Red cell distribution width/platelet ratio predicts decompensation of metabolic dysfunction-associated steatotic liver disease-related compensated advanced chronic liver disease

Abstract

Prognostication of compensated advanced chronic liver disease (cACLD) is of paramount importance for the physician-and-patient communication and for rational clinical decisions. The paper published by Dallio et al reports on red cell distribution width (RDW)/platelet ratio (RPR) as a non-invasive biomarker in predicting decompensation of metabolic dysfunction-associated steatotic liver disease (MASLD)-related cACLD. Differently from other biomarkers and algorithms, RPR is inexpensive and widely available, based on parameters which are included in a complete blood count. RPR is computed on the grounds of two different items, one of which, RDW, mirrors the host's response to a variety of disease stimuli and is non-specific. The second parameter involved in RPR, platelet count, is more specific and has been used in the hepatological clinic to discriminate cirrhotic from non-cirrhotic chronic liver disease for decades. Cardiovascular disease is the primary cause of mortality among MASLD subjects, followed by extra-hepatic cancers and liver-related mortality. Therefore, MASLD biomarkers should be validated not only in terms of liver-related events but also in the prediction of major adverse cardiovascular events and cardiovascular mortality and extra-hepatic cancers. Adequately sized multi-ethnic confirmatory investigation is required to define the role and significance of RPR in the stratification of MASLD-cACLD.

Keywords: Cirrhosis; Liver fibrosis; Natural course; Prognostication; Stratification.

Figure 1

Modifiers of the natural course of metabolic dysfunction-associated steatotic liver disease. Schematic illustration of multiple factors [schematically depicted in the upper line clockwise: (1) Age; (2) Ethnicity; (3) Lifestyle; (4) Genetics; (5) Obesity; (6) Diabetes; and (7) Medications] which, further to the fundamental components of metabolic dysfunction-associated steatotic liver disease (MASLD) histology [shown in the bottom-line, from left to right: (1) Steatosis; (2) Steatohepatitis; and (3) Cirrhosis], can potentially modulate the natural course of MASLD and the odds of decompensation of MASLD-related compensated advanced chronic liver disease. MASLD: Metabolic dysfunction-associated steatotic liver disease.