Value of red blood cell distribution width-to-platelet ratio, platelet-to-lymphocyte ratio, and neutrophil-to-lymphocyte ratio in predicting compensated liver cirrhosis in patients with chronic hepatitis C / 临床肝胆病杂志

ObjectiveTo investigate the value of red blood cell distribution width-to-platelet ratio (RPR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) in predicting chronic hepatitis C (CHC)-related compensated liver cirrhosis by comparing serological markers between CHC patients and patients with compensated hepatitis C cirrhosis. MethodsThe patients with CHC in two townships of Fuyu County were screened for liver cirrhosis and liver cancer from September to December in 2019 and 2020, respectively. General information was collected; HCV RNA quantification, liver function, and routine blood test results were measured; liver transient elastography and abdominal ultrasound were performed at the same time. RPR, PLR, NLR, fibrosis-4 (FIB-4), and aspartate aminotransferase-to-platelet ratio index (APRI) were calculated. The Mann-Whiney U test was used for comparison between groups. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off values of RPR and PLR. A multivariate unconditional logistic regression analysis was used to investigate the risk factors for CHC-related liver cirrhosis. The linear regression trend test was used to investigate the changing trend of RPR, PLR, FIB-4, and APRI in hepatitis C patients with different fibrosis stages. ResultsA total of 968 CHC patients were enrolled, among whom 123 (12.7%) were diagnosed with compensated liver cirrhosis (liver cirrhosis group). Compared with the CHC group, the liver cirrhosis group had a significant increase in RPR and a significant reduction in PLR (P＜0.001). The multivariate logistic regression analysis showed that age ＞60 years (odds ratio ［OR］=1.79, 95% confidence interval ［CI］: 1.12-2.86, P=0.015), albumin ＜40 g/L (OR=1040, 95% CI: 3.47-31.18, P＜0.001), RPR ＞0.081 (OR=3.83, 95% CI: 2.19-6.69, P＜0.001), PLR ＜91.11 (OR=225, 95% CI: 1.31-3.89, P=0.004), FIB-4 ＞3.25 (OR=3.14, 95% CI: 1.74-5.67, P＜0.001), and APRI ＞2 (OR=360, 95% CI: 110-11.78, P=0.035) were associated with the development of CHC-related compensated liver cirrhosis. With the aggravation of liver fibrosis, RPR, FIB-4, and APRI gradually increased and PLR gradually decreased (all P＜0.001). ConclusionRPR and PLR are associated with the development and fibrosis progression of CHC-related compensated liver cirrhosis. Elderly patients with CHC (age ＞60 years) should be monitored for the changes in albumin and liver fibrosis indicators, and RPR and PLR should also be monitored regularly to identify liver cirrhosis in the early stage, give timely treatment, and reduce the incidence rate of liver cancer.