Role of INR to Platelet Ratio (INPR) in Predicting Advanced Liver Fibrosis in Patients with Chronic Hepatitis C Infection

Abstract

Background: Chronic hepatitis C (HCV) infection is a leading cause of liver fibrosis, which can progress to cirrhosis and hepatocellular carcinoma if not diagnosed and treated early. The gold standard for assessing liver fibrosis, liver biopsy, is invasive and carries risks, driving the need for reliable non-invasive diagnostic methods. The International Normalized Ratio to platelet ratio (INPR) has been proposed as a potential non-invasive marker to assess advanced liver fibrosis, but its effectiveness in patients with chronic HCV infection remains to be thoroughly evaluated. Objective: This study aimed to assess the efficacy of the INR to platelet ratio (INPR) as a non-invasive marker for predicting advanced liver fibrosis in patients with chronic hepatitis C infection. Methods: In this retrospective cohort study, 267 patients diagnosed with chronic HCV infection were evaluated at the Hepato-gastroenterology department of a tertiary care center from July 2021 to May 2023. Participants underwent comprehensive diagnostic evaluations, including liver parenchymal biopsies, shear wave elastography (SWE), and laboratory tests to calculate INPR. The diagnostic performance of INPR in detecting advanced liver fibrosis (>F3) was analyzed using the area under the receiver operating characteristic (AUROC) curve, alongside sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The study population had a mean age of 43.45 ± 12.33 years, with a gender distribution of 61.8% male and 38.2% female. Advanced liver fibrosis was identified in 57 patients (21.3%). The INPR demonstrated an AUROC of 0.81 for predicting advanced liver fibrosis, with a sensitivity of 81.2%, specificity of 60.8%, PPV of 76.7%, and NPV of 91.2%. Comparatively, the Gamma Glutamyl Transpeptidase to Platelet Ratio (GPR) showed a slightly lower diagnostic accuracy. Conclusion: The INR to platelet ratio (INPR) is a promising non-invasive marker for predicting advanced liver fibrosis in chronic HCV-infected patients. It offers a practical bedside tool for clinicians, potentially reducing the need for invasive liver biopsies. However, further large-scale prospective studies are needed to validate these findings and fully establish INPR's role in the management of liver fibrosis.