A new model using platelet indices to predict liver fibrosis in patients with chronic hepatitis B infection

Assessment of the performance of haematological and non-invasive fibrotic indices for the monitoring of chronic HBV infection: a pilot study in a Ghanaian population

OBJECTIVE

Haematological and liver fibrotic markers could be appreciably utilized for effective monitoring of Chronic Hepatitis B viral (HBV) infection, thereby increasing patient's treatment outcome. The objective of this study was to assess the applicability of complete blood count (CBC) and non-invasive liver-fibrotic indices as markers of prognostic outcome and monitoring in HBV infections.

RESULTS

Significant differences in levels of white cell and differentials counts, red blood cell count, hemoglobin indices, and platelet indices were observed between HBV-infected patients (cases) and uninfected persons (controls). Levels of haemoglobin (Hb), total white blood cells (tWBC), neutrophils, monocytes, platelets, and Platelet Distribution width (PDW) were significantly lower (p < 0.05) in the cases compared to the controls. Total and indirect bilirubin; De-Ritis ratio, Aspartate transaminase to platelet ratio index (APRI) and RDW-to-platelet ratio (RPR) were elevated in cases compared with controls (p-value < 0.05). In a multivariate adjusted model to test the significance of markers, Hemoglobin Index (beta coefficient = - 0.876, p-value < 0.001), NLR (beta coefficient = - 0.839, p-value < 0.001), MPV_10000 (beta coefficient = - 0.333, p-value < 0.001) and Albumin (beta coefficient = - 0.059, p-value = 0.014), were associated with HBV infection status. Receiver operative characteristics curve analysis showed Hemoglobin Index (AUC = 0.744) and MPV_10000 (AUC = 0.730) as better prognostic markers for HBV-infection.

The Relationship between Mean Platelet Volume and Neutrophil-Lymphocyte Ratio and Liver Fibrosis in Patients with Chronic Hepatitis B

Objective: The neutrophil-lymphocyte ratio (NLR) can be helpful both in demonstrating acute and chronic liver injury and predicting malignant potential. The mean platelet volume (MPV) is also a marker that can be used as a risk indicator in atherosclerosis-associated diseases, reflecting inflammation. Within the scope of this research, we aimed to elucidate the relationship between the mean platelet volume and neutrophil-lymphocyte ratio in liver fibrosis in chronic hepatitis B patients. Materials and Methods: A total of 84 patients who were followed up with the diagnosis of chronic hepatitis B and who underwent liver biopsy were included in this prospective study. Complete blood count parameters (neutrophil, lymphocyte, neutrophil-lymphocyte ratio, hemoglobin, thrombocyte, MCV, and MPV values), demographic data, biochemistry panel (AST, ALT), HBV DNA, and liver biopsy fibrosis scores obtained from hospital database were analyzed. Since the follow-up period of chronic hepatitis B patients is six months, patients were screened in order to include a full 3-year screening pool. Results: A total of 84 patients were enrolled within the scope of this study. The chronicity index was '0' in 7.1% (n = 6), '1' in 23.8% (n = 20), '2' in 56% (n = 47), and '3' in 13.1% (n = 11)of the patients. According to the chronicity index groups, there was a statistically significant difference between the medians of the hepatitis activity index (HAI) values at the 5% significance level (p < 0.001). The correlation analysis revealed a statistically significant relationship between the chronicity index and the mean platelet volume to lymphocyte ratio (MPVL). However, considering the degree of the relationship, it can be said that it was a positive and weak relationship (p = 0.046, r = 0.218). Conclusions: Regarding the outcomes of this research, a significant relationship was found between the neutrophil-lymphocyte ratio, mean platelet volume, and fibrosis.

Mansoura simple scoring system for prediction of spontaneous bacterial peritonitis: lesson learnt

BACKGROUND AND OBJECTIVE

Spontaneous bacterial peritonitis (SBP) is a common bacterial infection with life-threatening sequelae in cirrhotic ascites. The purpose of this retrospective cohort study was to recognize the predictors of SBP to build up a noninvasive system to exclude or establish an episode of SBP.

