The advanced lung cancer inflammation index has an L-shaped association with prognosis in American adults with metabolic dysfunction-associated fatty liver disease: a cohort study

Yuexia Lu¹Shuaipeng Yuan²Huazhao Xu¹Jiqi Ouyang¹Jinsheng Dong¹Runshun Zhang^1*

• ¹Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
• ²First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China

The ALI was assessed as a composite measure reflecting nutritional status and systemic inflammation. It was calculated as body mass index (BMI) (kg/m²) × serum albumin (g/dL) / neutrophil-to-lymphocyte ratio (NLR).Our study aims to find the relationship between advanced lung cancer inflammation index (ALI) levels and the prognosis of patients with MAFLD and to determine the predictive value of ALI in this context.Multivariate-adjusted Cox regression models were used to analyze the association between ALI and all-cause, cardiovascular, cancer, and diabetes-related mortalities in patients with MAFLD. Kaplan-Meier curves showed the association of ALI with allcause and cardiovascular mortalities in patients with MAFLD. Restricted cubic spline (RCS) analysis was conducted to assess the potential non-linear relationship between ALI level and MAFLD prognosis.The predictive ability of ALI was observed using receiver operating characteristic (ROC) curves. Stratified and sensitivity analyses were used to enhance the reliability and robustness.This study included 2,908 patients with MAFLD from the National Health and Nutrition Examination Survey (NHANES) database between 2003 and 2018. The median follow-up period for the 2,908 participants was 10.3 years, during which 636 deaths occurred. In the Cox regression model, the HRs(95%CIs) for all-cause, cardiovascular, cancer, and diabetes-related mortalities in the last quartile compared to the first quartile of ALI levels were 0.62 (0.44-0.85), 0.25 (0.14-0.45), 0.96(0.51-1.81), and 0.69 (0.25-1.92), respectively. RCS analysis demonstrated a L-shaped non-linear association between ALI levels and both all-cause and cardiovascular mortalities in participants with MAFLD. Subgroup analyses highlighted population heterogeneity in the relationship between ALI and MAFLD prognosis. ROC curve analysis showed that ALI had strong predictive power for all-cause and cardiovascular mortalities, with area under the curve values of 0.80 (0.77-0.83) and 0.82 (0.74-0.89), respectively.There was an L-shaped nonlinear association of the protective effect of ALI: when the indicators are below specific thresholds (all-cause mortality 71.48, cardiovascular mortality 68.54), a higher ALI was significantly associated with reduced mortality risks in MAFLD patients; otherwise the protective effect tended to be consistent. ALI exhibits a robust predictive capability for all-cause and cardiovascular mortalities among participants with MAFLD, providing a valuable prognostic tool for optimizing patient management.