Can mean platelet volume determine the severity of liver fibrosis or inflammation in patients with chronic hepatitis B?

Platelet-associated biomarkers in nonalcoholic steatohepatitis: Insights from a female cohort with obesity

BACKGROUND

There is a lack of noninvasive diagnostic methods for nonalcoholic steatohepatitis (NASH), the severe condition of metabolic dysfunction-associated steatotic liver disease (MASLD). Platelet activation, evaluated through certain related parameters, is associated with liver disease and inflammation, but previous results are inconclusive.

AIM

To investigate the potential utility of platelet-related indices as noninvasive diagnostic markers for the detection and prediction of MASLD, focusing on NASH.

RESULTS

We found that mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW) were increased in the severe and morbidly obese (SMO) group compared to the normal weight (NW) group. We found decreased levels of MPV in steatosis and NASH patients. MPV and PCT values were decreased in the presence of mild liver inflammation. Platelet count (PLA) and PCT values were lower in the presence of ballooning. We obtained an area under the ROC curve of 0.84 using MPV and three other variables to predict MASLD.

CONCLUSIONS

Some platelet-related indices vary depending on liver condition. Here, we reported decreased MPV in MASLD presence. Moreover, we presented for the first time a predictive model using MPV, ALT levels and the presence of diabetes mellitus and metabolic syndrome to predict MASLD in obese women. Also, MPV is closely related to early liver inflammation in NASH, and PLA and PCT are related to hepatic ballooning. These indices could be widely used for the early detection of NASH since they are usually determined in routine laboratory tests.

Mean platelet volume and platelet to lymphocyte count ratio are associated with hepatitis B-related liver fibrosis

AIM

Chronic hepatitis B is associated with important morbidity and mortality. Inflammation has a pivotal role in hepatic fibrosis of this population. Hemogram-derived inflammatory predictors, such as mean platelet volume (MPV) and platelet to lymphocyte ratio (PLR), are supposed as inflammatory markers in various diseases. We aimed to compare MPV and PLR of the patients with chronic hepatitis B to those of healthy controls and to observe possible correlation between these markers and fibrosis.

METHODS

Chronic hepatitis B patients that visited our outpatient gastroenterology clinics were enrolled in the study. Healthy volunteers were enrolled as controls. MPV, PLR and other parameters of the study groups were compared.

RESULTS

Median MPV of the mild fibrosis, advanced fibrosis control groups were 8.1 (6.6-13) fL, 8.2 (6.3-14.5) fL and 7.2 (4.6-8.9) fL, respectively (P < 0.001). Median PLR of the mild fibrosis, advanced fibrosis control groups were 99.5 (36-259) %, 119 (61-1547) % and 122 (64-197) %, respectively (P = 0.02). PLR was correlated with the ISHAK score (r = 0.32, P = 0.002). A MPV value greater than 7.52 fL have 80% sensitivity and 56% specificity in determining advanced fibrosis (AUC: 0.68, P = 0.002, 95% confidence interval, 0.58-0.77).

CONCLUSION

We think that increased MPV and decreased PLR are characteristics of chronic hepatitis B disease. Moreover, increased MPV could predict advanced fibrosis in this population.

Predictive value of noninvasive indices in chronic hepatitis B virus-related fibrosis

OBJECTIVES

Despite being an invasive method, liver biopsy followed by pathological grading remains the gold standard in evaluating liver fibrosis resulting from chronic hepatitis B virus (HBV) infection. The present study aims to evaluate the utility of biochemical parameters and their derived indices in predicting development of fibrosis related to HBV infection.

PATIENTS AND METHODS

Pathology results and biochemical parameters of patients who underwent liver biopsy were retrieved from electronic archive records dated 2010-2019 and evaluated retrospectively. Pathological fibrosis grading was performed as per Ishak scoring, with scores of 1-2 considered as mild fibrosis and 3-6 as advanced fibrosis.

