Association of Lipid Profile, Prothrombin Time, INR, and Hepatic Profile with Ultrasonographic Grades of Fatty Liver Disease: A Prospective Observational Study in a Tertiary Care Hospital

Abstract

Background: Fatty liver disease (FLD), particularly non-alcoholic fatty liver disease (NAFLD), is a major health problem worldwide and affects 25-38% of the adult population. Ultrasonography is one of the most common non-invasive methods to grade hepatic steatosis as Grade I (mild), Grade II (moderate) and Grade III (severe). Correlation of ultrasonographic grades with biochemical parameters including lipid profile and coagulation markers is not well defined in Indian tertiary care settings. Objectives: To assess the relationship between lipid profile parameters, coagulation parameters (Prothrombin time [PT] and international normalised ratio [INR]), and hepatic biochemical markers with ultrasonographic grades of FLD. Methods: This prospective observational study enrolled 100 consecutive patients in whom ultrasonography established a diagnosis of FLD. Steatosis grade was determined by abdominal ultrasonography, and fasting blood samples were analysed for total cholesterol, triglycerides, HDL, LDL, PT and INR. Clinical histories were collected, and biochemical parameters were compared by steatosis grades. Results: Grade I FLD (72%) was the most common, followed by grade II (21%) and grade III (7%). The most significantly affected age group was 51–65 years (35%). Total cholesterol (139.7, 174.1, 174.4 mg/dL), triglycerides (147.1, 157.4, 238.1 mg/dL), LDL cholesterol (82.0, 96.4, 101.5 mg/dL) and LDL/HDL ratio (2.45, 2.84, 3.16) progressively increased from Grade I to III. HDL levels were low in all grades (35.0-37.4 mg/dL). INR had a significant grade-dependent increase (1.50, 2.39, 3.15). PT increased from 18.3 sec in Grade I to 21.1 sec in Grade II, indicating a worsening hepatic synthetic dysfunction. The most severe abnormalities were found in patients with liver failure and alcoholic liver disease. Conclusion: Triglycerides and INR had the strongest correlation, and the severity of FLD on ultrasonography was associated with progressive dyslipidemia and coagulation impairment. Routine testing of lipids and coagulation may improve risk stratification and clinical management of FLD.