Skip to main content

Advertisement

SpringerLink
Log in

Platelet count for predicting fibrosis in nonalcoholic fatty liver disease

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The severity of liver fibrosis is known to be a good indicator for surveillance, and for determining the prognosis and optimal treatment of nonalcoholic fatty liver disease (NAFLD). However, it is virtually impossible to carry out liver biopsies in all NAFLD patients. The purpose of this study was to investigate the clinical usefulness of measuring the platelet count for predicting the severity of liver fibrosis in a large retrospective cohort of Japanese patients with NAFLD.

Methods

A total of 1,048 patients with liver-biopsy-confirmed NAFLD seen between 2002 and 2008 were enrolled from nine hepatology centers in Japan. Laboratory evaluations were performed for all patients.

Results

A linear decrease of the platelet count with increasing histological severity of hepatic fibrosis was revealed. The area under the receiver operating characteristic curve estimating the diagnostic performance of the platelet count for hepatic fibrosis Stage 3 was 0.774 (optimal cutoff value, 19.2 × 104/μl; sensitivity, 62.7%; specificity, 76.3%), and that for Stage 4 was 0.918 (optimal cutoff value, 15.3 × 104/μl; sensitivity, 80.5%; specificity, 88.8%).

Conclusions

The platelet count may be an ideal biomarker of the severity of fibrosis in NAFLD patients, because it is simple, easy to measure and handle, cost-effective, and accurate for predicting the severity of fibrosis. Furthermore, by using the platelet count cutoff value validated in our multiple large trials, efficient recruitment of NAFLD patients may be facilitated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

NAFLD:

Nonalcoholic fatty liver disease

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

AUROC:

Area under the receiver operating characteristic

BMI:

Body mass index

APRI:

Aspartate aminotransferase to platelet ratio index

References

  1. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002;18:1221–31.

    Article  Google Scholar 

  2. Liou I, Kowdley KV. Natural history of nonalcoholic steatohepatitis. J Clin Gastroenterol. 2006;40(Suppl 1):S11–6.

    PubMed  Google Scholar 

  3. National Institutes of Health. National Institutes of Health Consensus Development Conference statement: management of hepatitis C 2002 (June 10–12, 2002). Hepatology. 2002;36(5 Suppl 1):S3–20.

    Google Scholar 

  4. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology. 1999;30:1356–62.

    Article  PubMed  CAS  Google Scholar 

  5. Cadranel JF. Good clinical practice guidelines for fine needle aspiration biopsy of the liver: past, present and future. Gastroenterol Clin Biol. 2002;26:823–4.

    PubMed  CAS  Google Scholar 

  6. Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver biopsy in chronic hepatitis C. Hepatology. 2001;33:196–200.

    Article  PubMed  CAS  Google Scholar 

  7. Poynard T, Ratziu V, Bedossa P. Appropriateness of liver biopsy. Can J Gastroenterol. 2003;14:543–8.

    Google Scholar 

  8. Saibara T. Nonalcoholic steatohepatitis in Asia-Oceania. Hepatol Res. 2005;33:64–7.

    Article  PubMed  Google Scholar 

  9. Poynard T, Yuen MF, Ratziu V, Lai CL. Viral hepatitis C. Lancet. 2003;362:2095–100.

    Article  PubMed  CAS  Google Scholar 

  10. Liaw YF, Tai DI, Chu CM, Chen TJ. The development of cirrhosis in patients with chronic type B hepatitis: a prospective study. Hepatology. 1988;8:493–6.

    Article  PubMed  CAS  Google Scholar 

  11. Poynard T, Bedossa P. Age and platelet count: a simple index for predicting the presence of histological lesions in patients with antibodies to hepatitis C virus. METAVIR and CLINIVIR Cooperative Study Groups. J Viral Hepat. 1997;4:199–208.

    Article  PubMed  CAS  Google Scholar 

  12. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38:518–26.

    Article  PubMed  Google Scholar 

  13. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninvasive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45:846–54.

    Article  PubMed  CAS  Google Scholar 

  14. Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–25.

    Article  PubMed  CAS  Google Scholar 

  15. Sumida Y, Yoneda M, Hyogo H, Yamaguchi K, Ono M, Fujii H, et al. A simple clinical scoring system using ferritin, fasting insulin and type IV collagen 7S for predicting steatohepatitis in nonalcoholic fatty liver disease. J Gastroenterol. 2011;46(2):257–68.

    Article  PubMed  CAS  Google Scholar 

  16. Sanyal AJ. AGA technical review on nonalcoholic fatty liver disease. Gastroenterology. 2002;123:1705–25.

    Article  PubMed  Google Scholar 

  17. Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ, et al. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116:1413–9.

    Article  PubMed  CAS  Google Scholar 

  18. Sanyal AJ, Brunt EM, Kleiner DE, Kowdley K, Chalasani N, Lavine J, et al. Endpoints and clinical trial design for nonalcoholic steatohepatitis. Hepatology. 2011;54(1):344–53.

    Article  PubMed  Google Scholar 

  19. Brunt EM, Tiniakos DG. Histopathology of nonalcoholic fatty liver disease. World J Gastroenterol. 2010;16:5286–96.

    Article  PubMed  Google Scholar 

  20. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41:1313–21.

