Observational Study
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World J Gastroenterol. Oct 14, 2022; 28(38): 5636-5647
Published online Oct 14, 2022. doi: 10.3748/wjg.v28.i38.5636
Red blood cell distribution width derivatives in alcohol-related liver cirrhosis and metabolic-associated fatty liver disease
Agata Michalak, Małgorzata Guz, Joanna Kozicka, Marek Cybulski, Witold Jeleniewicz, Tomasz Lach, Halina Cichoż-Lach
Agata Michalak, Joanna Kozicka, Halina Cichoż-Lach, Department of Gastroenterology, Medical University of Lublin, Lublin 20-954, Poland
Małgorzata Guz, Marek Cybulski, Witold Jeleniewicz, Department of Biochemistry and Molecular Biology, Medical University of Lublin, Lublin 20-093, Poland
Tomasz Lach, Department of Orthopedics and Traumatology, Medical University of Lublin, Lublin 20-954, Poland
Author contributions: Michalak A, Lach T and Cichoż-Lach H prepared data; Michalak A and Cichoż-Lach H invented and conducted the study; Guz M, Kozicka J and Jeleniewicz W applied the experiments, gained and interpreted data; Cybulski M statistically analyzed the data; Michalak A and Cichoż-Lach H wrote the article; All authors accepted the current version of the manuscript.
Institutional review board statement: The survey was accepted by the local ethics committee of the Medical University of Lublin (No. KE-0254/86/2016).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Halina Cichoż-Lach, PhD, Professor, Department of Gastroenterology, Medical University of Lublin, Jaczewski Str. 8, Lublin 20-954, Poland. lach.halina@wp.pl
Received: July 4, 2022
Peer-review started: July 4, 2022
First decision: July 31, 2022
Revised: August 7, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: October 14, 2022
Processing time: 99 Days and 7.5 Hours
Abstract
BACKGROUND

Looking for undiscovered blood markers of liver fibrosis and steatosis still remains an issue worth exploring. There are still plenty of unresolved issues related to the actual role of hematological indices as potential markers of liver function.

AIM

To study red blood cell distribution width (RDW), RDW-to-platelet ratio (RPR) and RDW-to-lymphocyte ratio (RLR) in alcohol-related liver cirrhosis (ALC) and metabolic-associated fatty liver disease (MAFLD).

METHODS

The study group was composed of 302 people: 142 patients with ALC and 92 with MAFLD; 68 persons were included as controls. RDW, RPR and RLR were measured in each person. Indirect and direct parameters of liver fibrosis were also assessed [aspartate transaminase to alkaline transaminase ratio, aspartate transaminase to platelet ratio index (APRI), fibrosis-4 (FIB-4), gamma-glutamyl transpeptidase to platelet ratio (GPR), procollagen I carboxyterminal propeptide, procollagen III aminoterminal propeptide, transforming growth factor-α, platelet-derived growth factor AB, laminin]. MELD score in ALC patients and non-alcoholic fatty liver disease (NAFLD) fibrosis score together with BARD score were obtained in the MAFLD group. The achieved results were compared to controls. Then a correlation between assessed markers was done. Diagnostic value of each investigated parameter and its suggested cut-off in the research group were evaluated with area under the curve (AUC).

RESULTS

RDW, RPR and RLR values turned out to be significantly higher in ALC and MAFLD groups compared to controls (ALC: P < 0.0001; NAFLD: P < 0.05, P < 0.0001 and P < 0.0001, respectively). RPR correlated positively with MELD score (P < 0.01) and indirect indices of liver fibrosis (FIB-4 and GPR; P < 0.0001) in ALC patients; negative correlations were found between PDGF-AB and both: RDW and RPR (P < 0.01 and P < 0.0001, respectively). RPR correlated positively with NAFLD fibrosis score and APRI (P < 0.0001) in the MAFLD group; a positive relationship was observed between RDW and FIB-4, too (P < 0.05). AUC values and suggested cut-offs for RDW, RPR and RLR in ALC patients were: 0.912 (> 14.2%), 0.965 (> 0.075) and 0.914 (> 8.684), respectively. AUC values and suggested cut-offs for RDW, RPR and RLR in MAFLD patients were: 0.606 (> 12.8%), 0.724 (> 0.047) and 0.691 (> 6.25), respectively.

CONCLUSION

RDW with its derivatives appear to be valuable diagnostic markers in patients with ALC. They can also be associated with a deterioration of liver function in this group.

Keywords: Hematological indices; Alcohol-related liver cirrhosis; Metabolic-associated liver disease; Red blood cell distribution width; Red blood cell distribution width-to-platelet ratio; Red blood cell distribution width-to-lymphocyte ratio

Core Tip: Red blood cell distribution width (RDW), RDW-to-platelet ratio (RPR) and RDW-to-lymphocyte ratio (RLR) remain uninvestigated in Polish patients suffering from alcohol-related liver cirrhosis (ALC) and metabolic-associated liver disease. Based on the available literature, association between RDW, RPR, RLR and serological (indirect and direct) indices of liver fibrosis have never been explored in a single study to date. We consider RPR as a potential reliable diagnostic tool in the assessment of ALC patients, corresponding with MELD score and serous markers of liver cirrhosis. Hematological parameters could be perceived as possible indices in the noninvasive evaluation of people with liver disorders.