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. 2025 May 29;25(1):415.
doi: 10.1186/s12876-025-04000-z.

Association between C-reactive protein to lymphocyte ratio and gallstones: a cross-sectional study

Xiaoyang Sun #  1 , Jie Lin #  1 , Zhenao Wang  1 , Chenfang Zhang  1 , Kai Zhao  1 , Xuewen Zhang  2 , Jiyao Sheng  3
Affiliations

Association between C-reactive protein to lymphocyte ratio and gallstones: a cross-sectional study

Xiaoyang Sun et al. BMC Gastroenterol. .

Abstract

Background: Inflammation plays a key role in the development of gallstones, and the C-reactive protein to lymphocyte ratio (CLR) has been introduced as a promising biomarker for evaluating inflammatory processes. Nonetheless, its correlation with gallstone prevalence remains ambiguous. This study aims to evaluate the potential link between CLR levels and gallstone prevalence.

Methods: This study utilized data from the National Health and Nutrition Examination Survey, covering the periods from March 2017 to 2020 and 2021 to 2023. Multivariate logistic regression was employed to examine the association between CLR and gallstone prevalence. Furthermore, smoothed curve fitting, subgroup analysis, and interaction testing were performed to provide a comprehensive evaluation. We also employed receiver operating characteristic (ROC) curves to determine the predictive ability of the index for gallstones.

Results: Among the 13,386 participants included in this study, 1,444 were diagnosed with gallstones. In a fully adjusted model, a small but statistically significant positive association between CLR and the prevalence of gallstones was observed (odds ratio [OR] = 1.07, 95% CI: 1.01-1.12). Compared to individuals in the lowest tertile of CLR (T1), those in the middle tertile (T2) showed a non-significant increase in gallstone prevalence (OR = 1.10, 95% CI: 0.94-1.29), while the highest tertile (T3) exhibited a statistically significant elevation (OR = 1.20, 95% CI: 1.03-1.41). Smoothed curve fitting further confirmed this positive relationship. Bonferroni-corrected subgroup analysis demonstrated a statistically significant association between CLR and gallstones in the "Married/Living with Partner" subgroup (P < 0.0015), while no significant associations were observed in the other subgroups. Additionally, Bonferroni-corrected interaction tests indicated no significant interactions between CLR and gallstones across all subgroups (P for interaction > 0.0038).

Conclusion: Higher CLR was associated with higher gallstone prevalence. However, additional large-scale prospective studies are required to further investigate the role of CLR in the prevalence of gallstones.

Keywords: C-reactive protein to lymphocyte ratio; Cross-sectional study; Gallstones; Inflammation; NHANES.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the National Center for Health Statistics Research Ethics Review Board. The patients/participants provided their written informed consent to participate in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of participants selection. NHANES, National Health and Nutrition Examination Survey
Fig. 2
Fig. 2
The linear associations between CLR and gallstones. The solid red line illustrates the smooth curve fit between the variables. The blue bands represent the 95% confidence interval derived from the fit
See this image and copyright information in PMC

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