RDW to Platelet Ratio: A Novel Noninvasive Index for Predicting Hepatic Fibrosis and Cirrhosis in Chronic Hepatitis B

Abstract

ObjectiveTo develop a simple predictive model for significant fibrosis and cirrhosis in chronic hepatitis B (CHB) using the routine hematological parameters of a complete blood count.MethodsA total of 458 eligible CHB patients who had undergone a liver biopsy were randomly divided into two cohorts: an estimation group (n = 310) and a validation group (n = 148). Liver histology was assessed according to the Metavir scoring scheme. All common demographics, hematological parameters, HBeAg status, HBV DNA, and liver biochemistry were analyzed.ResultsBased on routinely available clinical parameters (age, sex, HBeAg status, HBV DNA, common hematological parameters of a complete blood cell count), a model for predicting significant fibrosis (Metavir score ≥2) in the estimation group was derived using platelets and red cell distribution width (RDW), and another model for predicting cirrhosis (Metavir score = 4) was derived using platelets, RDW and hemoglobin. A novel index, the RDW to platelet ratio (RPR), was developed to amplify the opposing effects of liver fibrosis on the RDW and platelets. The AUCs of the RPR for predicting significant fibrosis and cirrhosis were 0.825 and 0.884, respectively, which is superior to the AAR, FIB-4 and APRI in the estimation group. Compared with the two derived models, the RPR has a comparable predictive power for significant fibrosis and cirrhosis. Using optimized cutoffs (0.10 and 0.16), the RPR accurately predicted 63.1% of cases with significant fibrosis and 73.7% of cases with cirrhosis and accurately excluded 85.5% of the cases with mild fibrosis and 93.0% of the cases with no cirrhosis.ConclusionThe RPR, a routinely available, inexpensive and easily calculated index, can predict significant fibrosis and cirrhosis in CHB patients with relatively high accuracy. The application of this index may reduce the need for liver biopsy in CHB patients.

Mean platelet volume, red cell distribution width, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in the diagnosis acute appendicitis

“…Some studies have shown that RDW levels are an independent variant of prognosis in cases with cardiovascular diseases, type 2 diabetes mellitus, pulmonary thromboembolism and ischemic stroke (13,14). Additionally, It was found to be related to mortality and other severe adverse outcomes in infectious diseases (28). Nowadays, different authors have been studied as an inflammatory marker in AA (8,15,16) however the results are limited and contradictory.…”

Fibrosis assessment in patients with chronic hepatitis B virus (HBV) infection

“…Of these, indirect markers utilize routine laboratory measures such transaminases, markers of liver synthetic function (albumin, bilirubin, prothrombin time), or other readily available indices which relate to liver disease stage (platelet levels, red cell distribution width). Multiple studies using a combination of these parameters have yielded useful noninvasive scores of fibrosis, and the most commonly used will be discussed here ( Table 1) (31)(32)(33)(34)(35).…”

Association Between Red Cell Distribution Width (RDW)/Platelet Ratio and Degree of Fibrosis in Patient with Chronic Hepatitis B

“…Based on the results of the analysis, this ratio is better than APRI with AUC 0.825 in predicting significant fibrosis. 10 In this study, there was a significant relationship between RDW/platelet ratio and degree of liver fibrosis. In our study ROC analysis, obtained AUC of 0.706, lower than previous studies by Chen et al This may be due to the small number of samples in this study and the characteristics of the sample also differed between the studies.…”