Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.225
Peer-review started: June 27, 2022
First decision: July 25, 2022
Revised: August 2, 2022
Accepted: January 13, 2023
Article in press: January 13, 2023
Published online: February 27, 2023
Processing time: 241 Days and 19.7 Hours
Cirrhosis and its complications develop in a subgroup of patients with non-alcoholic fatty liver disease (NASH). Early detection of liver fibrosis represents an important goal of clinical care.
To test the hypothesis that the development of cirrhosis in nonalcoholic fatty liver disease patients is preceded by the long-term trends of platelet counts and Fib-4 scores.
We identified all patients in our healthcare system who had undergone fibrosis staging by liver biopsy or magnetic resonance elastography (MRE) for non-alcoholic fatty liver disease during the past decade (n = 310). Platelet counts, serum glutamic-pyruvic transaminase and serum glutamic oxalacetic transaminase values preceding the staging tests were extracted from the electronic medical record system, and Fib-4 scores were calculated. Potential predictors of advanced fibrosis were evaluated using multivariate regression analysis.
Significant decreases in platelet counts and increases in Fib-4 scores were observed in all fibrosis stages, particularly in patients with cirrhosis. In the liver biopsy group, the presence of cirrhosis was best predicted by the combination of the Fib-4 score at the time closest to staging (P < 0.0001), the presence of diabetes (P = 0.0001), and the correlation coefficient of the preceding time-dependent drop in platelet count (P = 0.044). In the MRE group, Fib4 score (P = 0.0025) and platelet drop (P = 0.0373) were significant predictors. In comparison, the time-dependent rise of the Fib-4 score did not contribute in a statistically significant way.
Time-dependent changes in platelet counts and Fib-4 scores contribute to the prediction of cirrhosis in NASH patients with biopsy- or MRE-staged fibrosis. Their incorporation into predictive algorithms may assist in the earlier identification of high-risk patients.
Core Tip: Our study is based on the well-known phenomenon of declining platelet counts in patients who develop cirrhosis, including those with underlying non-alcoholic fatty liver disease (NASH). This phenomenon has resulted in several recent publications using large health registries to show that progressive changes in non-invasive fibrosis scores preceded the ICD 9-based diagnoses of cirrhosis. These studies raised the issue of “predictability” of cirrhosis development. Our analysis extends these studies by examining a smaller, well-defined NASH patient population. Unlike previous studies, we included ALL fibrosis stages, provided that patients had undergone definitive staging by liver biopsy or magnetic resonance elastography. Our data unequivocally confirm that progressive thrombocytopenia and an increase in the Fib-4 scores precedes the diagnosis of cirrhosis. Moreover, the kinetics of the platelet drop add to the prediction of cirrhosis, suggesting that the time-dependent decrease in platelet counts may have true predictive power.