The predictive value of the hepatorenal index for detection of impaired glucose metabolism in patients with non-alcoholic fatty liver disease

Background/Purpose Non-alcoholic fatty liver disease (NAFLD) patients are at increased risk of liver-related as well as cardiovascular mortality, including diabetes, coronary heart disease, and stroke, independently of traditional cardiovascular risk factors and metabolic syndrome. The aim of this study was to find out the predictive impact of hepatorenal index (HRI) in the detection of impaired glucose metabolism in asymptomatic NAFLD patients. Methods B-mode ultrasound examinations were performed and ultrasound images from all 89 NAFLD patients aged 50.8 +/- 10.1 years were analyzed by echogenicity analyzing software and HRI was acquired, and appropriate laboratory tests for liver, glucose, and lipid metabolism were undertaken. Results The mean HRI was 1.345 +/- 0.189. 23.59% of patients had mild NAFLD (HRI = 1.167 +/- 0.041), 64.04% moderate (HRI = 1.401 +/- 0.102), and 12.36% patients severe NAFLD (HRI = 1.802 +/- 0.098). Impaired glucose metabolism was present in 48.31% of patients. A positive correlation was present between HRI and impaired glucose metabolism (r = 0.335, p = 0.001). The coefficients of determinations R-2 for linear regression for HRI and glycated hemoglobin (HbA1c) and oral glucose tolerance test (GTT) were 0.05841 and 0.07498, respectively. The cutoff values for HRI in the detection of diabetes and prediabetes, and prediabetes only, were 1.4 and 1.38, respectively. In logistic regression, the beta coefficients for oral GTT, HbA1c, or HRI were 0.62042 (p = 0.0002), 2.18036 (p = 0.0033), and 2.36986 (p = 0.012). The hazard ratio (HR) coefficients (exp [b]) for HRI, HbA1c, and oral GTT sorted according to their HR strength were 10.6958, 8.8494, and 1.8597, respectively. Conclusion Ultrasonographically acquired HRI has a significant predictive impact on the detection of prediabetes and diabetes in patients with NAFLD.