PATIENTS AND METHODS

Of 1194 consecutive patients with cirrhotic ascites, only 966 patients were enrolled in this study. SBP was diagnosed once polymorphonuclear count was at least 250 cells/mm and/or there was a positive ascitic fluid culture result. Biochemical and clinical parameters were evaluated as predictors of SBP. A scoring system was established in the training group of 682 and validated in a second group of 284 participants.

RESULTS

The incidence of SBP was 12.3 and 12% in the training and validation groups, respectively. Age of at least 55 years, mean platelet volume (MPV) of at least 8.5 fl, neutrophil-to-lymphocyte ratio (NLR) of at least 2.5, and C-reactive protein (CRP) of at least 40 mg/l were identified as independent predictors of SBP. A scoring system including these four variables (age, MPV, and NLR with 1 point each, whereas CRP with 2 points) achieves a specificity of 98.2% with a positive predictive value for the diagnosis of SBP of 88.1% (score≥4). At a threshold of 1 point, the negative predictive value is 97.5% with a sensitivity of 92.9%. SBP is not associated with a high Model for End-stage Liver Disease score (P=0.135).

CONCLUSION

The combination of age, MPV, NLR, and CRP in a simple scoring system, Mansoura simple scoring system, supports quick and accurate exclusion or diagnosis of SBP.

New predictive factors of poor response to therapy in autoimmune hepatitis: role of mean platelet volume

BACKGROUND AND OBJECTIVES

The response to immunosuppressive therapy in autoimmune hepatitis (AIH) is a matter of debate. The aim of this work is to identify the histological, biochemical, and clinical predictive factors of incomplete response/treatment failure to the standard treatment (prednisone with or without azathioprine) in a well-characterized series of AIH Egyptian patients.

PATIENTS AND METHODS

Of 49 AIH patients, only 36 patients completed this retrospective cohort study. The immunological, biochemical, histopathological, and clinical characteristics of patients were evaluated at diagnosis and during follow-up.

RESULTS

Patients were classified into two groups; group A showed a complete response to therapy (n=22; 61%) and group B showed partial response/treatment failure (n=14; 39%). In a multivariate analysis, we observed that age at diagnosis up to 22 years [odds ratio (OR): 23.22; confidence interval (CI): 3.978-135.549; P<0.001], serum albumin up to 3.2 g/dl (OR: 5.36; CI: 1.237-23.209; P=0.025), mean platelet volume (MPV) of at least 10.75 fl (OR: 16.5; CI: 3.093-88.037; P<0.001), and presence of cirrhosis at diagnosis (OR: 8.44; CI: 1.682-42.392; P=0.001) were independent variables that can predict partial response/treatment failure. MPV correlated positively with stages of fibrosis/cirrhosis and grades of activity in liver biopsy at diagnosis and correlated inversely with serum albumin and age at presentation. During therapy, group B showed a fluctuation in MPV levels, however, group A showed a progressive decline until the end point.

CONCLUSION

Our study confirmed that younger age, hypoalbuminemia, increased MPV, and cirrhosis at diagnosis were all independent predictors of incomplete response/treatment failure in AIH patients. MPV may reflect the response to therapy.

Clinical usefulness and performance of acoustic radiation force impulse in patients with chronic hepatitis B

AIM

The aim of this study was to evaluate the performance of acoustic radiation force impulse (ARFI) compared with liver biopsy in quantifying fibrosis levels in patients with chronic hepatitis B (CHB).

PATIENTS AND METHODS

The study was approved by the institutional review board at our hospital. One hundred CHB patients and 30 healthy controls (130 individuals) were included in the study. ARFI measurements were performed on all of these cases. CHB was diagnosed when serum hepatitis surface antigen was positive for more than 6 months and when persistent or intermittent elevations in alanine aminotransferase and aspartate aminotransferase levels and histopathological changes in liver biopsy were present. Liver biopsies were taken as a reference standard for 100 CHB patients. Liver biopsy samples were examined using the Ishak scoring system and compared with ARFI velocity values.

