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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 6
Jun.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(6): 1319-1325

Value of red blood cell distribution width-to-platelet ratio, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio in predicting compensated liver cirrhosis in patients with chronic hepatitis C

DOI: 10.3969/j.issn.1001-5256.2021.06.021

  • Division of Clinical Research, First Hospital of Jilin University, Changchun 130021, China

Research funding:

 (2017YFC0907405);

 (20200403098SF);

 

  • Received Date: 2021-02-24
  • Accepted Date: 2021-04-23
  • Published Date: 2021-06-20
    Abstract
  •   Objective  To investigate the value of red blood cell distribution width-to-platelet ratio (RPR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) in predicting chronic hepatitis C (CHC)-related compensated liver cirrhosis by comparing serological markers between CHC patients and patients with compensated hepatitis C cirrhosis.  Methods  The patients with CHC in two townships of Fuyu County were screened for liver cirrhosis and liver cancer from September to December in 2019 and 2020, respectively. General information was collected; HCV RNA quantification, liver function, and routine blood test results were measured; liver transient elastography and abdominal ultrasound were performed at the same time. RPR, PLR, NLR, fibrosis-4 (FIB-4), and aspartate aminotransferase-to-platelet ratio index (APRI) were calculated. The Mann-Whiney U test was used for comparison between groups. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off values of RPR and PLR. A multivariate unconditional logistic regression analysis was used to investigate the risk factors for CHC-related liver cirrhosis. The linear regression trend test was used to investigate the changing trend of RPR, PLR, FIB-4, and APRI in hepatitis C patients with different fibrosis stages.  Results  A total of 968 CHC patients were enrolled, among whom 123 (12.7%) were diagnosed with compensated liver cirrhosis (liver cirrhosis group). Compared with the CHC group, the liver cirrhosis group had a significant increase in RPR and a significant reduction in PLR (P < 0.001). The multivariate logistic regression analysis showed that age > 60 years (odds ratio [OR]=1.79, 95% confidence interval [CI]: 1.12-2.86, P=0.015), albumin < 40 g/L (OR=10.40, 95% CI: 3.47-31.18, P < 0.001), RPR > 0.081 (OR=3.83, 95% CI: 2.19-6.69, P < 0.001), PLR < 91.11 (OR=2.25, 95% CI: 1.31-3.89, P=0.004), FIB-4 > 3.25 (OR=3.14, 95% CI: 1.74-5.67, P < 0.001), and APRI > 2 (OR=3.60, 95% CI: 1.10-11.78, P=0.035) were associated with the development of CHC-related compensated liver cirrhosis. With the aggravation of liver fibrosis, RPR, FIB-4, and APRI gradually increased and PLR gradually decreased (all P < 0.001).  Conclusion  RPR and PLR are associated with the development and fibrosis progression of CHC-related compensated liver cirrhosis. Elderly patients with CHC (age > 60 years) should be monitored for the changes in albumin and liver fibrosis indicators, and RPR and PLR should also be monitored regularly to identify liver cirrhosis in the early stage, give timely treatment, and reduce the incidence rate of liver cancer.

     

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    • References(35)
  • [1]
    CHEN YS, LI L, CUI FQ, et al. A sero-epidemiological study on hepatitis C in China[J]. Chin J Epidemiol, 2011, 32(9): 888-891. DOI: 10.3760/cma.j.issn.0254-6450.2011.09.009.