RESULTS

The mean age of 302 patients was 37.69 ± 11.33 years. Of the 302 patients, 230 (76.2%) had mild fibrosis and 72 (23.8%) had advanced fibrosis. Age-platelet index, aspartate aminotransferase/platelet ratio index, fibrosis-4 (FIB-4), modified fibrosis-4, platelets count, aspartate aminotransferase to alanine aminotransferase ratio/platelet ratio index, Goteborg University Cirrhosis Index and King's score were markedly and significantly higher in patients with advanced fibrosis than those with mild fibrosis. FIB-4, age-platelet index and King's score had higher (>80%) area under the curve values than other indices in the receiver operating characteristics analysis. Evaluation of sensitivity, specificity and accuracy of these indices with the specified cut-off values revealed 87% sensitivity with FIB-4, 70% specificity with King's score and 72% accuracy with the age-platelet index.

CONCLUSION

In this study, the highest rates of sensitivity, specificity and accuracy in distinguishing and predicting liver fibrosis were observed with the noninvasive indices FIB-4, King's score and the age-platelet index, respectively.

Plateletcrit and Mean Platelet Volume in the Evaluation of Alcoholic Liver Cirrhosis and Nonalcoholic Fatty Liver Disease Patients

Platelet (PLT) indices have been proposed as potential markers in the assessment of liver fibrosis and exacerbation of liver failure. The aim of our study was to verify mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in alcohol-related liver cirrhosis (ALC) and nonalcoholic fatty liver disease (NAFLD) patients. One hundred forty-two patients with ALC, 92 with NAFLD, and 68 in control group were enrolled in this study. Hematological indices (MPV, PCT, and PDW) and serological (indirect and direct) markers of liver fibrosis (AAR, APRI, FIB-4, GPR, PICP, PIIINP, TGF-α, PDGF-AB, laminin) were measured in each participant. MELD score in ALC patients and NAFLD fibrosis score (NFS) together with BARD score in the NAFLD group were also obtained. Results were compared between research and control groups. Then, a correlation between evaluated indices was performed in study groups. Receiver operating characteristic curves (ROCs) and area under the curve (AUC) values were applied to assess the diagnostic accuracy of measured indices. Significant increase in PDW and decrease in PCT in comparison to controls were noted in examined ALC (60.4% vs. 51.2% and 0.1% vs. 0.21%, respectively, p < 0.0001) and NAFLD (54.75% vs. 51.2% and 0.19 vs. 0.21%, respectively, p < 0.01) patients. Decreased level of MPV was observed in NAFLD group (7.85 fl vs. 8.90 fl, p < 0.0001). Additionally, PCT correlated with NFS (p < 0.0001). Evaluated PLT indices correlated with MELD score (MPV and PDW, p < 0.001; PCT, p < 0.05). They correlated with indirect and direct markers of liver fibrosis in the whole research group, too. PCT was the parameter with the greatest diagnostic accuracy in ALC patients (AUC = 0,839 for cutoff < 0.17%); in NAFLD group, it was MPV (AUC = 0,808 for cutoff < 7.9 fl). PCT in ALC and MPV in NAFLD can be perceived as potential diagnostic markers.

A novel predictive model based on inflammatory markers to assess the prognosis of patients with HBV-related acute-on-chronic liver failure: a retrospective cohort study

Background

Systemic inflammatory response is closely related to the development and prognosis of liver failure. This study aimed to establish a new model combing the inflammatory markers including neutrophil/lymphocyte ratio (NLR) and red blood cell distribution width (RDW) with several hematological testing indicators to assess the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).

Methods

A derivation cohort with 421 patients and a validation cohort with 156 patients were recruited from three hospitals. Retrospectively collecting their clinical data and laboratory testing indicators. Medcalc-15.10 software was employed for data analyses.

Results

Multivariate analysis indicated that RDW, NLR, INR, TBIL and Cr were risk factors for 90-day mortality in patients with HBV-ACLF. The risk assessment model is COX_RNTIC = 0.053 × RDW + 0.027 × NLR + 0.003 × TBIL+ 0.317 × INR + 0.003 × Cr (RNTIC) with a cut-off value of 3.08 (sensitivity: 77.89%, specificity: 86.04%). The area under the receiver operating characteristics curve (AUC) of the RNTIC was 0.873 [95% CI(0.837–0.903)], better than the predictive value of MELD score [0.732, 95% CI(0.687–0.774)], MELD-Na [0.714, 95% CI(0.668–0.757)], CTP[0.703, 95% CI(0.657–0.747)]. In the validation cohort, RNTIC also performed a better prediction value than MELD score, MELD-Na and CTP with the AUC of [0.845, 95% CI(0.778–0.898)], [0.768, 95% CI (0.694–0.832)], [0.759, 95% CI(0.684–0.824)] and [0.718, 95% CI(0.641–0.787)] respectively.