RESULTS

Of the 130 participants, 107 (82.3%) were men and 23 (17.7%) were women. Thirty of these participants were healthy controls and their fibrotic score was evaluated as an Ishak fibrosis score of 0. A gradual increase in the mean velocity value was obtained for fibrosis scores F0-F6 (Ishak fibrosis score) in our study. A strong positive correlation was found between the mean velocity values and fibrosis scores of liver biopsy that were performed on liver segment 8. The area under the receiver operating characteristic curve was used to detect the best cutoff velocity values, and no or mild fibrosis (F≤2), significant fibrosis (F≥3), and severe fibrosis (F≥5) were calculated to be 0.95, 1.75, and 2.55 m/s, respectively. When a cutoff value of 1.75 m/s was used, ARFI had a sensitivity of 83% and a specificity of 98% in differentiating patients with fibrosis score F≤2 versus F≥3.

CONCLUSION

ARFI elastography in patients with CHB can be considered an easy-to-use and accurate noninvasive tool to evaluate the severity of liver fibrosis.

The Relationship between Inflammatory Marker Levels and Hepatitis C Virus Severity

Background. Red cell distribution width (RDW) and platelet-lymphocyte ratio (PLR) have been studied in a variety of etiological diseases. We aim to investigate the relationship between RDW and PLR and the severity of hepatitis C virus- (HCV-) related liver disease. Methods. We included fifty-two chronic HCV and 42 HCV-related cirrhosis patients and 84 healthy controls. Hematological and virological parameters and liver function biomarkers of HCV-related patients at admission were recorded. Results. RDW, RDW-to-platelet (RPR), and 1/PLR values in HCV-related cirrhosis patients were significantly higher than in chronic HCV patients and healthy controls (all P < 0.001). The aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), AST-to-platelet ratio index (APRI), and fibrosis index based on the four factors (FIB-4) scores in HCV-related cirrhosis patients were significantly higher than in chronic HCV patients (all P < 0.001). The areas under the curve of the RDW, RPR, and 1/PLR for predicting cirrhosis were 0.791, 0.960, and 0.713, respectively. Bivariate logistic regression analysis showed that RDW could independently predict the presence of cirrhosis in chronic HCV patients. Conclusions. RDW, RPR, and PLR may be potential markers for estimating HCV severity.

Relationship between platelet parameters and hepatic pathology in patients with chronic hepatitis B infection - a retrospective cohort study of 677 patients

OBJECTIVE

A retrospective study to determine the relationships between platelet parameters and inflammation and fibrosis of the liver in patients with chronic hepatitis B virus infection (CHB).

METHODS

Patients with liver biopsy-confirmed CHB were included in the study. Liver fibrosis and inflammation were assessed by histopathology of biopsied liver tissue. Platelet count (PLT), platelet distribution width (PDW) and mean platelet volume (MPV) were determined as part of routine blood tests. The relationship between inflammation and fibrosis and platelet parameters were analysed by multiple linear regression.

RESULTS

The study included 677 patients. PLT and PDW accounted for 20.5% of liver inflammation. PLT and PDW accounted for 18.4% of liver fibrosis.

CONCLUSION

Platelet parameters can provide valuable information for the assessment of hepatic inflammation and fibrosis.

The effect of standard therapy on mean platelet volume in patients with chronic hepatitis C

Introduction

Chronic hepatitis C (CHC) infection is a systemic disorder that can lead to liver inflammation, fibrosis, cirrhosis, and hepatocellular cancer. The mean platelet volume (MPV) is widely used as an inflammatory marker to evaluate the platelet function and the status of systemic inflammation.

Aim

To determine the pre- and post-treatment MPV values in CHC patients who were administered a 48-week antiviral therapy based on systemic inflammation.

Material and methods

We enrolled 28 patients, diagnosed with CHC genotype 1b, who received a 48-week antiviral therapy and attended regular follow-up, and 28 healthy individuals. In diagnosing CHC, a positive anti-HCV for a minimum duration of 6 months and a positive serum HCV RNA were accepted as the criteria. The patients were assigned to one of two groups based on their group 1 (pre-treatment values) and group 2 (post-treatment values) after 3 months therapy. We analysed and compared the blood samples of all of the groups.

