Diagnostic accuracy of red blood cell distribution width to platelet ratio for predicting staging liver fibrosis in chronic liver disease patients: A systematic review and meta-analysis

Abstract

Background: Red cell volume distribution width to platelet ratio (RPR), as a novel noninvasive assessment, is frequently investigated. However, the utility of RPR to evaluate the diagnostic accuracy of liver fibrosis remains controversial. We performed a meta-analysis to determine the diagnostic performance of RPR for detecting staging liver fibrosis in patients with chronic liver disease.

Methods: MEDLINE, EMBASE, and Cochrane Library databases were systematically searched. Summary receiver operating characteristic curves (SROC), diagnostic odds ratios (DOR), pooled estimates of sensitivity, specificity, and likelihood ratios were used to assess the diagnostic accuracy of RPR. Meta-regression and subgroup analyses were also performed to identify factors that contributed to heterogeneity. The Quality Assessment for Studies of Diagnostic Accuracy Studies-2 tool was applied to assess the quality.

Results: Fifteen studies with a total of 3346 patients were included in the meta-analysis. The area under the curve for SROC to summarize diagnostic accuracy of RPR for prediction of significant fibrosis, advanced fibrosis, and cirrhosis was 0.73 (standard error [SE] = 0.02), 0.83 (SE = 0.03), and 0.85 (SE = 0.04), respectively. Pooled DOR with corresponding 95% confidence interval (CI) was 4.93 (95% CI: 3.78-6.43), 10.27 (95% CI: 6.26-16.84), and 12.16 (95% CI: 5.85-25.28), respectively, using a random effects model. Meta-regression showed that length of liver biopsy specimen potentially contributed to heterogeneity. There was no significant publication bias observed across the eligible studies.

Conclusions: In chronic liver disease patients, RPR presented a good performance for prediction of significant fibrosis, advanced fibrosis, and cirrhosis. More future trials are required for prospective validation.

Figure 1

Study flow diagram.

Figure 2

Methodological quality. (A) Individual study graph, (B) study summary.

Figure 3

SROC and DOR of RPR for prediction of significant fibrosis, advanced fibrosis and cirrhosis. (A and B) SROC and DOR of RPR for prediction of significant fibrosis; (C and D) SROC and DOR of RPR for prediction of advanced fibrosis; (E and F) SROC and DOR of RPR for prediction of cirrhosis. DOR = diagnostic odds ratios, RPR = red cell volume distribution width to platelet ratio, SROC = summary receiver operating characteristic curve.

Figure 4

Sensitivity, specificity, positive LR and negative LR of RPR for prediction advanced fibrosis. (A) Sensitivity; (B) specificity; (C) positive LR; (D) negative LR. CI = confidence interval, LR = likelihood ratio, RPR = red cell volume distribution width to platelet ratio.

Figure 5

Sensitivity, specificity, positive LR and negative LR of RPR for prediction cirrhosis. (A) Sensitivity; (B) specificity; (C) positive LR; (D) negative LR. CI = confidence interval, LR = likelihood ratio, RPR = red cell volume distribution width to platelet ratio.