Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2020; 26(47): 7538-7549
Published online Dec 21, 2020. doi: 10.3748/wjg.v26.i47.7538
Towards an evaluation of alcoholic liver cirrhosis and nonalcoholic fatty liver disease patients with hematological scales
Agata Michalak, Halina Cichoż-Lach, Małgorzata Guz, Joanna Kozicka, Marek Cybulski, Witold Jeleniewicz, Andrzej Stepulak
Agata Michalak, Halina Cichoż-Lach, Joanna Kozicka, Department of Gastroenterology, Medical University of Lublin, Lublin 20-954, Jaczewskiego 8, Poland
Małgorzata Guz, Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin 20-093, Chodźki 3, Poland
Marek Cybulski, Witold Jeleniewicz, Andrzej Stepulak, Department of Biochemistry and Molecular Biology, Medical Univeristy of Lublin, Lublin 20-093, Chodźki 3, Poland
Author contributions: Michalak A and Cichoż-Lach H designed and coordinated the study; Guz M, Kozicka A and Jeleniewicz W performed the experiments, acquired and analyzed data; Cybulski M and Stepulak A interpreted the data; Michalak A and Cichoż-Lach H wrote the manuscript; all authors approved the final version of the article.
Institutional review board statement: The local ethics committee of the Medical University of Lublin approved the study (Approval No. KE-0254/86/2016).
Informed consent statement: All patients signed an informed written consent in accordance with the Helsinki Declaration for the procedures they underwent.
Conflict-of-interest statement: Nothing to disclose.
Data sharing statement: Dataset available from the corresponding author at lach.halina@wp.pl.
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: Halina Cichoż-Lach, MD, PhD, Professor, Department of Gastroenterology, Medical University of Lublin, Jaczewskiego 8, Lublin 20-954, Jaczewskiego 8, Poland. lach.halina@wp.pl
Received: July 27, 2020
Peer-review started: July 27, 2020
First decision: September 30, 2020
Revised: October 12, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: December 21, 2020
Processing time: 145 Days and 2.6 Hours
Abstract
BACKGROUND

Seeking potentially novel blood markers of liver fibrosis and steatosis is constantly of crucial importance. Despite a growing number of studies in this field of hepatology, a certain role of hematological indices in the course of liver disorders has not been fully elucidated, yet.

AIM

To evaluate a diagnostic accuracy of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume-to-platelet-ratio (MPR) in the course of alcoholic liver cirrhosis (ALC) and nonalcoholic fatty liver disease (NAFLD).

METHODS

One hundred forty-two patients with ALC, 92 with NAFLD and 68 persons in control group were enrolled in the study. Hematological indices (NLR, PLR and MPR), indirect and direct markers of liver fibrosis (aspartate transaminase to alkaline transaminase ratio, aspartate transaminase to platelet ratio index, fibrosis-4, gamma-glutamyl transpeptidase to platelet ratio, procollagen I carboxyterminal propeptide, procollagen III aminoterminal propeptide, transforming growth factor-α, platelet-derived growth factor AB, laminin) were measured in each person. Model for end-stage liver disease (MELD) score in ALC group and NAFLD fibrosis score together with BARD score were calculated in NAFLD patients. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were applied to assess the sensitivity and specificity of examined markers and to evaluate proposed cut-offs of measured indices in the course of ALC and NAFLD.

RESULTS

MPR and NLR values in ALC patients were significantly higher in comparison to control group; PLR level was significantly lower. MPR and PLR correlated with assessed indirect and direct markers of liver fibrosis. MPR, NLR and PLR correlated with MELD score. NLR level in NAFLD patients was significantly higher in comparison to controls. MPR correlated with indirect markers of liver fibrosis and NAFLD fibrosis score. AUC values and proposed cut-offs for NLR, PLR and MPR in ALC patients were: 0.821 (> 2.227), 0.675 (< 70.445) and 0.929 (> 0.048), respectively. AUC values and proposed cut-offs for NLR, PLR and MPR in NAFLD group were: 0.725 (> 2.034), 0.528 (> 97.101) and 0.547 (> 0.038), respectively.

CONCLUSION

Hematological markers are inseparably connected with serological indices of liver fibrosis in ALC and NAFLD patients. MPR and NLR turned out to be the most powerful parameters in ALC patients.

Keywords: Hematological markers; Alcoholic liver cirrhosis; Nonalcoholic fatty liver disease; Neutrophil-to-lymphocyte ratio; Platelet-to-lymphocyte ratio; Mean platelet volume-to-platelet-ratio

Core Tip: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume-to-platelet-ratio (MPR) seem to be unexplored in Polish population of patients with alcoholic liver cirrhosis (ALC) and non-alcoholic fatty liver disease (NAFLD). What is more, according to available literature, relationships between NLR, MPR, PLR and serological (indirect and indirect) markers of liver fibrosis have never been investigated in a single study, yet. We found MPR to be a parameter with high diagnostic accuracy in the course ALC, correlating with model for end-stage liver disease score and serological markers of liver fibrosis. Hematological indices should be considered as potential tools in the noninvasive diagnostics in hepatology.