    陈园生, 李黎, 崔富强, 等. 中国丙型肝炎血清流行病学研究[J]. 中华流行病学杂志, 011, 2(9): 888-891. DOI: 10.3760/cma.j.issn.0254-6450.2011.09.009.
    [2]
    DUAN Z, JIA JD, HOU J, et al. Current challenges and the management of chronic hepatitis C in mainland China[J]. J Clin Gastroenterol, 2014, 48(8): 679-686. DOI: 10.1097/MCG.0000000000000109.
    [3]
    MCGLYNN KA, PETRICK JL, EL-SERAG HB. Epidemiology of hepatocellular carcinoma[J]. Hepatology, 2021, 73(Suppl 1): 4-13. DOI: 10.1002/hep.31288.
    [4]
    FATTOVICH G, STROFFOLINI T, ZAGNI I, et al. Hepatocellular carcinoma in cirrhosis: Incidence and risk factors[J]. Gastroenterology, 2004, 127(5 Suppl 1): s35-s50. DOI: 10.1053/j.gastro.2004.09.014.
    [5]
    KUMAR R, TEO EK, HOW CH, et al. A practical clinical approach to liver fibrosis[J]. Singapore Med J, 2018, 59(12): 628-633. DOI: 10.11622/smedj.2018145.
    [6]
    GRGUREVIC I, BOZIN T, MADIR A. Hepatitis C is now curable, but what happens with cirrhosis and portal hypertension afterwards?[J]. Clin Exp Hepatol, 2017, 3(4): 181-186. DOI: 10.5114/ceh.2017.71491.
    [7]
    KONG Y, SUN Y, ZHOU J, et al. Early steep decline of liver stiffness predicts histological reversal of fibrosis in chronic hepatitis B patients treated with entecavir[J]. J Viral Hepat, 2019, 26(5): 576-585. DOI: 10.1111/jvh.13058.
    [8]
    STASI C, MILANI S. Evolving strategies for liver fibrosis staging: Non-invasive assessment[J]. World J Gastroenterol, 2017, 23(2): 191-196. DOI: 10.3748/wjg.v23.i2.191.
    [9]
    CARMONA I, CORDERO P, AMPUERO J, et al. Role of assessing liver fibrosis in management of chronic hepatitis C virus infection[J]. Clin Microbiol Infect, 2016, 22(10): 839-845. DOI: 10.1016/j.cmi.2016.09.017.
    [10]
    ZHENG J, CAI J, LI H, et al. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as prognostic predictors for hepatocellular carcinoma patients with various treatments: A Meta-analysis and systematic review[J]. Cell Physiol Biochem, 2017, 44(3): 967-981. DOI: 10.1159/000485396.
    [11]
    STOJKOVIC LALOSEVIC M, PAVLOVIC MARKOVIC A, STANKOVIC S, et al. Combined diagnostic efficacy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as biomarkers of systemic inflammation in the diagnosis of colorectal cancer[J]. Dis Markers, 2019, 2019: 6036979. DOI: 10.1155/2019/6036979.
    [12]
    PAN YC, JIA ZF, CAO DH, et al. Preoperative lymphocyte-to-monocyte ratio (LMR) could independently predict overall survival of resectable gastric cancer patients[J]. Medicine (Baltimore), 2018, 97(52): e13896. DOI: 10.1097/MD.0000000000013896.
    [13]
    LAI Q, CASTRO SANTA E, RICO JURI JM, et al. Neutrophil and platelet-to-lymphocyte ratio as new predictors of dropout and recurrence after liver transplantation for hepatocellular cancer[J]. Transpl Int, 2014, 27(1): 32-41. DOI: 10.1111/tri.12191.
    [14]
    LIN L, YANG F, WANG Y, et al. Prognostic nomogram incorporating neutrophil-to-lymphocyte ratio for early mortality in decompensated liver cirrhosis[J]. Int Immunopharmacol, 2018, 56: 58-64. DOI: 10.1016/j.intimp.2018.01.007.
    [15]
    MILAS GP, KARAGEORGIOU V, CHOLONGITAS E. Red cell distribution width to platelet ratio for liver fibrosis: A systematic review and meta-analysis of diagnostic accuracy[J]. Expert Rev Gastroenterol Hepatol, 2019, 13(9): 877-891. DOI: 10.1080/17474124.2019.1653757.
    [16]
    MENG X, WEI G, CHANG Q, et al. The platelet-to-lymphocyte ratio, superior to the neutrophil-to-lymphocyte ratio, correlates with hepatitis C virus infection[J]. Int J Infect Dis, 2016, 45: 72-77. DOI: 10.1016/j.ijid.2016.02.025.
    [17]
    ZHAO Z, LIU J, WANG J, et al. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) are associated with chronic hepatitis B virus (HBV) infection[J]. Int Immunopharmacol, 2017, 51: 1-8. DOI: 10.1016/j.intimp.2017.07.007.
    [18]
    PENG Y, LI Y, HE Y, et al. The role of neutrophil to lymphocyte ratio for the assessment of liver fibrosis and cirrhosis: a systematic review[J]. Expert Rev Gastroenterol Hepatol, 2018, 12(5): 503-513. DOI: 10.1080/17474124.2018.1463158.
    [19]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of hepatitis C (2019 version)[J]. J Clin Hepatol, 2019, 35(12): 2670-2686. DOI: 10.3969/j.issn.1001-5256.2019.12.008.