    Article  PubMed  Google Scholar 

  21. Charlton M. Nonalcoholic fatty liver disease: a review of current understanding and future impact. Clin Gastroenterol Hepatol. 2004;2:1048–58.

    Article  PubMed  Google Scholar 

  22. Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW, et al. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology. 1990;11:74–80.

    Article  PubMed  Google Scholar 

  23. Kajihara M, Okazaki Y, Kato S, Ishii H, Kawakami Y, Ikeda Y, et al. Evaluation of platelet kinetics in patients with liver cirrhosis: similarity to idiopathic thrombocytopenic purpura. J Gastroenterol Hepatol. 2007;22:112–8.

    Article  PubMed  CAS  Google Scholar 

  24. Park KS, Lee YS, Park HW, Seo SH, Jang BG, Hwang JY, et al. Factors associated or related to with pathological severity of nonalcoholic fatty liver disease. Korean J Intern Med. 2004;19:19–26.

    PubMed  Google Scholar 

  25. Kaneda H, Hashimoto E, Yatsuji S, Tokushige K, Shiratori K. Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol. 2006;21:1459–65.

    PubMed  CAS  Google Scholar 

  26. Aster RH. Pooling of platelets in the splenic. J Clin Invest. 1966;45:645–57.

    Article  PubMed  CAS  Google Scholar 

  27. Schmidt KG, Rasmussen JW, Bekker C, Madsen PE. Kinetics and in vivo distribution of 111-In-labelled autologous platelets in chronic hepatic disease: mechanisms of thrombocytopenia. Scand J Haematol. 1985;34:39–46.

    Article  PubMed  CAS  Google Scholar 

  28. Nakamura S, Konishi H, Kishino M, Yatsuji S, Tokushige K, Hashimoto E, et al. Prevalence of esophagogastric varices in patients with non-alcoholic steatohepatitis. Hepatol Res. 2008;38:572–9.

    Article  PubMed  Google Scholar 

  29. Reynolds TB, Hidemura R, Michel H, Peters R. Portal hypertension without cirrhosis in alcoholic liver disease. Ann Intern Med. 1969;70:497–506.

    PubMed  CAS  Google Scholar 

  30. Bolognesi M, Merkel C, Sacerdoti D. Role of spleen enlargement in cirrhosis with portal hypertension. Dig Liver Dis. 2002;34:144–50.

    Article  PubMed  CAS  Google Scholar 

  31. Suzuki K, Kirikoshi H, Yoneda M, Mawatari H, Fujita K, Nozaki Y, et al. Measurement of spleen volume is useful for distinguishing between simple steatosis and early-stage non-alcoholic steatohepatitis. Hepatology Res. 2010;40:693–700.

    Article  CAS  Google Scholar 

  32. Fujii H, Enomoto M, Fukushima W, Ohfuji S, Mori M, Kobayashi S, et al. Noninvasive laboratory tests proposed for predicting cirrhosis in patients with chronic hepatitis C are also useful in patients with non-alcoholic steatohepatitis. J Gastroenterol. 2009;44:608–814.

    Article  PubMed  Google Scholar 

  33. Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7:1104–12.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Atsushi Nakajima for helpful suggestions. This work was supported by a Grant-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology of Japan (22790660) to MY, and by a Grant from the Chiyoda Mutual Life Foundation to YS, and by a Thrust Area Research Grant from Osaka City University to HF and NK.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Masato Yoneda & Kento Imajo

  2. Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Hideki Fujii & Norifumi Kawada

  3. Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan

    Yoshio Sumida & Kazuyuki Kanemasa

  4. Department of Medicine and Molecular Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan

    Hideyuki Hyogo & Kazuaki Chayama

  5. Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yoshito Itoh & Toshikazu Yoshikawa

  6. Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan

    Masafumi Ono & Toshiji Saibara

  7. Department of General Medicine, Saga Medical School, Saga, Japan

    Yuichiro Eguchi & Kazuma Fujimoto

  8. Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan

    Yasuaki Suzuki & Yutaka Kohgo

  9. School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA

    Noriaki Aoki

  10. Hepatology Center, Saiseikai Suita Hospital, Suita, Japan

    Takeshi Okanoue

Authors
  1. Masato Yoneda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hideki Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshio Sumida
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideyuki Hyogo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshito Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masafumi Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuichiro Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasuaki Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Noriaki Aoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazuyuki Kanemasa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kento Imajo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Kazuaki Chayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Toshiji Saibara
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Norifumi Kawada
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Kazuma Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Yutaka Kohgo
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Toshikazu Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Takeshi Okanoue
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)

Corresponding author

Correspondence to Hideyuki Hyogo.

Additional information

All authors are members of the Japan Study Group of NAFLD (JSG-NAFLD).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoneda, M., Fujii, H., Sumida, Y. et al. Platelet count for predicting fibrosis in nonalcoholic fatty liver disease. J Gastroenterol 46, 1300–1306 (2011). https://doi.org/10.1007/s00535-011-0436-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-011-0436-4

Keywords

Search

Navigation