Results

The MPV value was 8.89 ±1.20 in group 1 and 8.00 ±1.07 in group 2, and 8.21 ±1.18 in the control group. The value in group 1 was detected to be statistically significantly different from that in group 2 and the control group (p < 0.0001, p = 0.045, respectively). No statistically significant difference was observed between group 2 and the control group (p = 0.455).

Conclusions

The results of this study suggest that MPV could represent an inexpensive marker for use in assessing low-grade inflammation in patients with CHC.

Relationship between clinical parameters and degree of liver fibrosis and risk factors for significant liver fibrosis in patients with chronic hepatitis B: A Logistic regression analysis

AIM: To investigate the relationship between the severity of fibrosis and clinical parameters in patients with chronic hepatitis B (CHB), and to analyze risk factors for significant liver fibrosis in CHB patients.

METHODS: A total of 76 biopsy-proven CHB cases treated from January 2012 to July 2015 at the Second Hospital Affiliated to Kunming Medical University were included in the study. Gender, age, blood count variables including white blood cells, hemoglobin (HB), platelet count (PLT), red blood cell distribution width (RDW), mean platelet volume (MPV), as well as albumin (ALB), globin (GLO), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TB), prothrombin time (PT) and serum HBV DNA were recorded. Relationship between these parameters and liver fibrosis stage and risk factors for significant liver fibrosis were analyzed.

RESULTS: With the increase in the severity of liver fibrosis, white blood cells, HB, PLT, and ALB gradually decreased, and RDW, GLB, AST, PT, GGT increased; all of these parameters had significant differences between the S1-S4 groups (P < 0.05). Spearman correlation analysis showed that there was a positive correlation between ALT, AST, GGT, TB, GLO, PT, RDW, MPV, age and liver stage of fibrosis, and a negative correlation between liver stage of fibrosis and ALB, white blood cells, HB, and PLT. In logistic regression analysis, PLT was identified as an independent risk factor for significant liver fibrosis in CHB.

CONCLUSION: ALT is not predictive of liver fibrosis stage. PLT is an independent risk factor for significant liver fibrosis in CHB. Liver histopathology can be recommended for CHB patients with older age, lower PLT, even though ALT is normal or only mildly elevated.

Serum soluble urokinase-type plasminogen activator receptor and interferon-γ-induced protein 10 levels correlate with significant fibrosis in chronic hepatitis B

BACKGROUND

Hepatitis B virus (HBV) presents an important public health problem. Liver biopsy is currently the gold standard for assessing the degree of intrahepatic inflammation and for staging liver fibrosis. However, the value of liver biopsies is limited by sampling errors, understaging and interobserver variability in interpretation. There is, therefore, a need to identify novel, non-invasive serologic biomarkers for the development of new predictive models of fibrosis.

METHODS

We enrolled patients with chronic hepatitis B infection (CHB) and examined the relationships between serum soluble urokinase plasminogen activator receptor (suPAR) and interferon-induced protein-10 (IP-10), and the results of liver biopsies. Healthy volunteers with normal aminotransferase levels and negative serological results for HBV, hepatitis C virus and human immunodeficiency virus were recruited as controls.

RESULTS

Mean platelet volume, serum suPAR and IP-10 were significantly elevated in patients with CHB compared with controls. Median serum suPAR and IP-10 levels were significantly higher in patients with liver fibrosis compared with patients with mild fibrosis. There was no significant difference in mean platelet volume or aspartate aminotransferase-to-platelet ratio index scores between patients with mild and significant fibrosis.

CONCLUSION

suPAR and IP-10 were able to distinguish between significant and mild fibrosis with good sensitivity and specificity, and may thus represent useful biomarkers for identifying patients with significant fibrosis.

