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Platelet count as a screening tool for compensated cirrhosis in chronic viral hepatitis
Pallavi Surana1, Julian Hercun1, Varun Takyar1
1Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, United States.
Insights
Platelet counts can be a simple tool for identifying cirrhosis in patients with chronic viral hepatitis. This method aids in timely treatment initiation and cancer screening for better patient management.
Area of Science:
- Hepatology
- Clinical Diagnostics
- Virology
Background:
- Cirrhosis identification is crucial for managing chronic viral hepatitis (Hepatitis B, C, D).
- Simple, reliable diagnostic tools are needed for timely treatment initiation, hepatocellular cancer screening, and patient management.
Purpose of the Study:
- To evaluate platelet counts and other laboratory markers as simple tools for identifying cirrhosis in patients with chronic viral hepatitis.
- To establish an optimal cut-off value for platelet counts to detect cirrhosis.
Main Methods:
- Retrospective analysis of clinical, biochemical, and histological data from 1027 treatment-naive patients with chronic viral hepatitis B, C, and D.
- Subjects were divided into training (n=715) and validation (n=312) cohorts.
- Receiver operating characteristic (ROC) curve analysis was used to assess marker performance, with optimal cut-offs determined in the training cohort and validated.
Main Results:
- Platelet counts demonstrated the highest accuracy in identifying cirrhosis (AUROC = 0.86) compared to other markers (AUROC ≤ 0.77).
- The optimal platelet count cut-off of 143 × 10^9/L showed good sensitivity (77%) and specificity (83%) in the training cohort.
- This cut-off performed consistently well in the validation cohort (AUROC = 0.85).
Conclusions:
- Platelet count is a valuable and simple laboratory marker for identifying cirrhosis in patients with chronic viral hepatitis.
- Incorporating platelet count assessment can improve patient care, treatment initiation, and monitoring for hepatocellular cancer.
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.
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