Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2022; 28(38): 5636-5647
Published online Oct 14, 2022. doi: 10.3748/wjg.v28.i38.5636
Red blood cell distribution width derivatives in alcohol-related liver cirrhosis and metabolic-associated fatty liver disease
Agata Michalak, Małgorzata Guz, Joanna Kozicka, Marek Cybulski, Witold Jeleniewicz, Tomasz Lach, Halina Cichoż-Lach
Agata Michalak, Joanna Kozicka, Halina Cichoż-Lach, Department of Gastroenterology, Medical University of Lublin, Lublin 20-954, Poland
Małgorzata Guz, Marek Cybulski, Witold Jeleniewicz, Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin 20-093, Poland
Tomasz Lach, Department of Orthopedics and Traumatology, Medical University of Lublin, Lublin 20-954, Poland
Author contributions: Michalak A, Lach T and Cichoż-Lach H prepared data; Michalak A and Cichoż-Lach H invented and conducted the study; Guz M, Kozicka J and Jeleniewicz W applied the experiments, gained and interpreted data; Cybulski M statistically analyzed the data; Michalak A and Cichoż-Lach H wrote the article; All authors accepted the current version of the manuscript.
Institutional review board statement: The survey was accepted by the local ethics committee of the Medical University of Lublin (No. KE-0254/86/2016).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Halina Cichoż-Lach, PhD, Professor, Department of Gastroenterology, Medical University of Lublin, Jaczewski Str. 8, Lublin 20-954, Poland. lach.halina@wp.pl
Received: July 4, 2022
Peer-review started: July 4, 2022
First decision: July 31, 2022
Revised: August 7, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: October 14, 2022
ARTICLE HIGHLIGHTS
Research background

The most meaningful and valuable future diagnostic tools are new noninvasive blood markers of liver fibrosis, and red blood cell distribution width (RDW) together with RDW-to-platelet-(PLT)-ratio (RPR) were suggested to be such probable indices. Their potential role in the course of liver disorders still requires further elucidation.

Research motivation

In light of the above, we decided to study the diagnostic role of RDW derivatives and their relationships with direct and indirect indices of liver fibrosis in patients with alcohol-related liver cirrhosis (ALC) and metabolic-associated fatty liver disease (MAFLD). It seems to be the first investigation performed among Polish patients to evaluate the potential dependences between hematological parameters and serological markers of liver fibrosis.

Research objectives

The aim of the study was the evaluation of RDW, RPR and RDW-to-lymphocyte ratio (RLR) in ALC and MAFLD patients.

Research methods

The study group was comprised of 302 persons: 142 patients with ALC, 92 with MAFLD and 68 volunteers as controls. RDW, RPR and RLR were assessed in each participant. Indirect and direct indices of liver fibrosis were also measured [aspartate transaminase to alkaline transaminase ratio, aspartate transaminase to platelet ratio index (APRI), fibrosis-4 (FIB-4), gamma-glutamyl transpeptidase to platelet ratio (GPR), procollagen I carboxyterminal propeptide, procollagen III aminoterminal propeptide, transforming growth factor-α, platelet-derived growth factor AB, laminin]. MELD score in the ALC patients and NAFLD fibrosis score together with BARD score were obtained in the MAFLD group. The achieved results were compared to controls. Then a correlation between investigated parameters was done. Diagnostic value of each evaluated marker together with suggested cut-off in the research group were assessed with area under the curve (AUC).

Research results

RDW, RPR and RLR values were significantly higher in ALC and MAFLD patients in comparison to controls. RPR correlated positively with MELD score and indirect parameters of liver fibrosis in the ALC group. RPR correlated positively with the NAFLD fibrosis score and APRI in the MAFLD patients; a positive dependency was noted between the RDW and FIB-4. The AUC values and suggested cut-offs for RDW, RPR and RLR in ALC patients were: 0.912 (> 14.2%), 0.965 (> 0.075) and 0.914 (> 8.684), respectively. AUC values and proposed cut-offs for RDW, RPR and RLR in MAFLD patients were: 0.606 (> 12.8%), 0.724 (> 0.047) and 0.691 (> 6.25), respectively.

Research conclusions

Our study gives a new insight into the tight relationship between serological indices of liver fibrosis and RDW derivatives in ALC and MAFLD patients. RLR seems to be a valuable unexplored parameter in the course of ALC patients. Its high diagnostic accuracy in ALC is a promising message for subsequent studies. Undoubtedly, this direction of research should be continued to define a potential role of commonly accessible RDW derivatives as indicators of liver disorders in everyday clinical life.

Research perspectives

It seems that our results have important clinical implications and could be applied in everyday diagnostics of patients with liver disorders.