Conclusions

The inflammatory markers RDW and NLR could be used as independent predictors of 90-day mortality in patients with HBV-ACLF. Compared with MELD score, MELD-Na and CTP, RNTIC had a more powerful predictive value for prognosis of patients with HBV-ACLF.

Artificial Neural Network Model for Liver Cirrhosis Diagnosis in Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma

Background

Testing for the presence of liver cirrhosis (LC) is one of the most critical diagnostic and prognostic assessments for patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). More non-invasive tools are needed to diagnose LC but the predictive abilities of current models are still inconclusive. This study aimed to develop and validate a novel and non-invasive artificial neural network (ANN) model for diagnosing LC in patients with HBV-related HCC using routine laboratory serological indicators.

Methods

A total of 1152 HBV-related HCC patients who underwent hepatectomy were included and randomly divided into the training set (n = 864, 75%) and validation set (n = 288, 25%). The ANN model was constructed from the training set using multivariate Logistic regression analysis and then verified in the validation set.

Results

The morbidity of LC in the training and validation sets was 41.2% and 46.8%, respectively. Multivariate analysis showed that age, platelet count, prothrombin time and total bilirubin were independent risk factors for LC (P < 0.05). The area under the ROC curve (AUC) analyses revealed that the ANN model had higher predictive accuracy than the Logistic model (ANN: 0.757 vs Logistic: 0.721; P < 0.001), and other scoring systems (ANN: 0.757 vs CP: 0.532, MELD: 0.594, ALBI: 0.575, APRI: 0.621, FIB-4: 0.644, AAR: 0.491, and GPR: 0.604; P < 0.05 for all) in diagnosing LC. Similar results were obtained in the validation set.

Conclusion

The ANN model has better diagnostic capabilities than other commonly used models and scoring systems in assessing LC risk in patients with HBV-related HCC.

Haematologic indices in hepatitis B virus-related liver disease

Several markers and prognostic scores have been identified for predicting the development and progression of liver disease; among them, haematological parameters (the neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), RDW to platelet ratio (RPR), mean platelet volume (MPV), and mean corpuscular volume (MCV)) have recently gained significant interest. Compared with traditional prognostic factors, haematological indices are easy to obtain and relatively inexpensive. There is growing evidence that these haematological indices play a key role in HBV-related liver diseases and has been proposed as a predictive marker of adverse outcomes in these patients. This article focuses on discussing the diagnostic and prognostic value of the haematological indices in patients with HBV-related liver diseases.

MEAN PLATELET VOLUME: AN OVERLOOKED HERALD OF MALIGNANT THYROID NODULES

Physicians and surgeons pay much attention to evaluating thyroid nodules due to the malignant potential of these growths. Inflammation has a crucial role in the development of cancer. Increase in the mean platelet volume (MPV) has been described in various inflammatory conditions. Since some of thyroid nodules are malignant, we aimed to compare MPV values between patients with malignant and benign thyroid nodules after precise pathologic diagnosis. We retrospectively analyzed hemograms of patients having undergone thyroid surgery for thyroid nodule between January 2013 and January 2015, and compared them to those recorded in healthy subjects. MPV was higher in the malignant thyroid nodule group than in the benign nodule group (9.1±1 fL vs. 7.8±0.8 fL). The difference was statistically significant (p<0.001). Increased MPV should be considered as an assistive diagnostic tool in differentiating malignant and benign thyroid nodules. However, further prospective studies are required to confirm its usefulness in this population.

Ratio of mean platelet volume to platelet count is a potential surrogate marker predicting liver cirrhosis

AIM

To provide a simple surrogate marker predictive of liver cirrhosis (LC).

METHODS

Specimens from 302 patients who underwent resection for hepatocellular carcinoma between January 2006 and December 2012 were retrospectively analyzed. Based on pathologic findings, patients were divided into groups based on whether or not they had LC. Parameters associated with hepatic functional reserve were compared in these two groups using Mann-Whitney U-test for univariate analysis. Factors differing significantly in univariate analyses were entered into multivariate logistic regression analysis.

