Surana P, Hercun J, Takyar V, Kleiner DE, Heller T, Koh C. Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis. World J Gastrointest Pathophysiol 2021; 12(3): 40-50 [PMID: 34084591 DOI: 10.4291/wjgp.v12.i3.40]
Corresponding Author of This Article
Christopher Koh, FAASLD, MD, MHSc, Associate Professor, Clinical Director, Doctor, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, 10 Center Drive, Room 5-2740, Bethesda, MD 20892, United States. christopher.koh@nih.gov
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
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 Gastrointest Pathophysiol. May 22, 2021; 12(3): 40-50 Published online May 22, 2021. doi: 10.4291/wjgp.v12.i3.40
Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis
Pallavi Surana, Julian Hercun, Varun Takyar, David E Kleiner, Theo Heller, Christopher Koh
Pallavi Surana, Julian Hercun, Varun Takyar, Theo Heller, Christopher Koh, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, United States
David E Kleiner, Laboratory of Pathology, National Cancer Institute, Bethesda, MD 20892, United States
Author contributions: Surana P designed and performed the research and wrote the paper; Koh C designed the research and supervised the report; Takyar V performed the research; Hercun J performed the research and wrote the paper; Kleiner DE and Heller T provided clinical advice; all authors reviewed the manuscript for important intellectual content and approved the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the National Institute of Diabetes and Digestive and Kidney Diseases Institutional Review Board.
Informed consent statement: Patients gave written informed consent to the study agreeing to the use of anonymous clinical data obtained under protocol 91-DK-0214.
Conflict-of-interest statement: We have no financial relationships related to this research to disclose.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christopher Koh, FAASLD, MD, MHSc, Associate Professor, Clinical Director, Doctor, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, 10 Center Drive, Room 5-2740, Bethesda, MD 20892, United States. christopher.koh@nih.gov
Received: January 21, 2021 Peer-review started: January 21, 2021 First decision: February 9, 2021 Revised: February 25, 2021 Accepted: March 31, 2021 Article in press: March 31, 2021 Published online: May 22, 2021 Processing time: 112 Days and 18.8 Hours
Abstract
BACKGROUND
Simple tools for clinicians to identify cirrhosis in patients with chronic viral hepatitis are medically necessary for treatment initiation, hepatocellular cancer screening and additional medical management.
AIM
To determine whether platelets or other laboratory markers can be used as a simple method to identify the development of cirrhosis.
METHODS
Clinical, biochemical and histologic laboratory data from treatment naive chronic viral hepatitis B (HBV), C (HCV), and D (HDV) patients at the NIH Clinical Center from 1985-2019 were collected and subjects were randomly divided into training and validation cohorts. Laboratory markers were tested for their ability to identify cirrhosis (Ishak ≥ 5) using receiver operating characteristic curves and an optimal cut-off was calculated within the training cohort. The final cut-off was tested within the validation cohort.
RESULTS
Overall, 1027 subjects (HCV = 701, HBV = 240 and HDV = 86), 66% male, with mean (standard deviation) age of 45 (11) years were evaluated. Within the training cohort (n = 715), platelets performed the best at identifying cirrhosis compared to other laboratory markers [Area Under the Receiver Operating Characteristics curve (AUROC) = 0.86 (0.82-0.90)] and sensitivity 77%, specificity 83%, positive predictive value 44%, and negative predictive value 95%. All other tested markers had AUROCs ≤ 0.77. The optimal platelet cut-off for detecting cirrhosis in the training cohort was 143 × 109/L and it performed equally well in the validation cohort (n = 312) [AUROC = 0.85 (0.76-0.94)].
CONCLUSION
The use of platelet counts should be considered to identify cirrhosis and ensure optimal care and management of patients with chronic viral hepatitis.
Core Tip: Platelet count is a well-recognized surrogate marker for progression of liver disease, however a specific cut-off for cirrhosis has not been established. In this study, platelet counts can accurately stratify chronic viral hepatitis patients with cirrhosis; and a platelet count > 143 × 109/L appears to have the most clinical utility in ruling out cirrhosis across all chronic viral hepatitis. This widely available laboratory value may be useful in decision making for the management of patients with chronic viral hepatitis and represents a finding which may be of particular value in a primary care setting.
