Association of pan-immune-inflammatory value with metabolic dysfunction-associated steatotic liver disease: findings from NHANES 2017-2020

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease worldwide. The pan-immune-inflammation value (PIV) has been proposed as a biomarker for assessing immune status and inflammation. There is currently no evidence regarding the effect of PIV on the risk of MASLD. This study aimed to investigate the association between PIV and MASLD. Methods The cross-sectional study included 6462 adults aged >= 20 years from the National Health and Nutrition Examination Survey 2017-2020. PIV was calculated based on blood count data. Weighted multivariable logistic regression was employed to calculate the odds ratio (OR) and 95% confidence interval (CI) to investigate the association of PIV and MASLD. Restricted cubic spline (RCS) analysis was conducted to explore the dose-response relationship between PIV and MASLD. Stratified and sensitivity analyses were performed to confirm the robustness of our findings. Results Among 6462 participants, 2458 were diagnosed with MASLD. Positive associations between LnPIV and MASLD were observed in all three models (Model 1: OR = 1.46, 95% CI: 1.28-1.66, P < 0.001; Model 2: OR = 1.41, 95% CI: 1.24-1.60, P < 0.001; Model 3: OR = 1.39, 95% CI: 1.16-1.65, P = 0.004). When PIV was classified into quartiles, both Q3 and Q4 exhibited significantly increased risks of MASLD compared with the reference Q1 in full adjusted Model 3 (Q3: OR = 1.63, 95% CI: 1.20-2.22, P = 0.012; Q4: OR = 1.76, 95% CI: 1.28-2.41, P = 0.008; P for trend = 0.002). RCS analysis did not show a nonlinear relationship between LnPIV and MASLD (P = 0.093 for nonlinearity). Stratified analysis showed a consistent positive association between LnPIV and MASLD in all subgroups, and sensitivity analyses supported the reliability of these results. Conclusions Higher PIV levels are significantly associated with an increased prevalence of MASLD, indicating that PIV is a potentially effective inflammatory marker for assessing MASLD in participants.