Published online Dec 21, 2020. doi: 10.3748/wjg.v26.i47.7538
Peer-review started: July 27, 2020
First decision: September 30, 2020
Revised: October 12, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: December 21, 2020
A noninvasive evaluation of liver fibrosis remains still an unexplored field of hepatology. Seeking potentially new parameters of liver disease progression is constantly a key task among hepatologists. Recently several new hematological markers have been proposed as potential indices in the monitoring of alcoholic liver cirrhosis (ALC) and non-alcoholic fatty liver disease (NAFLD) patients, however the number of available studies on them is strictly limited.
So far there is little evidence about the potential relationships between hematological indices [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume-to-platelet-ratio (MPR)] and serological markers of liver fibrosis in the course of ALC and NAFLD. Available data suggest their potential role in the monitoring and prediction of outcome in liver diseases.
We performed a retrospective study to evaluate the clinical utility of selected hematological indices and their potential relationships with serological markers of liver fibrosis among patients with ALC and NAFLD.
One hundred forty two patients with ALC, 92 with NAFLD and 68 persons in control group were enrolled in the study. Hematological indices (NLR, PLR and MPR), indirect and direct markers of liver fibrosis [AST and ALT ratio (AAR), AST to platelet ratio index (APRI), fibrosis-4 (FIB-4), gamma-glutamyl transpeptidase to platelet ratio (GPR), procollagen I carboxyterminal propeptide (PICP), procollagen III aminoterminal propeptide (PIIINP), platelet-derived growth factor AB (PDGF-AB), transforming growth factor-α (TGF-α) and laminin] were measured in each person. Model for end-stage liver disease (MELD) score in ALC group and NAFLD fibrosis score together with BARD score were calculated in NAFLD patients. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were applied to assess the sensitivity and specificity of examined markers and to evaluate proposed cut-offs of measured indices in the course of ALC and NAFLD.
MPR and NLR values in ALC patients were significantly higher compared to control group; PLR level was significantly lower. MPR and PLR correlated with assessed indirect and direct markers of liver fibrosis. MPR, NLR and PLR correlated with MELD score as well. NLR level in NAFLD patients was significantly higher in comparison to controls. MPR correlated with indirect markers of liver fibrosis and NAFLD fibrosis score. AUC values and proposed cut-offs for NLR, PLR and MPR in ALC patients were: 0.821 (> 2.227), 0.675 (< 70.445) and 0.929 (> 0.048), respectively. AUC values and proposed cut-offs for NLR, PLR and MPR in NAFLD group were: 0.725 (> 2.034), 0.528 (> 97.101) and 0.547 (> 0.038), respectively.
We demonstrated that NLR, MPR and PLR belong to hematological parameters with a relatively high diagnostic accuracy especially in the course of ALC. They are closely related to indirect and direct markers of liver fibrosis. Moreover, NLR, MPR and PLR seem to correlate with a clinical progression of liver cirrhosis (MELD score). These relationships propose evaluated hematological indices to be explored as potential parameters of liver disorders, especially liver cirrhosis.
We consider that further studies on NLR, MPR and PLR might broaden the range of noninvasive diagnostic tools in the evaluation of liver fibrosis and the decompensation of liver cirrhosis.