Is increased red cell distribution width an indicating marker of nonalcoholic steatohepatitis and fibrotic stage?

Abstract

Aim: To evaluate the red cell distribution width (RDW) as an indicator of the presence of non-alcoholic steatohepatitis (NASH) and its association with fibrotic scores.

Methods: A retrospective study was carried out that included sixty-two biopsy proven NASH, 32 simple steatosis patients and 30 healthy controls. The correlation between the clinical and histopathological features of NASH patients and RDW values was evaluated. Liver fibrosis scores were measured using a 0 to 4 point scale and were divided in to two groups; fibrosis scores 0-1 were termed mild and fibrosis scores 2-4 were termed advanced fibrosis. RDW values were compared between NASH, simple steatosis and healthy controls. Univariate and multivariate analyses were performed to evaluate the independent predicting factors for the presence of liver fibrosis caused by NASH.

Results: Patients with NASH had higher RDW values compared with simple steatosis and healthy control groups [14.28% ± 0.25% vs 13.37% ± 0.12%, 12.96% ± 0.14% (P < 0.01), respectively]. Patients with advanced fibrosis had higher RDW values than the mild fibrosis group (15.86% ± 0.4% vs 13.63% ± 0.67%, P < 0.01, respectively). RDW also correlated with fibrotic scores (r = 0.579 and P < 0.01). The variables that were significant in the univariate analysis were evaluated in multivariate logistic regression analysis, and RDW was an independent predicting factor of NASH (OR = 1.75, 95%CI: 1.129-2.711, P < 0.05).

Conclusion: RDW a new non-invasive marker that can be used to demonstrate the presence of NASH and indicate advanced fibrotic scores.

Keywords: Liver biopsy; Liver fibrosis; Non-alcoholic steatohepatitis; Non-invasive marker; Red cell distribution width; Simple steatosis.

Figure 1

Mild perivenular-perisinusoidal fibrosis (A) and advanced perivenular-perisinusoidal, and periportal fibrosis (B) in non-alcoholic steatohepatitis. A, B: Trichrome stain, x 400.

Figure 2

Red cell distribution width values of healthy controls, simple steatosis and non-alcoholic steatohepatitis groups (A), and fibrotic subgroups of non-alcoholic steatohepatitis (B). RDW: Red cell distribution width.

Figure 3

Receiver operating characteristics curve of red cell distribution width values for the identification of patients with non-alcoholic steatohepatitis (A), and the identification of fibrosis in non-alcoholic steatohepatitis (B).

Figure 4

Correlation between red cell distribution width values and fibrotic scores of non-alcoholic steatohepatitis. RDW: Red cell distribution width. Score 0, n = 8; Score 1, n = 32; Score 2, n = 10; Score 3, n = 8; Score 4, n = 4.