Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2020; 26(47): 7538-7549
Published online Dec 21, 2020. doi: 10.3748/wjg.v26.i47.7538
Towards an evaluation of alcoholic liver cirrhosis and nonalcoholic fatty liver disease patients with hematological scales
Agata Michalak, Halina Cichoż-Lach, Małgorzata Guz, Joanna Kozicka, Marek Cybulski, Witold Jeleniewicz, Andrzej Stepulak
Agata Michalak, Halina Cichoż-Lach, Joanna Kozicka, Department of Gastroenterology, Medical University of Lublin, Lublin 20-954, Jaczewskiego 8, Poland
Małgorzata Guz, Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin 20-093, Chodźki 3, Poland
Marek Cybulski, Witold Jeleniewicz, Andrzej Stepulak, Department of Biochemistry and Molecular Biology, Medical Univeristy of Lublin, Lublin 20-093, Chodźki 3, Poland
Author contributions: Michalak A and Cichoż-Lach H designed and coordinated the study; Guz M, Kozicka A and Jeleniewicz W performed the experiments, acquired and analyzed data; Cybulski M and Stepulak A interpreted the data; Michalak A and Cichoż-Lach H wrote the manuscript; all authors approved the final version of the article.
Institutional review board statement: The local ethics committee of the Medical University of Lublin approved the study (Approval No. KE-0254/86/2016).
Informed consent statement: All patients signed an informed written consent in accordance with the Helsinki Declaration for the procedures they underwent.
Conflict-of-interest statement: Nothing to disclose.
Data sharing statement: Dataset available from the corresponding author at lach.halina@wp.pl.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Halina Cichoż-Lach, MD, PhD, Professor, Department of Gastroenterology, Medical University of Lublin, Jaczewskiego 8, Lublin 20-954, Jaczewskiego 8, Poland. lach.halina@wp.pl
Received: July 27, 2020
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
Processing time: 145 Days and 2.6 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.