Red blood cell distribution width derivatives in alcohol-related liver cirrhosis and metabolic-associated fatty liver disease

Table 1 Clinical characteristics of study participants

Parameter	ALC, n = 142	MAFLD, n = 92	Controls, n = 68	Together, n = 302
Sex (F/M)	36/106	33/59	36/32	105/197
Age (yr), (mean ± SD; median; min-max)	54 ± 12; 55; 31-84	60 ± 15; 61; 22-90	46 ± 16; 45; 20-85	54 ± 15; 55; 20-90
BMI (kg/m2) (mean ± SD; median; min-max)	25.89 ± 9.31; 25.91; 16.7-36.71	29.49 ± 4.9; 28.7; 16.26-43.01	21.95 ± 2.62; 22.45; 16.18-24.86	-
DM type 2	0/142	22/92	-	-
AH	32/142	46/92	-	-

F: Female; M: Male; min: Minimum; max: Maximum; BMI: Body mass index; DM: Diabetes mellitus; AH: Arterial hypertension.

Table 2 Results of used scores in research group

Score	ALC				MAFLD
	mean ± SD	Median	Min	Max	mean ± SD	Median	Min	Max
MELD	17 ± 8	16	6	45	-	-	-	-
BARD	-	-	-	-	2 ± 1	2	0	4
NAFLD fibrosis score	-	-	-	-	-1.36 ± 1.5	-1.16	-5.83	1.74

Min: Minimum; Max: Maximum; MELD: Model for end-stage liver disease; NAFLD: Non-alcoholic fatty liver disease.

Table 3 Results of indirect and direct markers of liver fibrosis together with hematological markers in examined patients

Parameter (reference range)	ALC				MAFLD				Controls
	mean ± SD	Median	Min	Max	mean ± SD	Median	Min	Max	mean ± SD	Median	Min	Max
RDW (11%-15%)	17.27 ± 3.26	16.7d	12.2	27.9	14.25 ± 2.52	13.85a	4.2	25	13.45 ± 1.1	13.4	11.1	15
RPR	0.26 ± 0.37	0.18d	0.04	3.55	0.06 ± 0.02	0.06d	0.02	0.18	0.05 ± 0.01	0.05	0.03	0.08
RLR	19.14 ± 12.27	15.73d	1.6	79.23	10.89 ± 8.55	8.13d	0.66	60	7.09 ± 2.48	6.24	3.38	12.5
FIB-4	11.67 ± 25.46	6.34d	0.69	287.59	1.92 ± 1.63	1.57d	0.23	11.58	0.85 ± 0.54	0.71	0.28	3.27
GPR	15.73 ± 28.54	6.65d	0.18	188.71	2.76 ± 5.57	0.54d	0.13	35.41	0.25 ± 0.1	0.24	0.06	0.63
PICP (ng/mL)	63.32 ± 31.53	60.53	6.15	161.12	52.14 ± 27.56	46.08	10.10	147.27	58.26 ± 37.39	44.18	0	202.89
PIIINP (ng/mL)	9.28 ± 4.33	8.4b	2.43	28.65	11.41 ± 3.99	11.00	2.18	25.35	11.07 ± 5.61	10.25	4.35	43.63
PDGF-AB (pg/mL)	18280.47 ± 8061.06	17343.71c	1925.68	42823.84	26858.68 ± 7335.09	26682.83	10821.02	49808.07	23579.28 ± 10068.8	25623.2	1638.2	47758.7
TGF-α (pg/mL)	24 ± 45.33	13.77d	0.872	507.09	17.89 ± 19.18	12.09d	1.39	142.63	28.44 ± 17.21	24.59	1.31	93.55
Laminin (ng/mL)	976.34 ± 705.29	832.06a	101.933	3301.00	48 ± 230.24	375.23d	72.87	1335.92	718.24 ± 386.1	663.27	140.88	1813.88

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

^dP < 0.0001.

ALC: Alcoholic liver cirrhosis; MAFLD: Metabolic associated fatty liver disease; Min: Minimum; Max: Maximum; AAR: Aspartate transaminase to alkaline transaminase ratio; APRI: Aspartate transaminase to platelet ratio index; FIB-4: Fibrosis-4; GPR: Gamma-glutamyl transpeptidase to platelet ratio; PICP: Procollagen I carboxyterminal propeptide; PIIINP: Procollagen III aminoterminal propeptide; PDGF-AB: Platelet-derived growth factor AB; TGF-α: Transforming growth factor-α; RDW: Red blood cell distribution width; RPR: Red blood cell distribution width-to-platelet ratio; RLR: Red blood cell distribution width-to-lymphocyte ratio.

Table 4 Correlations between examined parameters in examined alcohol-related liver cirrhosis and metabolic-associated fatty liver disease patients

Pair	R Spearman	P value
ALC
RPR vs FIB-4	0.733	P < 0.0001
RPR vs GPR	0.398	P < 0.0001
RPR vs MELD	0.267	P < 0.01
RDW vs PDGF-AB	-0.257	P < 0.01
RPR vs PDGF-AB	-0.380	P < 0.0001
MAFLD
RDW vs FIB-4	0.215	P < 0.05
RPR vs APRI	0.469	P < 0.0001
RPR vs NFS	0.688	P < 0.0001

ALC: Alcoholic liver cirrhosis; MAFLD: Metabolic-associated fatty liver disease; RDW: Red blood cell distribution width; RPR: Red blood cell distribution width-to-platelet ratio; MELD: Model of end stage liver disease; APRI: Aspartate transaminase to platelet ratio index; FIB-4: Fibrosis-4; GPR: Gamma-glutamyl transpeptidase to platelet ratio; PDGF-AB: Platelet-derived growth factor AB; NFS: NAFLD fibrosis score.

Table 5 Diagnostic accuracy of hematological indices in examined alcohol-related liver cirrhosis and metabolic-associated fatty liver disease patients

Parameter	ALC								MAFLD
	Diagnostic accuracy								Diagnostic accuracy
	AUC	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	PLR	NLR	P value	AUC	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	PLR	NLR	P value
RDW	0.912	91	71	87	79	3.14	0.13	P < 0.0001	0.606	88	32	64	67	1.29	0.38	P < 0.05
RPR	0.965	88	97	98	80	29.33	0.12	P < 0.0001	0.724	77	54	70	64	1.67	0.43	P < 0.0001
RLR	0.914	89	77	89	78	3,87	0,14	P < 0.0001	0.691	80	52	69	66	1.67	0.38	P < 0.0001

ALC: Alcoholic liver cirrhosis; MAFLD: Metabolic-associated fatty liver disease; AUC: Area under the curve; PPV: Positive predictive value; NPV: Negative predictive value; PLR: Positive likelihood; NLR: Negative likelihood ratio.