Zijlstra MK, Gampa A, Joseph N, Sonnenberg A, Fimmel CJ. Progressive changes in platelet counts and Fib-4 scores precede the diagnosis of advanced fibrosis in NASH patients. World J Hepatol 2023; 15(2): 225-236 [PMID: 36926233 DOI: 10.4254/wjh.v15.i2.225]
Corresponding Author of This Article
Claus J Fimmel, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, NorthShore University Health System, Evanston Hospital 2650 Ridge Avenue Burch Building, Room 103A, Evanston, IL 60201, United States. clausfimmel@att.net
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical and Translational Research
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Hepatol. Feb 27, 2023; 15(2): 225-236 Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.225
Progressive changes in platelet counts and Fib-4 scores precede the diagnosis of advanced fibrosis in NASH patients
Michael K Zijlstra, Anuhya Gampa, Nora Joseph, Amnon Sonnenberg, Claus J Fimmel
Michael K Zijlstra, Department of Internal Medicine, NorthShore University Health System, Evanston, IL 60201, United States
Anuhya Gampa, Division of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
Nora Joseph, Department of Pathology, NorthShore University Health System, Evanston, IL 60201, United States
Amnon Sonnenberg, Portland VA Medical Center, Portland, OR 97239, United States
Amnon Sonnenberg, Department of Gastroenterology, Oregon Health Sciences University, Portland, OR 97201, United States
Claus J Fimmel, Division of Gastroenterology, Department of Internal Medicine, NorthShore University Health System, Evanston, IL 60201, United States
Author contributions: Zijlstra MK, Gampa A, and Fimmel CJ performed the data extraction and chart reviews; Joseph N performed the pathology reviews, and Sonnenberg A performed the statistical analysis; All authors contributed to the writing of the manuscript; All authors have read and approved the final manuscript.
Institutional review board statement: The study protocol (EH 21-163) conformed with the ethical guidelines of the 1975 Declaration of Helsinki, and was approved by the Institutional Review Board of NorthShore University Health System. Informed consent and HIPAA authorization requirements were waived.
Clinical trial registration statement: Since our analysis was retrospective and de-identified, our study did not meet the criteria for clinical trial registration.
Informed consent statement: The study protocol (EH 21-163) conformed with the ethical guidelines of the 1975 Declaration of Helsinki, and was approved by the Institutional Review Board of NorthShore University Health System. Informed consent and HIPAA authorization requirements were waived.
Conflict-of-interest statement: All authors have no conflict of interest to report.
Data sharing statement: The authors agree to share their original data upon request.
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: Claus J Fimmel, MD, Professor, Division of Gastroenterology, Department of Internal Medicine, NorthShore University Health System, Evanston Hospital 2650 Ridge Avenue Burch Building, Room 103A, Evanston, IL 60201, United States. clausfimmel@att.net
Received: June 27, 2022 Peer-review started: June 27, 2022 First decision: July 25, 2022 Revised: August 2, 2022 Accepted: January 13, 2023 Article in press: January 13, 2023 Published online: February 27, 2023 Processing time: 241 Days and 19.7 Hours
ARTICLE HIGHLIGHTS
Research background
Our study was prompted by the growing public health challenges of non-alcoholic fatty liver disease. One of the key issues is the early detection of significant liver fibrosis. Our study focuses on the use of non-invasive predictors of cirrhosis, using data that can be easily extracted from patients' medical records.
Research motivation
We focused our attention on longitudinal changes in platelet count and Fib-4 scores that precede the development of progressive liver fibrosis. Our results suggest that such changes become apparent several years prior to the establishment of a clinical diagnosis of cirrhosis. Future research should include the prospective evaluation of our predictive algorithms.
Research objectives
The main objective was to determine whether longitudinal changes in platelet count and Fib-4 scores precede the establishment of cirrhosis by liver biopsy or magnetic resonance elastography (MRE). We found that such changes occur, regardless of the method of fibrosis staging. Our results suggest that longitudinal analyses such as those described in our study may have clinical utility for earlier disease detection.
Research methods
We extracted clinical and demographic data from the patients' electronic medical records, and related them to the biopsy- or MRE-documented fibrosis stages. Regression and multivariable analyses were performed to detect significant trends related to fibrosis stage.
Research results
We found that the time-dependent changes in platelet counts and Fib4-scores are correlated with successive fibrosis stages. Our data contribute to the growing field of non-invasive fibrosis prediction in chronic liver disease.
Research conclusions
Our study suggests that longterm, progressive changes in platelet counts and Fib-4 scores occur during the progression of non-alcoholic fatty liver disease (NASH)-related fibrosis. Our results could be incorporated into new predictive algorithms, which in turn would need to be validated prospectively. If successful, our approach might lead to a significantly earlier diagnosis of advanced liver fibrosis in NASH patients.
Research perspectives
The next step in our work will be the prospective evaluation of platelet count and Fib-4 changes to detect stage 4 fibrosis prior to the clinical establishment of the diagnosis.
