Red cell distribution width/platelet ratio estimates the 3-year risk of decompensation in Metabolic Dysfunction-Associated Steatotic Liver Disease-induced cirrhosis

Figure 1 Experimental design. Clinically Significant Portal Hypertension Rule-in Liver Stiffness Measurement > 25 kPa. ¹Baveno VI criteria; ²Baveno VII criteria. AD: Acute decompensation; NAD: Non-acute decompensation; LSM: Liver Stiffness Measurement; CSPH: Clinically Significant Portal Hypertension; MASLD: Metabolic Dysfunction-Associated Steatotic Liver Disease; cACLD: Compensated advanced chronic liver disease; BMI: Body mass index; Whr: Waist-to-hip ratio; SBP: Systolic; DBP: Diastolic blood pressure; CP: Child-Pugh; MELD: Model for End-Stage Liver Disease; APRI: Aspartate aminotransferase/platelet count ratio index; ALBI: Albumin-Bilirubin; FIB-4: Fibrosis-4; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; INR: International Normalized Ratio; PLT: Platelet; RDW: Red cell distribution width; FPG: Fasting plasma glucose; HOMA-IR: Homeostasis model assessment for insulin resistance; LDL: Low-density lipoprotein; HDL: High-density lipoprotein.

Figure 2 Comparison of red cell distribution width/platelet ratio and other non-invasive tools baseline values between compensated individuals and patients progressing to decompensation during the follow-up period. A and B: Cell distribution width/platelet ratio (A), other non-invasive tools (B). LSM: Liver Stiffness Measurement; CSPH: Clinically Significant Portal Hypertension; cACLD: Compensated advanced chronic liver disease; dACLD: Decompensated advanced chronic liver disease; MELD: Model for End-Stage Liver Disease; APRI: Aspartate aminotransferase/platelet count ratio index; ALBI: Albumin-Bilirubin; FIB-4: Fibrosis-4.

Figure 3 Relationship between baseline red cell distribution width/platelet ratio values and validated tools non-invasively assessing liver-function status and hepatic fibrosis. A, B, C, E, F, G and H: Linear regression of red cell distribution width to platelet ratio (RPR) and Model for End-Stage Liver Disease (A); RPR and Child-Push score (B); RPR and aspartate aminotransferase/platelet count ratio index (C); RPR and Liver Stiffness Measurement (E); RPR and Fibrosis-4 (FIB-4; F); RPR and Albumin-Bilirubin (ALBI; G); RPR and ALBI/FIB-4 (H). D: Heat map of R values revealed of to the linear regression analysis between baseline RPR others tools reported in panel A, B, C, E, F, G, H. LSM: Liver Stiffness Measurement; ALBI: Albumin-Bilirubin; FIB-4: Fibrosis-4; APRI: Aspartate aminotransferase/platelet count ratio index; MELD: Model for End-Stage Liver Disease; RPR: Red cell distribution width to platelet ratio.

Figure 4 3-year decompensation predictive accuracy of red cell distribution width/platelet ratio and comparison with other non-invasive tools. A: Accuracy of baseline red cell distribution width to platelet ratio in predicting 3-years decompensation; B: Comparison with other non-invasive tools. ALBI: Albumin-Bilirubin; FIB-4: Fibrosis-4; APRI: Aspartate aminotransferase/platelet count ratio index; MELD: Model for End-Stage Liver Disease; RPR: Red cell distribution width to platelet ratio; AUC: Area under the curve.

Figure 5 The first decompensation event’s occurrence risk according to the baseline red cell distribution width/platelet ratio values. RPR: Red cell distribution width to platelet ratio.

Figure 6 Adjusted odds ratios for non-invasive tools on the first decompensation event’s occurrence. ^aP = 0.02. RPR: Red cell distribution width to platelet ratio; ALBI: Albumin-Bilirubin; FIB-4: Fibrosis-4; MELD: Model for End-Stage Liver Disease; LSM: Liver Stiffness Measurement; OR: Odds ratio.

Figure 7 3-year acute decompensation predictive accuracy of red cell distribution width/platelet ratio and comparison with other non-invasive tools. A: Red cell distribution width/platelet ratio; B: Comparison with other non-invasive tools. AD: Acute decompensation; NAD: Non-acute decompensation; ALBI: Albumin-Bilirubin; FIB-4: Fibrosis-4; APRI: Aspartate aminotransferase/platelet count ratio index; MELD: Model for End-Stage Liver Disease; RPR: Red cell distribution width to platelet ratio; AUC: Area under the curve.

Figure 8 The first decompensation event’s occurrence risk according to the baseline red cell distribution width/platelet ratio values and the presence of Clinically Significant Portal Hypertension. RPR: Red cell distribution width to platelet ratio; CSPH: Clinically Significant Portal Hypertension; HR: Hazard ratio.