Red blood cell distribution width derivatives in alcohol-related liver cirrhosis and metabolic-associated fatty liver disease

Abstract

Background: Looking for undiscovered blood markers of liver fibrosis and steatosis still remains an issue worth exploring. There are still plenty of unresolved issues related to the actual role of hematological indices as potential markers of liver function.

Aim: To study red blood cell distribution width (RDW), RDW-to-platelet ratio (RPR) and RDW-to-lymphocyte ratio (RLR) in alcohol-related liver cirrhosis (ALC) and metabolic-associated fatty liver disease (MAFLD).

Methods: The study group was composed of 302 people: 142 patients with ALC and 92 with MAFLD; 68 persons were included as controls. RDW, RPR and RLR were measured in each person. Indirect and direct parameters of liver fibrosis were also assessed [aspartate transaminase to alkaline transaminase ratio, aspartate transaminase to platelet ratio index (APRI), fibrosis-4 (FIB-4), gamma-glutamyl transpeptidase to platelet ratio (GPR), procollagen I carboxyterminal propeptide, procollagen III aminoterminal propeptide, transforming growth factor-α, platelet-derived growth factor AB, laminin]. MELD score in ALC patients and non-alcoholic fatty liver disease (NAFLD) fibrosis score together with BARD score were obtained in the MAFLD group. The achieved results were compared to controls. Then a correlation between assessed markers was done. Diagnostic value of each investigated parameter and its suggested cut-off in the research group were evaluated with area under the curve (AUC).

Results: RDW, RPR and RLR values turned out to be significantly higher in ALC and MAFLD groups compared to controls (ALC: P < 0.0001; NAFLD: P < 0.05, P < 0.0001 and P < 0.0001, respectively). RPR correlated positively with MELD score (P < 0.01) and indirect indices of liver fibrosis (FIB-4 and GPR; P < 0.0001) in ALC patients; negative correlations were found between PDGF-AB and both: RDW and RPR (P < 0.01 and P < 0.0001, respectively). RPR correlated positively with NAFLD fibrosis score and APRI (P < 0.0001) in the MAFLD group; a positive relationship was observed between RDW and FIB-4, too (P < 0.05). AUC values and suggested cut-offs for RDW, RPR and RLR in ALC patients were: 0.912 (> 14.2%), 0.965 (> 0.075) and 0.914 (> 8.684), respectively. AUC values and suggested cut-offs for RDW, RPR and RLR in MAFLD patients were: 0.606 (> 12.8%), 0.724 (> 0.047) and 0.691 (> 6.25), respectively.

Conclusion: RDW with its derivatives appear to be valuable diagnostic markers in patients with ALC. They can also be associated with a deterioration of liver function in this group.

Keywords: Alcohol-related liver cirrhosis; Hematological indices; Metabolic-associated liver disease; Red blood cell distribution width; Red blood cell distribution width-to-lymphocyte ratio; Red blood cell distribution width-to-platelet ratio.

Figure 1

Flow chart demonstrating the selection of study participants. ALC: Alcohol-related liver cirrhosis; MAFLD: Metabolic-associated fatty liver disease; US: Ultrasound.

Figure 2

Receiver operating characteristics for red blood cell distribution width. A: Alcohol-related liver cirrhosis (ALC), area under the curve (AUC) = 0.912 (cut-off > 14.2%); B: Metabolic-associated fatty liver disease (MAFLD), AUC = 0.606 (cut-off > 12.8%). Youden index cut-off for red blood cell distribution width in ALC and MAFLD groups = 15.1% and 13%, respectively.

Figure 3

Receiver operating characteristics for red blood cell distribution width-to-platelet ratio. A: Alcohol-related liver cirrhosis (ALC), area under the curve (AUC) = 0.965 (cut off > 0.075); B: Metabolic-associated fatty liver disease (MAFLD), AUC = 0.724 (cut-off > 0.047). Youden index cut-off for red blood cell distribution width-to-platelet ratio in ALC and MAFLD groups = 0.08 and 0.06, respectively.

Figure 4

Receiver operating characteristics for red blood cell distribution width-to-lymphocyte ratio. A: Alcohol-related liver cirrhosis (ALC), area under the curve (AUC) = 0.914 (cut-off > 8.684); B: Metabolic-associated fatty liver disease (MAFLD), AUC = 0.691 (cut-off > 6.25). Youden index cut-off for red blood cell distribution width-to-lymphocyte ratio in ALC and MAFLD groups = 11.16 and 6.25, respectively.