Red Cell Distribution Width to Platelet Ratio: An Indicator of Liver Fibrosis and Cirrhosis in Chronic Hepatitis C Patients

Abstract

Introduction: RDW to platelet ratio (RPR) has been shown to be a useful predictor of severe liver fibrosis and cirrhosis in chronic hepatitis B. We investigated the correlation between RDW and RPR with degree of inflammation and fibrosis in chronic hepatitis C (CHC) in either the native liver or transplanted liver. Methods: We included the patients with diagnosis of CHC who had a biopsy of the liver done. Pathology reports for the liver biopsy and lab results before the biopsy were retrieved. Correlation of RDW, RPR, and MELD score with degree of liver inflammation, fibrosis and cirrhosis in native and transplanted liver groups were calculated. Results: 98 cases with native liver and 57 cases with transplanted liver were included. None of the investigated variables (RDW, RPR, and MELD) showed significant correlation with degree of inflammation in the native or transplanted liver groups. Strongest correlation with degree of fibrosis in native liver group was for RPR with 0.53 (P < 0.001) and then RDW and MELD with 0.33 (P=0.001) and 0.27 (P=0.008) respectively. In the transplanted liver group, only RPR showed significant correlation with 0.36 (P=0.006). Receiver Operator Curve (ROC) showed that RPR in the native liver group has the most significantly positive association with the risk of cirrhosis with Area Under the Curve (AUC) of 0.793. In transplant group, RPR was again the strongest predictors of cirrhosis with AUC of 0.868. Conclusion: RPR can be a strong predictor of degree of fibrosis and cirrhosis in patients with chronic hepatitis C with both native and transplanted liver. However, its use in predicting inflammation is limited. As a readily available and inexpensive biomarker, RPR can potentially reduce the need for liver biopsy in this patient population.Table 1: Correlation between RDW, RDW/Plt, and MELD score with liver fibrosis and inflammation