36.21±7.78) U/L], aspartate aminotransferase (AST) [(45.36±8.72) U/L vs (27.45±5.40) U/L], total bilirubin (TBIL) [(13.52±3.65) μmol/L vs (12.24±2.16) μmol/L], γ-glutamyltransferase (GGT) [(60.53±13.41) U/L vs (53.69±12.44) U/L], triglyceride (TG) [(1.99±0.53) mmol/L vs (1.05±0.33) mmol/L], C/RL-r [(1.15±0.12) vs (0.92±0.09)], APRI [(0.52±0.15) vs (0.32±0.10)] and FIB-4 [(1.47±0.47) vs (0.94±0.30)] between the hepatic fibrosis group and the non-hepatic fibrosis group. The level of high density lipoprotein-cholesterol (HDL-C) [(1.03±0.26) mmol/L vs (1.32±0.45) mmol/L] was significantly lower in the hepatic fibrosis group (t=4.189, 15.453, 2.674, 3.272, 13.322, 13.501, 4.302, 8.405, 4.801, all P<0.05). Furthermore, ALT, AST, TG, C/RL-r, APRI, FIB-4 were positively correlated with liver fibrosis in NAFLD patients (r=0.531, 0.435, 0.571, 0.605, 0.771, 0.716, all P<0.001). High levels of ALT, AST, TG, C/RL-r, APRI and FIB-4 were identified as independent risk factors for liver fibrosis in NAFLD patients (P<0.05). The combination of C/RL-r, APRI, and FIB-4 demonstrated a significantly higher AUC (0.936) in predicting liver fibrosis in NAFLD patients compared to the AUC of C/RL-r (0.767), APRI (0.830), and FIB-4 (0.754) alone (Z=4.495, 3.999, 4.677, all P<0.001). Conclusion Elevated levels of C/RL-r, APRI and FIB-4 are observed in NAFLD patients with liver fibrosis, and the combined detection of these indices demonstrates a high predictive value for the occurrence of liver fibrosis in NAFLD patients.

Key words: Non-alcoholic fatty liver disease, Modified caudate lobe of liver/right lobe ratio, Aspartic aminotransferase to platelet ratio index, Fibrosis index based on the four factors, Liver fibrosis