Use of Platelets and Their Properties in Predicting Activity and Fibrosis in HBV Infection
Year 2024,
, 61 - 64, 30.06.2024
Adnan Özkahraman
,
Ozan Durmaz
,
Mehmet Ali Bilgili
,
Okan Baybal
,
Nüket Bayram Kayar
,
Yusuf Kayar
,
Melih Karıncaoğlu
Abstract
Aim: Although liver biopsy is the gold standard for showing histological activity and fibrosis today, there are some non-invasive methods using biochemical calculations as an alternative since it is an invasive procedure. In our study, we aimed to examine the relationship between platelets and some related parameters and histopathology in patients who underwent liver biopsy due to chronic hepatitis B (HBV).
Material and Method: 70 patients diagnosed with chronic HBV and followed up between 2009 and 2013 were included. Demographic data, liver histopathological results and laboratory parameters of all patients were documented. The relationship between histopathology and platelets and some related laboratory parameters was examined.
Results: A total of 70 patients, 40 (28%) of whom were women, were included in the study. A statistically significant relationship was detected between HAI and AST (p=0.001), ALT (p=0.001), Sedimentation (p=0.026, r=0.5) and AAR, APRI, FIB4 (p<0.05).A statistically significant relationship was found between fibrosis and INR (p=0.02, r=0.2), between PDW/PLT, and between PLT/PDW (p<0.05).Additionally, the relationship between fibrosis and APRI, FIB4 and RPR was statistically found significant. (p<0.05).No correlation was found between HAI and Platelet, RDW, PDW (p>0.05).
Conclusions: Platelet and related parameters RDW and RPR have been shown to be associated with the degree of fibrosis. It is thought that RPR, which is an inexpensive and easily calculable index, can predict significant fibrosis and cirrhosis with relatively high accuracy in chronic hepatitis patients, potentially reducing unnecessary liver biopsies.
Ethical Statement
All participants gave written consent to participate in the study. Approval was received for this study from İnönü University Ethics Committee.
Supporting Institution
İnönü University Ethics Committee
References
- Lee WM. Hepatitis b virus infection, N Engl J Med 1997; 337: 1733-45.
- Konur S, Surmeli N, Ozkahraman A, Dertli R, Kayar Y. Are non invasive biochemical
parameters an alternative to liver biopsy in patients with chronic hepatitis B? Ann Med Res
2021;28(8):1462-6.
- Bravo A, Sheth SG, Chopra S. Liver biopsy. N Eng J Med 2001; 344: 495-500.
- Regev A, Berho M, Jeffers LJ, et al. Sampling error and intra observer variation in liver biopsy
in patients with chronic hcv infection. Am J Gastroenterol 2002; 97:2614–8.
- Ozel Coskun BD, Dizdar OS, Baspınar O, Ortakoyluoglu A. Use fulness of the neutrophil –
to – lymphocyte ratio and platelet morphologic parameters in predicting hepatic fibrosis in
chronic hepatitis c patients. Ann Clin Lab Sci 2016;46:4-8.
- Wang J, Yan X, Yang Y, et al. A novel predictive model using routinely clinical parameters
to predict liver fibrosis in patients with chronic hepatitis b. Onco Target 2017;8:59257-67.
- World Health Organization. Guidelines for the prevention, care and treatment of persons
with chronic hepatitis b infection. Geneva: World Health Organization; 2015;12:101-35
- Sheeth SG, Flamm SL, Gordon FD, Chopra S. ast/alt ratio predicts cirrhosis in patients with
chronic hepatitis c virus infection. Am J Gastroenterol 1998;93: 44-8.
- Chrysantos NV, Papatheodoritis GV, Savvas S, et al. Aspartate aminotrasferase to platelet
ratio index for fibrosis evaluation in chronic viral hepatitis. Eur J Gastroenterol Hepatol
2006;18:389-96.
- Sterling RK, Lissen E, Clumerk N, et al. Development of a simple noninvazive index to predict
significant fibrosis in patients with hiv/hcv coinfection. Hepatology 2006;43:1317-25.
- Yuyun D, Zhihua T, Haijun W, et al. Predictive value of the red blood celld is tribution widthto-
platelet ratio for hepatic fibrosis. Scand J Gastroenterol 2019 Jan;54(1):81-6.
- Knodell RG, Ishak KG, Black WC, et al. Formulation and application of a numerical
scoring system for assessing histological activity in asymptomatic chronic active hepatitis.
Hepatology 1981;1:431-5.
- Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheurer PJ. Classification of chronic hepatitis:
diagnosis, grading and staging. Hepatology 1994;19:1513-20.
- Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH, American association
for the study of liver diseases. aasld guidelines for treatment of chronic hepatitis b.
Hepatology. 2016; 63: 261–83.
- Ucar F, Sezer S, Gunes Z, at al. Apri, the fib-4 score, and forn’s index have non invasive
diagnostic value for liver fibrosis in patients with chronic hepatitis b. Eur J Gastroenterol
Hepatol 2013;25(9):1076–81.
- Alkhouri N, Morris – Stiff G, Campbell C, et al. Neutrophil to lymphocyte ratio: a new marker
for predicting ste a to hepatit is and fibrosisin patients with non alcoholic fatty liver disease.
Liver Int 2012 Feb;32(2):297-302.
- Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant
fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-526.
- Lin ZH, Xin YN, Dong QJ, et al. Performance of the aspartate aminotransferase-to-platelet
ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis.
Hepatology. 2011;53(3):726-736.
- Giannini E, Testa R. Noninvasive diagnosis of fibrosis: the truth is rarely pure and never
simple. Hepatology. 2003;38(5):1312-1313.
- Udell JA, Wang CS, Tinmouth J, et al. Does this patient with liver disease have cirrhosis?
JAMA. 2012;307(8):832-842.
- Li Y, Chen Y, Zhao Y. The diagnostic value of the FIB-4 index for staging hepatitis B-related
fibrosis: a meta-analysis. PLoS One. 2014;9(8):105728-105731.
- Lee J, Vali Y, Boursier J, et al. Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for
NAFLD-related events: A systematic review. Liver Int. 2021;41(2):261-270.
Platelet ve özelliklerinin HBV enfeksiyonunda aktivite ve fibrozis tahmininde kullanımı
Year 2024,
, 61 - 64, 30.06.2024
Adnan Özkahraman
,
Ozan Durmaz
,
Mehmet Ali Bilgili
,
Okan Baybal
,
Nüket Bayram Kayar
,
Yusuf Kayar
,
Melih Karıncaoğlu
Abstract
Amaç: Günümüzde histolojik aktiviteyi ve fibrozisi göstermede altın standart karaciğer biyopsisi olmasına karşın invaziv bir işlem olması nedeniyle alternatif olarak biyokimyasal hesaplanan bazı noninvaziv yöntemler bulunmaktadır. Biz de çalışmamızda kronik hepatit B (HBV) nedeniyle karaciğer biyopsisi yapılan hastalarda platelet ve ilişkili bazı parametrelerin histopatoloji ile olan ilişkisini incelemeyi amaçladık.
Gereç ve yöntem: Kronik HBV tanısı ile 2009 ile 2013 yılları arasında takipli, 70 hasta dahil edildi. Tüm hastaların demografik verileri, karaciğer histopatolojik sonuçları ile laboratuvar parametreleri dökümante edildi. Histopatoloji ile platelet ve ilişkili olduğu bazı laboratuar parametreleri arasındaki ilişki incelendi.
Bulgular: Çalışmaya 40 (%28) kadın olmak üzere toplamda 70 hasta alındı. HAİ ile AST (p=0.001), ALT (p=0.001), Sedimantasyon (p=0.026, r=0.5) ve AAR, APRI, FIB4 (p<0.05) arasında istatistiksel olarak anlamlı ilişki saptandı (p<0.05). Fibrozis ile İNR arasında (p=0.02, r=0.2), PDW/PLT arasında, PLT/PDW arasında (p<0.05) istatistiksel olarak anlamlı ilişki bulundu. Ayrıca Fibrozis ile APRI, FIB4 ve RPR arasındaki ilişki istatistiksel olarak anlamlı bulundu (p<0.05). HAI ile Platelet, RDW, PDW korelasyonu bulunamadı (p>0.05).
Sonuç: Trombosit ve ilişkili parametreler olan RDW ve RPR’nin fibrozisin derecesi ile ilişkili olduğu gösterildi. Pahalı olmayıp kolay hesaplanabilir bir index olan RPR, potansiyel olarak gereksiz karaciğer biopsilerini azaltarak kronik hepatit hastalarında nispeten yüksek doğruluk oranıyla belirgin fibrosis ve sirozu tahmin etmeyi sağlayabileceği düşünülmüştür.
Ethical Statement
Tüm katılımcılar çalışmaya katılmak için yazılı onam verdi. Bu çalışma için İnönü Üniversitesi Etik Kurulundan onay alındı.