RESULTS

There were significant differences between the LC group (n = 100) and non-LC group (n = 202) in prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin, albumin, cholinesterase, type IV collagen, hyaluronic acid, indocyanine green retention rate at 15 min, maximal removal rate of technitium-99m diethylene triamine penta-acetic acid-galactosyl human serum albumin and ratio of mean platelet volume to platelet count (MPV/PLT). Multivariate analysis showed that prothrombin activity, concentrations of alanine aminotransferase, aspartate aminotransferase, total bilirubin and hyaluronic acid, and MPV/PLT ratio were factors independently predictive of LC. The area under the curve value for MPV/PLT was 0.78, with a 0.8 cutoff value having a sensitivity of 65% and a specificity of 78%.

CONCLUSION

The MPV/PLT ratio, which can be determined simply from the complete blood count, may be a simple surrogate marker predicting LC.

Association Between Hemogram Parameters and Survival of Critically Ill Patients

AIM

Recently, hemogram parameters, such as mean platelet volume (MPV), had been proposed as novel inflammatory and prognostic factors. In present retrospective analysis, we aimed to determine and compare MPV of survived and dead patients whom admitted to intensive care unit (ICU) of our institution.

METHODS

We recorded hemogram parameters and other laboratory data and demographic characteristics of patients treated in ICU. Patients are divided into 2 groups-dead patients and survived patients. Laboratory data of survived patients compared to those of dead patients.

RESULTS

Age, gender, and other laboratory variables were not significantly different between dead and survived patients. On the other hand, MPV of survived patients was significantly higher than that of the dead patients ( P = .001).

CONCLUSION

We think that elevated MPV levels in an ICU patient should alert clinicians for worse outcome. Physicians should be more careful in the management of these patients.

Mean platelet volume in children with hepatitis A

BACKGROUND

Mean platelet volume (MPV), which is commonly used as a measure of platelet size, indicates the rate of platelet production and platelet activation. We aimed to evaluate the mean platelet volume in children with hepatitis A.

METHODS

In this retrospective case-controlled study, the study population consisted of 62 children with hepatitis A and 62 healthy control subjects.

RESULTS

MPV values, aspartate transaminase (AST), and alanine transaminase (ALT) levels on admission were significantly increased in patients with hepatitis A when compared to controls whereas white blood cell (WBC) counts were significantly lower. Two weeks after admission, the MPV values showed a significant decrease from 9.47 ± 1.62 to 8.84 ± 1.48 fL in patients with hepatitis A, but these values were still significantly higher than the controls. There was a significant difference in terms of MPV, WBC, AST, and ALT values between the controls and the patient group 2 weeks after admission.

CONCLUSIONS

This study is the first to evaluate the MPV levels in children with hepatitis A. MPV values were found to be increased in children hospitalized with hepatitis A.

Can mean platelet volume and red blood cell distribution width show disease activity in rheumatoid arthritis?

Aim: To evaluate the relationship between mean platelet volume (MPV) and red cell distribution width (RDW), and disease activity in rheumatoid arthritis (RA). Patients & methods: Hundred RA and 100 controls were included. Results: MPV and RDW were higher in RA (p < 0.0001). The cut-off levels of RDW and MPV were 14.8 and 10.4. Patients with RDW >14.8 had higher Disease Activity Score 28 (DAS28; p = 0.002) and pain score (p = 0.0007). RDW was positively correlated with DAS28 and pain. But, DAS28 and pain were not different between patients with MPV >10.4 and <10.4. Conclusion: MPV and RDW were significantly higher in RA. RDW and MPV were similar to erythrocyte sedimentation rate and C-reactive protein to indicate inflammatory activity. RDW was correlated with pain and DAS28, but MPV was not associated with them.

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.

Prognostic role of mean platelet volume in patients with cirrhosis

BACKGROUND

Studies carried out in patients with chronic hepatitis have shown that mean platelet volume (MPV) is associated with worse disease stage, although the role of MPV in patients with cirrhosis is less clear.

AIM

To evaluate the association between MPV values and clinical characteristics and stage of cirrhosis, and to assess its prognostic role.

METHODS

We studied 75 patients with cirrhosis and assessed the association between MPV values and cirrhosis characteristics, prognostic scores, and survival. The prognostic role of longitudinal variations of MPV was also assessed in 50 patients who had at least 12 months follow-up and who had MPV determination at 3-monhtly intervals.