The Prognostic Value of Platelet Count in Patients With Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Thrombocytopenia has been acknowledged to be a crucial risk factor for cirrhosis formation and hepatocarcinogenesis in chronic liver diseases. However, to date, the association between platelet count (PLT) and the prognosis of hepatocellular carcinoma (HCC) remains inconsistent and controversial. The aim of the present study was to determine whether PLT could be used as a useful predictor of survival in patients with HCC. We performed systematic review in online databases, including PubMed, EmBase, and Web of Science, from inception until 2014. Studies were included if a statistical relationship was investigated between PLT and survival for HCC, and hazard ratio (HR) and 95% confidence intervals (CIs) for overall survival (OS) or recurrence-free survival (RFS) were provided. The quality of each included study was assessed by Newcastle-Ottawa scale score. To synthesize these studies, a random-effects model or a fixed-effects model was applied as appropriate. Then, we calculated heterogeneity, performed sensitivity analysis, tested publication bias, and did subgrouped and meta-regression analysis. Finally, we identified 33 eligible articles (published from 1998 to 2014) involved 5545 patients by retrieval. A low level of preoperative PLT was found to be significantly associated with a poor survival of HCC. Irrespective of the therapy used, the pooled HRs for OS and RFS were 1.41 (95% CI, 1.14-1.75) and 1.44 (95% CI, 1.13-1.83), respectively. Specifically, in patients who underwent liver resection, the pooled HRs for OS and RFS were 1.67 (95% CI, 1.22-2.27) and 1.44 (95% CI, 1.04-1.99), respectively. Furthermore, patients with preoperative thrombocytopenia (PLT < 100 × 10⁹/L) had a worse OS (HR: 1.73, 95% CI, 1.29-2.32) and RFS (HR: 1.57, 95% CI, 1.31-1.87) in comparison with patients without thrombocytopenia. All our findings showed no significant changes due to the removal of any study or the use of an opposite-effects model, and there was no significant publication bias. The limitations of this meat-analysis were nonuniform cut-off values of PLT, high between-study heterogeneities, potential confounders, and a bias of publication year. A low preoperative PLT level results in an unfavorable outcome in HCC. PLT is a simple, inexpensive, and useful predictor of survival in patients with HCC.

Clinical usefulness of mean platelet volume and red blood cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in chronic hepatitis B virus patients

OBJECTIVE

Hepatitis B virus infection is still one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. Liver biopsy is the gold-standard method to assess the severity of liver fibrosis, but the invasive nature of this method limits its usage. Currently, noninvasive parameters are utilized to estimate liver histology. In the present study, we aimed to investigate the relationship between the severity of fibrosis and red blood cell distribution width (RDW), platelet distribution width (PDW), mean platelet volume (MPV), and MPV and red blood cell distribution width to platelet ratio (RPR) in patients with chronic hepatitis B (CHB).

DESIGN

A total of 229 biopsy-proven naïve CHB cases were included in the study. The complete blood count variables including white blood cell, hemoglobin, hematocrit value, platelet count, RDW, MPV and PDW, as well as aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin, and other routine biochemical parameters were tested. Liver biopsy samples were examined using the Ishak scoring system. Data analyses were carried out using SPSS 15 software. Statistical significance was set at a P-value of less than 0.05.

RESULTS

Of the 229 cases, 210 (91.7%) were men and 19 (8.3%) were women. The mean age of the patients was 30.9 years, and 85 cases (37.1%) had HBeAg positivity. Fibrosis scores of 41 cases (17.9%) were greater than or equal to 3, whereas 188 cases (82.1%) had fibrosis scores less than 3. There was a significant difference between these two groups for MPV (group 1=7.98±1.20, group 2=8.77±1.44, P<0.05). There was also a significant difference between these two groups for RDW (P<0.05). The RDW value in group 1 patients was 11.83±0.89, whereas this value was 12.57±1.32 in group 2. Moreover, the RPR was significantly higher in group 2 than in group 1 (P<0.001). There was no significant difference between the groups for PDW. We have compared the receiver operating characteristic curves for the diagnostic performance of aspartate aminotransferase, alanine aminotransferase, platelet count, RDW, MPV, and RPR in identifying fibrosis in CHB and area under the curve values for these variables were 0.666, 0.463, 0.657, 0.672, 0.677, and 0.758, respectively.

CONCLUSION

MPV and RDW values are significantly higher in hepatitis B virus-infected patients, associated with severity, and can be defined as independent predicting factors in hepatic fibrosis. Further studies are required to determine the associations between MPV and the severity of fibrosis in hepatitis B patients.