Supporting Institution
İnönü Üniversitesi Etik Kurulu
References
- Lee WM. Hepatitis b virus infection, N Engl J Med 1997; 337: 1733-45.
- Konur S, Surmeli N, Ozkahraman A, Dertli R, Kayar Y. Are non invasive biochemical
parameters an alternative to liver biopsy in patients with chronic hepatitis B? Ann Med Res
2021;28(8):1462-6.
- Bravo A, Sheth SG, Chopra S. Liver biopsy. N Eng J Med 2001; 344: 495-500.
- Regev A, Berho M, Jeffers LJ, et al. Sampling error and intra observer variation in liver biopsy
in patients with chronic hcv infection. Am J Gastroenterol 2002; 97:2614–8.
- Ozel Coskun BD, Dizdar OS, Baspınar O, Ortakoyluoglu A. Use fulness of the neutrophil –
to – lymphocyte ratio and platelet morphologic parameters in predicting hepatic fibrosis in
chronic hepatitis c patients. Ann Clin Lab Sci 2016;46:4-8.
- Wang J, Yan X, Yang Y, et al. A novel predictive model using routinely clinical parameters
to predict liver fibrosis in patients with chronic hepatitis b. Onco Target 2017;8:59257-67.
- World Health Organization. Guidelines for the prevention, care and treatment of persons
with chronic hepatitis b infection. Geneva: World Health Organization; 2015;12:101-35
- Sheeth SG, Flamm SL, Gordon FD, Chopra S. ast/alt ratio predicts cirrhosis in patients with
chronic hepatitis c virus infection. Am J Gastroenterol 1998;93: 44-8.
- Chrysantos NV, Papatheodoritis GV, Savvas S, et al. Aspartate aminotrasferase to platelet
ratio index for fibrosis evaluation in chronic viral hepatitis. Eur J Gastroenterol Hepatol
2006;18:389-96.
- Sterling RK, Lissen E, Clumerk N, et al. Development of a simple noninvazive index to predict
significant fibrosis in patients with hiv/hcv coinfection. Hepatology 2006;43:1317-25.
- Yuyun D, Zhihua T, Haijun W, et al. Predictive value of the red blood celld is tribution widthto-
platelet ratio for hepatic fibrosis. Scand J Gastroenterol 2019 Jan;54(1):81-6.
- Knodell RG, Ishak KG, Black WC, et al. Formulation and application of a numerical
scoring system for assessing histological activity in asymptomatic chronic active hepatitis.
Hepatology 1981;1:431-5.
- Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheurer PJ. Classification of chronic hepatitis:
diagnosis, grading and staging. Hepatology 1994;19:1513-20.
- Terrault NA, Bzowej NH, Chang KM, Hwang JP, Jonas MM, Murad MH, American association
for the study of liver diseases. aasld guidelines for treatment of chronic hepatitis b.
Hepatology. 2016; 63: 261–83.
- Ucar F, Sezer S, Gunes Z, at al. Apri, the fib-4 score, and forn’s index have non invasive
diagnostic value for liver fibrosis in patients with chronic hepatitis b. Eur J Gastroenterol
Hepatol 2013;25(9):1076–81.
- Alkhouri N, Morris – Stiff G, Campbell C, et al. Neutrophil to lymphocyte ratio: a new marker
for predicting ste a to hepatit is and fibrosisin patients with non alcoholic fatty liver disease.
Liver Int 2012 Feb;32(2):297-302.
- Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant
fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518-526.
- Lin ZH, Xin YN, Dong QJ, et al. Performance of the aspartate aminotransferase-to-platelet
ratio index for the staging of hepatitis C-related fibrosis: an updated meta-analysis.
Hepatology. 2011;53(3):726-736.
- Giannini E, Testa R. Noninvasive diagnosis of fibrosis: the truth is rarely pure and never
simple. Hepatology. 2003;38(5):1312-1313.
- Udell JA, Wang CS, Tinmouth J, et al. Does this patient with liver disease have cirrhosis?
JAMA. 2012;307(8):832-842.
- Li Y, Chen Y, Zhao Y. The diagnostic value of the FIB-4 index for staging hepatitis B-related
fibrosis: a meta-analysis. PLoS One. 2014;9(8):105728-105731.
- Lee J, Vali Y, Boursier J, et al. Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for
NAFLD-related events: A systematic review. Liver Int. 2021;41(2):261-270.