RESULTS

Median MPV values were not statistically different according to aetiology of liver disease (P=0.485) and disease severity both taking into consideration the Child-Pugh classification (P=0.438) and the Model for End-stage Liver Disease score (P=0.978). Median MPV values were not significantly different in 23 Child-Pugh class C patients who died or survived (9.15fL versus 9.10fL, P=0.794) during a 12-month follow-up. Lastly, there was no significant modification of MPV over time at the various study time-points (3-month, 6-month, 9-month, 12-month) between patients who died and those who survived.

CONCLUSIONS

In patients with cirrhosis, MPV has no association with severity of disease and prognosis.

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.

Mean platelet volume is an important predictor of hepatitis C but not hepatitis B liver damage

BACKGROUND

The mean platelet volume (MPV) is the most commonly used measure of platelet size and is a potential marker of platelet reactivity. In this study, we aimed to explore the relationship between hepatic histopathology in viral hepatitis and MPV levels, which are associated with platelet count and activity.

MATERIALS AND METHODS

We performed a retrospective case-control study of baseline histological and clinical parameters in chronic hepatitis B and C patients in our tertiary reference center between January 2005 and January 2011. Two hundred and five chronic hepatitis B patients and 133 chronic hepatitis C patients who underwent liver biopsy were included in the study. The patients were divided into two groups: Chronic hepatitis B and chronic hepatitis C and were additionally divided into groups of two according to histological activity index (HAI) and fibrosis scores obtained by liver biopsy results (according to the Ishak scoring system). The clinical characteristics of chronic viral hepatitis patients, including demographics, laboratory (especially MPV), and liver biopsy findings, were reviewed.

RESULTS

One hundred and forty-three patients were male (69.1%), and the mean age was 41.9 ± 12.75 with an age range of 18-71 years in hepatitis B patients. In the classification made according to HAI, 181 patients were in the low activity group (88.3%) and 24 in the high activity group (11.7%). In the evaluation made according to fibrosis score, 169 patients were found to have early fibrosis (82.4%) and 36 were found to have advanced fibrosis (17.6%). In patients with hepatitis B, there was no statistically significant difference in terms of their MPV values between the two groups, separated according to their degree of activity and fibrosis. Sixty-three patients were male (47.3%), and the mean age was 50.03 ± 12.75 with an age range of 19-75 years. In the classification made according to HAI, 109 patients were in low activity group (81.9%) and 24 in high activity group (18.1%). In the evaluation made according to fibrosis score, 101 patients were found to have early fibrosis (75.9%) and 32 have advanced fibrosis (24.1%). There was a statistically significant difference between the activity and fibrosis groups of the hepatitis C patients (P = 0.04 and P = 0.02, respectively).

CONCLUSION

MPV values are more reliable in hepatitis C patients than hepatitis B for predicting the advanced damage in liver histology. This finding might be useful for the detection of early fibrosis and also starting early treatment, which is important in hepatitis C.

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.

Elevated mean platelet volume is associated with poor short-term outcomes in hepatitis B virus-related acute-on-chronic liver failure patients

BACKGROUND AND AIM

It has been shown that mean platelet volume (MPV) can be used as a prognostic biomarker in some chronic diseases. The aim of the present study is to investigate the possible association between MPV and clinical outcome and prognosis in patients with HBV-related acute-on-chronic liver failure (HBV-ACLF) within 4 weeks.

METHODS

This study included 64 patients with HBV-ACLF, 19 chronic hepatitis B (CHB) patients, 27 patients with hepatitis B-related cirrhosis (CR, Child-Pugh A/B), 51 healthy subjects (healthy controls [HC]). The complete blood counts and biochemical examination of blood were obtained after 12h of fasting. In the ACLF group, the relationships between the prognosis and the MPV were analyzed.

RESULTS

At baseline, a statistically significant increase in MPV was shown in patients with ACLF (median 9.5, range 7.1-14.1) compared with HC (8.0, 7.2-11.9, P<0.001), CR (8.4, 5.9-11.1, P<0.001) and CHB (8.3, 7.3-12.0, P<0.001). The MPV value was positively correlated with model of end-stage liver disease (MELD) score and international normalized ratio (INR). The MPV level was significantly increased in nonsurvivors than survivors. High MPV level showed a significantly lower survival rate (P=0.001). Multivariate logistic regression analysis showed that only MPV level was independent factor predicting poor short-term outcomes.

