Assessment of liver fibrosis in Chronic hepatitis B: performance of hematological parameters

Hepatitis B is a major global health problem. Assessment of liver fibrosis is important for treatment decision. Liver biopsy (LB) represents the "Gold Standard" in the assessment of fibrosis. Several parameters have been identified for predicting the development and progression of liver disease; among them, hematological parameters. The aim of our study was to assess the performance of these hematological parameters in the assessment of fibrosis in chronic hepatitis B.

We conducted a retrospective study involving all patients with chronic hepatitis B managed in Gastroenterology department of Mohamed Taher Maamouri hospital during the period from January 2013 to December 2022, who underwent a liver biopsy and routine laboratory tests. According to the METAVIR scoring system, patients were divided into two groups: patients without significant fibrosis (F0, F1) and patients with significant fibrosis (F2, F3, F4). The predictive accuracy for liver fibrosis was assessed by receiver operating characteristics (ROC) analysis.

A total of 119 patients were included. Liver biopsy revealed significant fibrosis in 20.2% of the patients. The mean platelet count was significantly lower in patients with significant fibrosis, as compared to patients with non-significant fibrosis (p< 0.001). The AUROC of RDW was 0.857 with a cut-off value of 41.8 FL (sensitivity 88.9%; specificity 70.9%; Positive and negative predictive values 50% and 95.1% respectively).

Blood count parameters are non-invasive markers of liver fibrosis in patients with chronic hepatitis B. Thus, significant fibrosis can be ruled out in patients with RDW < 41.8 FL, which could help avoid liver biopsy in these patients.