Skip to main content

Advertisement

SpringerLink
Log in

Red cell distribution width to platelet ratio, a useful indicator of liver fibrosis in chronic hepatitis patients

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Aims

We investigated the correlation between the red cell distribution width (RDW) and RDW-to-platelet ratio (RPR) with the degree of inflammation and fibrosis in chronic hepatitis patients with different etiologies and in native and transplanted liver.

Methods

Between 2010 and 2013, patients from the MedStar Washington Hospital Center and Georgetown University Hospital with chronic hepatitis B, chronic hepatitis C, alcoholic hepatitis, and primary biliary cirrhosis who had a biopsy of the liver done in this time period were included. The correlation among the RDW, RPR, and model for end-stage liver disease (MELD) score with the degree of liver inflammation, fibrosis, and cirrhosis in separate groups of native and transplanted liver was calculated.

Results

A total of 152 cases with native liver and 70 cases with transplanted liver were included. The majority of patients had hepatitis C in both groups. None of the investigated variables showed significant correlation with the degree of inflammation in either group. The strongest correlation with the degree of fibrosis in the native liver group was for the RPR with 0.51 (p < 0.001) and then the RDW and MELD with 0.34 (p < 0.001) and 0.31 (p < 0.001), respectively. In the transplanted liver group, none of the variables showed significant correlation with the degree of fibrosis. The receiver-operator curve showed that only the RDW and RPR in the native liver group, with areas under the curve of 0.770 and 0.684, respectively, have significantly positive association with the risk of cirrhosis. In the transplanted group, none of the predictors were associated with risk of cirrhosis. In the native liver group, a cutoff value of 0.088 in the RPR led to 82.7 % sensitivity and 61.0 % specificity to predict cirrhosis.

Conclusion

The RPR can be a strong predictor of the degree of fibrosis and cirrhosis in patients with chronic hepatitis and native liver. It shows higher accuracy compared to the RDW and MELD score. However, its use in predicting inflammation is limited.

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.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Zalawadiya SK, Veeranna V, Niraj A, Pradhan J, Afonso L. Red cell distribution width and risk of coronary heart disease events. Am J Cardiol 2010;106:988–993

    Article  PubMed  Google Scholar 

  2. Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 2009;169:515–523

    Article  PubMed Central  PubMed  Google Scholar 

  3. Horne BD. A changing focus on the red cell distribution width: why does it predict mortality and other adverse medical outcomes? Cardiology 2012;122:213–215

    Article  PubMed  Google Scholar 

  4. Bojakowski K, Dzabic M, Kurzejamska E, Styczynski G, Andziak P, et al. A high red blood cell distribution width predicts failure of arteriovenous fistula. PLoS One 2012;7:e36482

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Lou Y, Wang M, Mao W. Clinical usefulness of measuring red blood cell distribution width in patients with hepatitis B. PLoS One 2012;7:e37644

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Karagoz E, Ulcay A, Tanoglu A, Kara M, Turhan V, et al. Clinical usefulness of mean platelet volume and red blood cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in chronic hepatitis B virus patients. Eur J Gastroenterol Hepatol 2014;26:1320–1324

    CAS  PubMed  Google Scholar 

  7. Huang R, Yang C, Wu K, Cao S, Liu Y, et al. Red cell distribution width as a potential index to assess the severity of hepatitis B virus-related liver diseases. Hepatol Res 2014;44:E464–E470

    Article  CAS  PubMed  Google Scholar 

  8. Chen B, Ye B, Zhang J, Ying L, Chen Y. RDW to platelet ratio: a novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B. PLoS One 2013;8:e68780

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000;31:864–871

    Article  CAS  PubMed  Google Scholar 

  10. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464–470

    Article  CAS  PubMed  Google Scholar 

  11. Kamath PS, Kim WR, Advanced Liver Disease Study G. The model for end-stage liver disease (MELD). Hepatology. 2007;45:797–805

    Article  Google Scholar 

  12. Batts KP, Ludwig J. Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol 1995;19:1409–1417

    Article  CAS  PubMed  Google Scholar 

  13. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837–845

    Article  CAS  PubMed  Google Scholar 

  14. Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32–35

    Article  CAS  PubMed  Google Scholar 

  15. Huo TI, Wu JC, Lin HC, Lee FY, Hou MC, et al. Evaluation of the increase in model for end-stage liver disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score. J Hepatol 2005;42:826–832

    Article  PubMed  Google Scholar 

  16. Karnad A, Poskitt TR. The automated complete blood cell count. Use of the red blood cell volume distribution width and mean platelet volume in evaluating anemia and thrombocytopenia. Arch Intern Med 1985;145:1270–1272

    Article  CAS  PubMed  Google Scholar 

  17. Thompson WG, Meola T, Lipkin M Jr, Freedman ML. Red cell distribution width, mean corpuscular volume, and transferrin saturation in the diagnosis of iron deficiency. Arch Intern Med 1988;148:2128–2130

    Article  CAS  PubMed  Google Scholar 

  18. Evans TC, Jehle D. The red blood cell distribution width. J Emerg Med 1991;9(Suppl 1):71–74

    Article  PubMed  Google Scholar 

  19. McHutchison JG, Manns MP, Longo DL. Definition and management of anemia in patients infected with hepatitis C virus. Liver Int 2006;26:389–398

    Article  PubMed  Google Scholar 

  20. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009;133:628–632

    CAS  PubMed  Google Scholar 

  21. Allen LA, Felker GM, Mehra MR, Chiong JR, Dunlap SH, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail 2010;16:230–238

    Article  PubMed Central  PubMed  Google Scholar 

  22. Coursaget P, Buisson Y, N’Gawara MN, Van Cuyck-Gandre H, Roue R. Role of hepatitis E virus in sporadic cases of acute and fulminant hepatitis in an endemic area (Chad). Am J Trop Med Hyg 1998;58:330–334

    CAS  PubMed  Google Scholar 

  23. Knight V, Tchongue J, Lourensz D, Tipping P, Sievert W. Protease-activated receptor 2 promotes experimental liver fibrosis in mice and activates human hepatic stellate cells. Hepatology 2012;55:879–887

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This project was funded in part by federal funds (grant no. UL1TR000101, previously UL1RR031975) from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through the Clinical and Translational Science Awards Program (CTSA), a trademark of DHHS, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.”

Compliance with Ethical Requirements and Conflict of interest

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). This study was reviewed and approved by the Institutional Review Board of MesdStar Health Research Institute. Amir Taefi, Chun-Chih Huang, Kirthi Kolli, Suzan Ebrahimi, and Mitesh Patel declare that they have no conflict of interests.

Author information

Authors and Affiliations

  1. Department of Medicine, Medstar Washington Hospital Center, 110 Irving St, NW, Washington, DC, 20010, USA

    Amir Taefi, Kirthi Kolli, Suzan Ebrahimi & Mitesh Patel

  2. MedStar Health Research Institute, Hyattsville, MD, USA

    Chun-Chih Huang

Authors
  1. Amir Taefi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chun-Chih Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kirthi Kolli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suzan Ebrahimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mitesh Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amir Taefi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taefi, A., Huang, CC., Kolli, K. et al. Red cell distribution width to platelet ratio, a useful indicator of liver fibrosis in chronic hepatitis patients. Hepatol Int 9, 454–460 (2015). https://doi.org/10.1007/s12072-015-9638-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-015-9638-9

Keywords

Search

Navigation