Predictive value of the red blood cell distribution width-to-platelet ratio for hepatic fibrosis

Abstract

Aims: The red blood cell distribution width-to-platelet ratio (RPR) has been reported to be an indicator of hepatic fibrosis in patients with chronic hepatitis B (HBV), nonalcoholic fatty liver disease (NAFLD) or chronic hepatitis C (HCV). However, no research has explored the RPR in all patients with hepatic fibrosis. There is a recognized need to establish whether the RPR could assess hepatic fibrosis and reflect the severity of fibrosis, regardless of the patient’s etiology.

Methods: Quantitative data from 1282 patients who underwent liver biopsy between January 2010 and December 2014 at the Second Affiliated Hospital of Zhejiang University School of Medicine were included. The etiologies included HBV or HCV infection, NAFLD, schistosomiasis, granulomatous liver disease, and vascular abnormalities. Five noninvasive models were calculated for all patients based on laboratory parameters. The degrees of fibrosis severity were evaluated based on the Metavir scoring scale.

Results: The RPR demonstrated the best accuracy of predicting hepatic fibrosis among the selected five models (0.75, p < .001) regardless of etiology. In addition, the RPR values increased with advanced hepatic fibrosis progression. Furthermore, combining the RPR with the white blood cell (WBC) count improved the accuracy of grading hepatic fibrosis as reflected by the likelihood ratio (LR + 9.03, LR − 0.49).

Conclusion: The RPR is a useful indicator for hepatic fibrosis, regardless of etiology, and can reflect the severity of fibrosis. This study supports further clinical development of the RPR both in a stepwise manner or in combination with inflammatory parameters to improve the accuracy of scoring hepatic fibrosis.

Keywords:

• RPR
• hepatic fibrosis
• noninvasive
• WBC
• RDW
• PLT

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Disclosure statement

Author Zhihua Tao received research grants from the National Natural Science Foundation of China. Author Zhaoping Liao received research grants from the National Natural Science Foundation of Zhejiang Province. Author Zhihua Tao declares that he has no conflict of interest. Author Zhaoping Liao declares that he has no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Funding

This study was funded by the National Natural Science Foundation of China [Grant no. 81271917] and the National Natural Science Foundation of Zhejiang Province [LY16H160023].