Clinical usefulness of mean platelet volume and red blood cell distribution width to platelet ratio for predicting the severity of hepatic fibrosis in chronic hepatitis B virus patients Ergenekon Karagoz a , Asım Ulcay a , Alpaslan Tanoglu b , Muammer Kara b , Vedat Turhan a , Hakan Erdem a , Oral Oncul a and Levent Gorenek a Objective Hepatitis B virus infection is still one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. Liver biopsy is the gold-standard method to assess the severity of liver fibrosis, but the invasive nature of this method limits its usage. Currently, noninvasive parameters are utilized to estimate liver histology. In the present study, we aimed to investigate the relationship between the severity of fibrosis and red blood cell distribution width (RDW), platelet distribution width (PDW), mean platelet volume (MPV), and MPV and red blood cell distribution width to platelet ratio (RPR) in patients with chronic hepatitis B (CHB). Design A total of 229 biopsy-proven naïve CHB cases were included in the study. The complete blood count variables including white blood cell, hemoglobin, hematocrit value, platelet count, RDW, MPV and PDW, as well as aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin, and other routine biochemical parameters were tested. Liver biopsy samples were examined using the Ishak scoring system. Data analyses were carried out using SPSS 15 software. Statistical significance was set at a P-value of less than 0.05. Results Of the 229 cases, 210 (91.7%) were men and 19 (8.3%) were women. The mean age of the patients was 30.9 years, and 85 cases (37.1%) had HBeAg positivity. Fibrosis scores of 41 cases (17.9%) were greater than or equal to 3, whereas 188 cases (82.1%) had fibrosis scores less than 3. There was a significant difference between these two groups for MPV (group 1 = 7.98 ± 1.20, group 2 = 8.77 ± 1.44, P < 0.05). There was also a significant difference between these two groups for RDW (P < 0.05). The RDW value in group 1 patients was 11.83 ± 0.89, whereas this value was 12.57 ± 1.32 in group 2. Moreover, the RPR was significantly higher in group 2 than in group 1 (P < 0.001). There was no significant difference between the groups for PDW. We have compared the receiver operating characteristic curves for the diagnostic performance of aspartate aminotransferase, alanine aminotransferase, platelet count, RDW, MPV, and RPR in identifying fibrosis in CHB and area under the curve values for these variables were 0.666, 0.463, 0.657, 0.672, 0.677, and 0.758, respectively. Conclusion MPV and RDW values are significantly higher in hepatitis B virus-infected patients, associated with severity, and can be defined as independent predicting factors in hepatic fibrosis. Further studies are required to determine the associations between MPV and the severity of fibrosis in hepatitis B patients. Eur J Gastroenterol Hepatol 26:1320–1324 © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2014, 26:1320–1324 Keywords: chronic hepatitis B, liver fibrosis, mean platelet volume, platelet distribution width, red blood cell distribution width Departments of a Infectious Diseases and Clinical Microbiology and b Gastroenterology, GATA Haydarpasa Training Hospital, Istanbul, Turkey Correspondence to Ergenekon Karagoz, MD, Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, 34668 Uskudar, Istanbul, Turkey Tel: + 90 216 5422020 x3669; fax: + 90 216 542 5747; e-mail: ergenekonkaragoz@hotmail.com Received 16 June 2014 Accepted 1 August 2014 Introduction Hepatitis B virus (HBV) infection, a serious health issue affecting over 400 million individuals worldwide, is the leading cause of cirrhosis and hepatocellular carcinoma (HCC) [1]. Currently, liver biopsy is the gold-standard method for assessing the severity of liver fibrosis [2]. However, this procedure is costly and the invasive nature of this method restricts its usage in some patient groups because of its complications and contraindications [1]. Therefore, noninvasive parameters have been utilized to estimate liver histology [3–6]. It is unfortunate that many of these methods are highly expensive and it is not possible to use them in daily practice; besides, most were developed for the evaluation of the patients infected with hepatitis C [1–6]. Red blood cell distribution width (RDW), platelet distribution width (PDW), and mean platelet volume (MPV), which are largely overlooked, are routine tests that are part of complete blood counts (CBCs). To evaluate the association between these parameters and the histological outcomes of diseases related to the liver in patients with chronic hepatitis B (CHB), a limited number of studies have been carried out. The present study was designed to investigate whether RDW, PDW, MPV, and red blood cell distribution width 1320 Original article 0954-691X © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEG.0000000000000203 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.