Kumar Vijesh, Aslam Muhammad, Kalwar Sanaullah, Hyder Ali, Tareen Khaild, Kumar Sandeep, Taha Yaseen Khan Raja, Tasneem Abbas A, Hassan Luck Nasir
Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, PAK.
Gastroenterology, Madinah Teaching Hospital, Faislabad, PAK.
Cureus. 2025 Apr 24;17(4):e82882. doi: 10.7759/cureus.82882. eCollection 2025 Apr.
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.
丙型肝炎病毒（HCV）感染仍是一个全球性的健康问题，可导致进行性肝纤维化、肝硬化和肝细胞癌。在晚期肝纤维化的早期阶段进行检测对于早期治疗和适当管理至关重要。肝活检虽然仍是纤维化分期的金标准，但具有侵入性且成本高昂，还存在潜在风险和并发症。血小板与淋巴细胞比值（PLR）等非侵入性生物标志物作为纤维化分期替代工具的应用正在增加。本研究旨在确定PLR在预测HCV感染患者晚期肝纤维化中的效用。
本回顾性观察性研究在巴基斯坦信德泌尿与移植研究所（SIUT）的胃肠肝病科对年龄≥18岁、已确诊为HCV慢性感染且在2018年1月至2023年12月期间接受过肝活检和剪切波弹性成像（SWE）的患者进行。排除标准包括并存的肝脏和血液系统疾病以及不完整的患者临床记录。比较实验室参数、人口统计学变量和纤维化评分。计算PLR比值。对PLR进行受试者操作特征（AUROC）曲线下面积分析，并在最佳临界值时获得PLR的诊断准确性，并与天冬氨酸转氨酶与血小板比值指数（APRI）和纤维化-4指数（FIB-4）进行比较。
共有107例HCV感染患者纳入研究，平均年龄为49.1±8.9岁。肝活检证实56例（52.3%）患者存在显著纤维化（病毒性肝炎组织学数据的荟萃分析（METAVIR）评分≥2）。晚期纤维化患者的PLR显著更低（4.17±1.44 vs. 6.8±1.99，p≤0.001）。PLR的AUROC为0.879（p≤0.001）。在最佳临界值≤5.41时，PLR显示出85.71%的高敏感性、86.27%的特异性和85.98%的优异诊断准确性。在预测HCV患者晚期肝纤维化方面，PLR的诊断准确性远优于APRI（37%）和FIB-4（40%）。
PLR是慢性HCV感染患者晚期肝纤维化的一种简单、经济有效、高度敏感的非侵入性标志物。它优于目前已确立的非侵入性标志物如APRI和FIB-4，可在资源有限的情况下用作纤维化的良好筛查工具。
