Surana P, Hercun J, Takyar V, Kleiner DE, Heller T, Koh C. Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis. World J Gastrointest Pathophysiol 2021; 12(3): 40-50 [PMID: 34084591 DOI: 10.4291/wjgp.v12.i3.40]
Corresponding Author of This Article
Christopher Koh, FAASLD, MD, MHSc, Associate Professor, Clinical Director, Doctor, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, 10 Center Drive, Room 5-2740, Bethesda, MD 20892, United States. christopher.koh@nih.gov
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
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 Gastrointest Pathophysiol. May 22, 2021; 12(3): 40-50 Published online May 22, 2021. doi: 10.4291/wjgp.v12.i3.40
Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis
Pallavi Surana, Julian Hercun, Varun Takyar, David E Kleiner, Theo Heller, Christopher Koh
Pallavi Surana, Julian Hercun, Varun Takyar, Theo Heller, Christopher Koh, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, United States
David E Kleiner, Laboratory of Pathology, National Cancer Institute, Bethesda, MD 20892, United States
Author contributions: Surana P designed and performed the research and wrote the paper; Koh C designed the research and supervised the report; Takyar V performed the research; Hercun J performed the research and wrote the paper; Kleiner DE and Heller T provided clinical advice; all authors reviewed the manuscript for important intellectual content and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the National Institute of Diabetes and Digestive and Kidney Diseases Institutional Review Board.
Informed consent statement: Patients gave written informed consent to the study agreeing to the use of anonymous clinical data obtained under protocol 91-DK-0214.
Conflict-of-interest statement: We have no financial relationships related to this research to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: Christopher Koh, FAASLD, MD, MHSc, Associate Professor, Clinical Director, Doctor, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, 10 Center Drive, Room 5-2740, Bethesda, MD 20892, United States. christopher.koh@nih.gov
Received: January 21, 2021 Peer-review started: January 21, 2021 First decision: February 9, 2021 Revised: February 25, 2021 Accepted: March 31, 2021 Article in press: March 31, 2021 Published online: May 22, 2021 Processing time: 112 Days and 18.8 Hours
ARTICLE HIGHLIGHTS
Research background
The diagnosis of cirrhosis in patients with chronic viral hepatitis has both treatment and management implications. Identifying these patients is crucial in order to ensure proper care, prevent complications of cirrhosis and for judicious allocation of resources.
Research motivation
With an increasing reliance on primary care in management of chronic viral hepatitis, reliable simple non-invasive assessments of cirrhosis are needed in order to identify cirrhosis and to determine requirement of referral to specialized care.
Research objectives
To evaluate the performance of single laboratory markers, with an emphasis on platelet counts, to identify development of cirrhosis in patients with chronic hepatitis B virus, hepatitis C virus, and hepatitis D virus infection.
Research methods
Retrospective study comparing the accuracy of single laboratory markers in determining cirrhosis (defined as Ishak fibrosis score ≥ 5). Area Under the Receiver Operating Characteristics curve (AUROC), sensitivity, specificity, positive predictive value and negative predictive value were measured first in a training cohort and then in a validation cohort.
Research results
In a cohort of 1027 subjects, compared to other single laboratory markers, platelet counts performed the best at identifying cirrhosis [AUROC 0.86 (0.82-0.90)] and sensitivity 77%, specificity 83%, positive predictive value 44%, and negative predictive value 95%. The optimal cut-off point was 143 × 109/L. This performed equally well in a validation cohort.
Research conclusions
Platelet counts are the most reliable single serological marker in ruling out cirrhosis in patients with chronic viral hepatitis. Thrombocytopenia can potentially be used in the primary care setting for management of patients with viral hepatitis.
Research perspectives
Future research directions include validation of this cut-off value of platelet counts in other cohorts of patients with liver disease and evaluation of longitudinal trends of thrombocytopenia.
