Zijlstra MK, Gampa A, Joseph N, Sonnenberg A, Fimmel CJ. Progressive changes in platelet counts and Fib-4 scores precede the diagnosis of advanced fibrosis in NASH patients. World J Hepatol 2023; 15(2): 225-236 [PMID: 36926233 DOI: 10.4254/wjh.v15.i2.225]
Corresponding Author of This Article
Claus J Fimmel, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, NorthShore University Health System, Evanston Hospital 2650 Ridge Avenue Burch Building, Room 103A, Evanston, IL 60201, United States. clausfimmel@att.net
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical and Translational Research
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Hepatol. Feb 27, 2023; 15(2): 225-236 Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.225
Progressive changes in platelet counts and Fib-4 scores precede the diagnosis of advanced fibrosis in NASH patients
Michael K Zijlstra, Anuhya Gampa, Nora Joseph, Amnon Sonnenberg, Claus J Fimmel
Michael K Zijlstra, Department of Internal Medicine, NorthShore University Health System, Evanston, IL 60201, United States
Anuhya Gampa, Division of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
Nora Joseph, Department of Pathology, NorthShore University Health System, Evanston, IL 60201, United States
Amnon Sonnenberg, Portland VA Medical Center, Portland, OR 97239, United States
Amnon Sonnenberg, Department of Gastroenterology, Oregon Health Sciences University, Portland, OR 97201, United States
Claus J Fimmel, Division of Gastroenterology, Department of Internal Medicine, NorthShore University Health System, Evanston, IL 60201, United States
Author contributions: Zijlstra MK, Gampa A, and Fimmel CJ performed the data extraction and chart reviews; Joseph N performed the pathology reviews, and Sonnenberg A performed the statistical analysis; All authors contributed to the writing of the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study protocol (EH 21-163) conformed with the ethical guidelines of the 1975 Declaration of Helsinki, and was approved by the Institutional Review Board of NorthShore University Health System. Informed consent and HIPAA authorization requirements were waived.
Clinical trial registration statement: Since our analysis was retrospective and de-identified, our study did not meet the criteria for clinical trial registration.
Informed consent statement: The study protocol (EH 21-163) conformed with the ethical guidelines of the 1975 Declaration of Helsinki, and was approved by the Institutional Review Board of NorthShore University Health System. Informed consent and HIPAA authorization requirements were waived.
Conflict-of-interest statement: All authors have no conflict of interest to report.
Data sharing statement: The authors agree to share their original data upon request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Claus J Fimmel, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, NorthShore University Health System, Evanston Hospital 2650 Ridge Avenue Burch Building, Room 103A, Evanston, IL 60201, United States. clausfimmel@att.net
Received: June 27, 2022 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
Core Tip
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.