CONCLUSION

MPV values at presentation were higher among nonsurvivors than survivors, and this parameter was well correlated with liver function parameters and may be used as a predictor for 4-week mortality rate in patients with HBV-ACLF.

Red blood cell distribution width levels correlate with liver fibrosis and inflammation: a noninvasive serum marker panel to predict the severity of fibrosis and inflammation in patients with hepatitis B

We aimed to study whether red blood cell distribution width (RDW) could be one of the variables determining the extent of liver fibrosis and inflammation in patients with biopsy-proven hepatitis B. A total of 446 hepatitis B virus-infected patients who underwent liver biopsy were divided into 2 groups: absent or mild and moderate-severe according to the severity of liver fibrosis and inflammation. The independent variables that determine the severity of liver fibrosis and inflammation were explored. RDW values increased with progressive liver fibrosis and inflammation. After adjustments for other potent predictors, liver fibrosis (moderate-severe) was independently associated with RDW, platelet, and albumin (odds ratio = 1.121, 0.987, and 0.941, respectively), whereas increased odds ratios of significant inflammation were found for RDW, alanine aminotransferase, albumin, and PLT (odds ratio = 1.146, 1.003, 0.927, and 0.990, respectively). The sensitivity and specificity of model A were 70.0% and 62.9% for detection of significant liver fibrosis [area under the receiver-operating characteristic curve (AUC) = 0.713, P < 0.001]. The sensitivity and specificity of model B were 66.1% and 79.4% for predicting advanced liver inflammation (AUC = 0.765, P < 0.001). Compared with preexisting indicators, model A achieved the highest AUC, whereas model B showed a higher AUC than RDW to platelet ratio (0.670, P < 0.001) and FIB-4 (0.740, P = 0.32). RDW may provide a useful clinical value for predicting liver fibrosis and necroinflammation in hepatitis B-infected patients with other markers.

Soluble MICB protein levels and platelet counts during hepatitis B virus infection and response to hepatocellular carcinoma treatment

Background

The human major histocompatibility complex class I polypeptide-related sequence B (MICB) is a protein that modulates the NK and T cell activation through the NKG2D receptor and is related to several diseases including cancer.

Methods

The study investigated the prognostic role of soluble MICB (sMICB) protein in the progression of HBV-related liver diseases and to HBV-related HCC treatment. The sMICB serum levels were measured in 266 chronic HBV-infected Vietnamese patients and in healthy controls, and correlated with clinical and laboratory parameters and with therapeutic interventions for HBV-related HCC.

Results

Significant differences in both clinical and laboratory parameters were observed among the patient groups with different stages of hepatitis. The platelet counts were significantly decreased with disease progression (P < 0.001). The sMICB serum levels were significantly increased in HBV patients compared to healthy controls (P < 0.0001). Among the patients with different stages of hepatitis, asymptomatic individuals (ASYM) revealed higher sMICB serum levels while liver cirrhosis (LC) patients revealed lower sMICB serum levels (P < 0.0001) compared to other patient groups. Notably, the sMICB serum levels were decreased in treated HCC patient group compared to not-treated HCC patient group (P = 0.05). Additionally, the sMICB levels were significantly correlated with platelet counts in ASYM and HCC patients (r = −0.37, P = 0.009; and r = 0.22, P = 0.025, respectively).

Conclusions

Our results demonstrate a potential role of sMICB serum levels and platelet counts during immune response to the HBV infection, liver disease progression and response to the HCC treatment.

Mean platelet volume in patients with increased γ-glutamyl transferase

Mean platelet volume (MPV) is the commonly measured platelet index for platelet size and surrogate marker of platelet activation. Changes of MPV in hepatic disease have been evaluated in inflammatory conditions, fibrosis and malignancy. We also had reported previous studies to analyze clinical meaning of MPV in patients with hepatocellular carcinoma and chronic hepatitis B. However, data about investigation of MPV in cholestatic conditions are not sufficient so far. Recently, it has been reported that MPV was increased in intrahepatic cholestasis of pregnancy. In this study, we planned to investigate the relationship between MPV and glutamyltransferase which is well-established laboratory marker for cholestasis, in various disease conditions.