# Utility of the Platelet-to-Lymphocyte Ratio in Predicting Advanced Liver Fibrosis in the Hepatitis C Virus (HCV)-Infected Population

## TL;DR

This study shows that the platelet-to-lymphocyte ratio (PLR) is a reliable and non-invasive tool for detecting advanced liver fibrosis in people with hepatitis C virus (HCV) infection.

## Contribution

The study demonstrates that PLR outperforms existing non-invasive fibrosis markers like APRI and FIB-4 in HCV-infected patients.

## Key findings

- PLR had an area under the ROC curve of 0.879, indicating strong diagnostic accuracy for advanced liver fibrosis.
- PLR showed higher sensitivity and specificity than APRI and FIB-4 in predicting fibrosis in HCV patients.
- PLR is a cost-effective and non-invasive alternative to liver biopsy for fibrosis staging.

## Abstract

Introduction

Hepatitis C virus (HCV) infection is still a worldwide health issue, leading to progressive liver fibrosis, cirrhosis, and hepatocellular carcinoma. Detection at early stages of advanced liver fibrosis is critical for early treatment and appropriate management. Liver biopsy, though still considered the gold standard for fibrosis staging, is invasive and costly and poses possible risks and complications. The application of non-invasive biomarkers such as the platelet-to-lymphocyte ratio (PLR) as substitute tools for fibrosis staging is on the rise. This study aimed to determine the utility of PLR in predicting advanced liver fibrosis in HCV infection.

Methodology

This retrospective observational study was carried out at the department of hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Pakistan, in patients aged ≥18 years old who had established chronic infection of HCV and had undergone liver biopsy and shear wave elastography (SWE) in the period between January 2018 and December 2023. Exclusion criteria consisted of coexisting liver and hematological disorders and incomplete patient clinical records. Laboratory parameters, demographic variables, and fibrosis scores were compared. The ratio of PLR was calculated. Area under the receiver operating characteristic (AUROC) curve analysis was done for PLR, and at an optimal cutoff, diagnostic accuracy was obtained for PLR and was compared to aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4).

Results

A total of 107 HCV-infected patients, who had a mean age of 49.1 ± 8.9 years, were enrolled in the study. Liver biopsy confirmed significant fibrosis (meta-analysis of histological data in viral hepatitis (METAVIR) score ≥ 2) in 56 (52.3%) patients. The PLR was significantly lower in patients with advanced fibrosis (4.17 ± 1.44 vs. 6.8 ± 1.99, p ≤ 0.001). The AUROC for PLR was 0.879 (p ≤ 0.001). At an optimal cutoff of ≤5.41, PLR showed a high sensitivity of 85.71%, specificity of 86.27%, and an excellent diagnostic accuracy of 85.98%. The diagnostic accuracy of PLR was far superior to APRI (37%) and FIB-4 (40%) in predicting advanced liver fibrosis in HCV patients.

Conclusion

PLR is a simple, cost-effective, highly sensitive, non-invasive marker for advanced liver fibrosis in chronic infection with HCV. It is superior to currently established non-invasive markers such as APRI and FIB-4 and can be utilized as a good screening tool for fibrosis in resource-limited situations.