title: Red cell distribution width to platelet ratio, a useful indicator of liver fibrosis in chronic hepatitis patients.
abstract: OBJECTIVE
  We investigated the correlation between the red cell distribution width (RDW) and RDW-to-platelet ratio (RPR) with the degree of inflammation and fibrosis in chronic hepatitis patients with different etiologies and in native and transplanted liver.
  
  
  METHODS
  Between 2010 and 2013, patients from the MedStar Washington Hospital Center and Georgetown University Hospital with chronic hepatitis B, chronic hepatitis C, alcoholic hepatitis, and primary biliary cirrhosis who had a biopsy of the liver done in this time period were included. The correlation among the RDW, RPR, and model for end-stage liver disease (MELD) score with the degree of liver inflammation, fibrosis, and cirrhosis in separate groups of native and transplanted liver was calculated.
  
  
  RESULTS
  A total of 152 cases with native liver and 70 cases with transplanted liver were included. The majority of patients had hepatitis C in both groups. None of the investigated variables showed significant correlation with the degree of inflammation in either group. The strongest correlation with the degree of fibrosis in the native liver group was for the RPR with 0.51 (p < 0.001) and then the RDW and MELD with 0.34 (p < 0.001) and 0.31 (p < 0.001), respectively. In the transplanted liver group, none of the variables showed significant correlation with the degree of fibrosis. The receiver-operator curve showed that only the RDW and RPR in the native liver group, with areas under the curve of 0.770 and 0.684, respectively, have significantly positive association with the risk of cirrhosis. In the transplanted group, none of the predictors were associated with risk of cirrhosis. In the native liver group, a cutoff value of 0.088 in the RPR led to 82.7% sensitivity and 61.0% specificity to predict cirrhosis.
  
  
  CONCLUSIONS
  The RPR can be a strong predictor of the degree of fibrosis and cirrhosis in patients with chronic hepatitis and native liver. It shows higher accuracy compared to the RDW and MELD score. However, its use in predicting inflammation is limited.
authors.affiliation: Department of Medicine, Medstar Washington Hospital Center, 110 Irving St, NW, Washington, DC, 20010, USA, taefi.amir@gmail.com.
authors.forename: Amir
authors.initials: A
authors.lastname: Taefi
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Huang
authors.forename: Kirthi
authors.initials: K
authors.lastname: Kolli
authors.forename: Suzan
authors.initials: S
authors.lastname: Ebrahimi
authors.forename: Mitesh
authors.initials: M
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D004909:Erythrocyte Indices; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood; D019698:Hepatitis C, Chronic / Q000097:blood; D006519:Hepatitis, Alcoholic / Q000097:blood; D006521:Hepatitis, Chronic / Q000097:blood*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000175:diagnosis; D008105:Liver Cirrhosis, Biliary / Q000097:blood; D008297:Male; D008875:Middle Aged; D010976:Platelet Count