    中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2670-2686. DOI: 10.3969/j.issn.1001-5256.2019.12.008.
    [20]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [21]
    TSOCHATZIS EA, BOSCH J, BURROUGHS AK. Liver cirrhosis[J]. Lancet, 2014, 383(9930): 1749-1761. DOI: 10.1016/S0140-6736(14)60121-5.
    [22]
    D'AMICO G, GARCIA-TSAO G, PAGLIARO L. Natural history and prognostic indicators of survival in cirrhosis: A systematic review of 118 studies[J]. J Hepatol, 2006, 44(1): 217-231. DOI: 10.1016/j.jhep.2005.10.013.
    [23]
    YANG M, PARIKH ND, LIU H, et al. Incidence and risk factors of hepatocellular carcinoma in patients with hepatitis C in China and the United States[J]. Sci Rep, 2020, 10(1): 20922. DOI: 10.1038/s41598-020-77515-y.
    [24]
    BIAN DD, JIANG YY, ZHOU HY, et al. Current status of antiviral therapy for hepatitis C related cirrhosis and hepatocellular carcinoma in mainland China[J]. Chin J Gastroenterol Hepatol, 2019, 28(7): 750-754. DOI: 10.3969/j.issn.1006-5709.2019.07.007.

    卞丹丹, 蒋莹莹, 周海洋, 等. 中国大陆丙肝相关肝硬化及肝癌患者抗病毒治疗现状调查[J]. 胃肠病学和肝病学杂志, 2019, 28(7): 750-754. DOI: 10.3969/j.issn.1006-5709.2019.07.007.
    [25]
    CAO MM, CHEN WQ. Research progress of liver cancer screening[J]. China Cancer, 2020, 29(12): 925-932. DOI: 10.11735/j.issn.1004-0242.2020.12.A007.

    曹毛毛, 陈万青. 肝癌筛查研究进展[J]. 中国肿瘤, 2020, 29(12): 925-932. DOI: 10.11735/j.issn.1004-0242.2020.12.A007.
    [26]
    LIPPI G, PLEBANI M. Red blood cell distribution width (RDW) and human pathology. One size fits all[J]. Clin Chem Lab Med, 2014, 52(9): 1247-1249. DOI: 10.1515/cclm-2014-0585.
    [27]
    TEKCE H, KIN TEKCE B, AKTAS G, et al. The evaluation of red cell distribution width in chronic hemodialysis patients[J]. Int J Nephrol, 2014, 2014: 754370. DOI: 10.1155/2014/754370.
    [28]
    JELKMANN W. Proinflammatory cytokines lowering erythropoietin production[J]. J Interferon Cytokine Res, 1998, 18(8): 555-559. DOI: 10.1089/jir.1998.18.555.
    [29]
    WANG ZD, WU H. Pathogenesis and treatment of thrombocytopenia in patients with liver cirrhosis[J]. Prac J Clin Med, 2020, 17(1): 212-215. DOI: 10.3969/j.issn.1672-6170.2020.01.065.

    王治东, 吴浩. 肝硬化患者血小板减少的发病机制及治疗[J]. 实用医院临床杂志, 2020, 17(1): 212-215. DOI: 10.3969/j.issn.1672-6170.2020.01.065.
    [30]
    KUROKAWA T, OHKOHCHI N. Platelets in liver disease, cancer and regeneration[J]. World J Gastroenterol, 2017, 23(18): 3228-3239. DOI: 10.3748/wjg.v23.i18.3228.
    [31]
    LI X, XU H, GAO P. Red Blood Cell Distribution width-to-platelet ratio and other laboratory indices associated with severity of histological hepatic fibrosis in patients with autoimmune hepatitis: A retrospective study at a single center[J]. Med Sci Monit, 2020, 26: e927946. DOI: 10.12659/MSM.927946.
    [32]
    HE Q, HE Q, QIN X, et al. The relationship between inflammatory marker levels and hepatitis C virus severity[J]. Gastroenterol Res Pract, 2016, 2016: 2978479. DOI: 10.1155/2016/2978479.
    [33]
    GOMEZ D, FARID S, MALIK HZ, et al. Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative resection for hepatocellular carcinoma[J]. World J Surg, 2008, 32(8): 1757-1762. DOI: 10.1007/s00268-008-9552-6.
    [34]
    LI X, WANG L, GAO P. Chronic hepatitis C virus infection: Relationships between inflammatory marker levels and compensated liver cirrhosis[J]. Medicine (Baltimore), 2019, 98(39): e17300. DOI: 10.1097/MD.0000000000017300.
    [35]
    ABDEL-RAZIK A, MOUSA N, BESHEER T A, et al. Neutrophil to lymphocyte ratio as a reliable marker to predict insulin resistance and fibrosis stage in chronic hepatitis C virus infection[J]. Acta Gastroenterol Belg, 2015, 78(4): 386-392. DOI: 10.1109/APS.2006.1711016.
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