Diagnostic Accuracy of Red Cell Distribution Width to Platelet Ratio for the Prediction of Liver Fibrosis in Patients With Chronic Liver Disease From Eastern India

Abstract

Background Early diagnosis of liver cirrhosis in patients with chronic liver disease (CLD) can help delay/prevent complications and thereby improve survival. The currently available diagnostic modalities for the non-invasive assessment of hepatic fibrosis, especially FibroScan, are costly and not widely available, whereas various non-invasive scores for the assessment of fibrosis are cumbersome. Hence, we aimed to develop an easy and simple score for predicting cirrhosis in patients from Eastern India suffering from CLD with a better diagnostic accuracy. Methodology This cross-sectional, observational study was conducted between September 2019 and September 2021 in East India. Our study participants were patients who had CLD of etiologies such as alcohol-related liver disease, non-alcoholic fatty liver disease, chronic viral hepatitis B, chronic viral hepatitis C, primary biliary cholangitis, and autoimmune hepatitis, who had undergone FibroScan of the liver. All demographic details were noted, and the patients were subjected to physical examination, followed by hematological as well as biochemical investigations, including liver function tests. Non-invasive scores (such as aspartate aminotransferase (AST) to platelet ratio index (APRI) and Fibrosis-4 score (FIB-4) and red cell distribution width (RDW) to platelet ratio (RPR)) were computed, and their diagnostic accuracy for prediction of advanced fibrosis and cirrhosis were evaluated by receiver operating characteristic curve (ROC curve) analysis with comparison of area under the ROC curves. Pearson correlation and logistic regression analysis were also performed to study the association of these scores with advanced fibrosis and cirrhosis. Results The area under the ROC (AUROC) curve of the APRI score, FIB-4 score, RPR, and RPR × AST for prediction of advanced liver fibrosis was 0.817, 0.799, 0.706, and 0.811, respectively. Similarly, the AUROC of the above scores for the prediction of cirrhosis was 0.889, 0.858, 0.797, and 0.898. However, the product of RPR and AST was superior than APRI and FIB-4 for predicting cirrhosis. An RPR × AST value above the cut-off of 4.818 can help predict liver cirrhosis with 85.7% sensitivity and 85.5% specificity. Pearson correlation and logistic regression analysis also proved the association of these scores with liver fibrosis. Conclusions RPR is a simple, inexpensive, and easily available marker for predicting liver cirrhosis. Nevertheless, the variable RPR × AST can predict liver cirrhosis in patients with CLD with even greater diagnostic accuracy.

Keywords: chronic liver disease; cirrhosis diagnosis; fibroscan; liver cirrhosis; liver fibrosis; liver fibrosis marker; rpr; transient elastography (fibroscan).

Figure 1. Area under the curve of receiver operating curve (ROC) analysis for various scores predicting cirrhosis.

AST: aspartate transaminase; APRI: aspartate transaminase to total platelet count ratio; FIB-4: Fibrosis-4 Index; RPR: red cell distribution width to total platelet count ratio

Figure 2. Area under the curve of the receiver operating curve (ROC) analysis for various scores predicting advanced fibrosis.

AST: aspartate transaminase; APRI: aspartate transaminase to total platelet count ratio; FIB-4: Fibrosis-4 Index; RPR: red cell distribution width to total platelet count ratio

Figure 3. Area under the curves of receiver operating curve (ROC) analysis for various scores predicting significant fibrosis.

AST: aspartate transaminase; APRI: aspartate transaminase to total platelet count ratio; FIB-4: Fibrosis-4 Index; RPR: red cell distribution width to total platelet count ratio